EMDR Dissociation and Target Selection: Treatment Planning Considerations
Treatment planning for EMDR clients can become more complicated when dissociation affects how the client recalls and organizes their history. A client may remember isolated events but have limited recall for entire periods of life. Another may describe a traumatic experience accurately while having little access to the emotions or body sensations connected with it. At other times, information that seemed unavailable earlier in treatment becomes accessible later.
These presentations can make EMDR target selection less straightforward. The clinician may have enough information to identify several possible targets while still having questions about how complete the history is or how consistently the client can access it. This creates an important treatment-planning question: How much confidence should I place in the target selection decisions I can make from the information currently available?
Dissociation does not automatically mean that a client cannot participate in EMDR reprocessing. It can affect memory access, autobiographical continuity, present orientation, and the information available during history taking. When those patterns are present, clinicians may need to treat current target selection decisions as provisional while continuing to assess dissociation, preparation capacities, and readiness for trauma processing.
How Is Dissociation Affecting the Information Available for EMDR Treatment Planning?
Clients do not need to provide a complete chronological autobiography before EMDR treatment can move forward. Many clients cannot identify every relevant experience, and target selection methods such as floatback and affect scan can be useful when the connection between current symptoms and earlier experiences is not immediately clear. Difficulty identifying an earliest memory, by itself, does not tell us that dissociation is interfering with treatment planning.
Dissociation adds another clinical consideration because it may affect which information is accessible and how consistently that information can be accessed. The clinician may need to consider whether difficulty with target selection reflects ordinary limitations of autobiographical memory, limited access to a particular memory network, or a broader pattern of dissociative disconnection. Looking at the pattern across sessions can provide more useful information than drawing conclusions from one memory gap or one unusual response.
A few clinical presentations can help organize that assessment:
If the client can identify distressing experiences but has difficulty placing them chronologically → Consider how much autobiographical continuity is available and whether a precise timeline is needed for the current treatment plan.
If the client can describe an event but has limited access to emotion, body sensation, or current disturbance → Assess whether dissociative disconnection may be affecting access to components of the memory.
If important information becomes available at different times or appears to vary with shifts in state → Consider whether access to memories, beliefs, emotions, or perspectives may be state dependent.
If the client experiences occasional spacing out or detachment but remains oriented and able to participate in assessment → Continue evaluating the pattern without assuming that dissociation prevents trauma processing.
If there is substantial autobiographical amnesia, loss of time, pronounced discontinuity, significant shifts in state, or difficulty maintaining present orientation → Consider whether additional dissociation assessment and preparation are indicated before treating the information currently available for target selection as complete.
These observations do not establish a dissociative disorder on their own. They help the clinician identify which questions need further assessment and how much confidence to place in the history currently available. They can also help distinguish between an incomplete trauma history that can continue developing during treatment and a dissociative pattern that may require closer assessment before treatment planning proceeds.
How Dissociation Can Complicate EMDR Target Selection
EMDR target selection usually draws from several sources of information. Clinicians may begin with current symptoms, identify when the problem first appeared, explore periods when symptoms were especially pronounced, examine recent triggers, or use methods such as floatback or affect scan to identify related memories. These approaches can still be used when dissociation is present.
The additional task is interpreting the information within the context of the client’s dissociative presentation. A memory that is currently inaccessible is different from a memory the client simply cannot identify during one conversation, and limited emotional access can have several explanations. The clinician is looking for patterns across history taking, preparation, and ongoing treatment instead of assigning a dissociative explanation to an isolated observation.
Fragmented or Incomplete Recall
Some clients know that a period of their life was distressing but cannot provide many specific memories from it. Others remember fragments, sensory details, or isolated experiences without a clear sequence. The resulting history may contain enough information to begin treatment planning while still leaving substantial areas uncertain.
For example, a client might say, “I know middle school was terrible, but I barely remember seventh grade.” Another may recall several frightening incidents from childhood but have difficulty determining their order or approximate age. In either situation, the clinician can document the information that is available without assuming what occurred during the periods the client cannot recall.
An incomplete timeline does not establish that the memory gaps are dissociative. It also does not give the clinician a reason to reconstruct missing events or suggest experiences the client has not reported. The clinical task is to identify what is known, what remains uncertain, and whether the overall pattern of memory access suggests that further dissociation assessment would be useful.
Target selection can still begin with information that is available. Current symptoms, recent triggers, known memories, negative beliefs, and periods of symptom escalation may provide reasonable starting points even when earlier history remains incomplete. The treatment plan can be updated if additional memories or clinically relevant connections become accessible later.
Autobiographical Memory Continuity
It can also be useful to look beyond whether the client remembers one particular event and consider continuity across larger periods of life. Some clients have detailed memories from certain developmental periods and can describe other periods only broadly. Others know factual information about where they lived, attended school, or who was present without having much experiential memory from those years.
For example, a client may be able to describe elementary school and college in considerable detail but have very little autobiographical recall for adolescence. Another may say, “I know high school was bad, but I barely remember it,” without being able to identify specific experiences that explain the current symptoms. The clinical question then extends beyond finding a single forgotten event and includes understanding the broader pattern of autobiographical memory access.
This pattern can affect how confidently the clinician interprets the treatment history. Target selection based on currently accessible memories may represent only part of the client’s relevant history, even when the identified targets appear clinically reasonable. Target selection can therefore remain provisional and change as additional information becomes available during treatment.
Access to Affect and Body Information
Memory access is not limited to whether a client can describe what happened. During EMDR assessment, clinicians are also attending to emotions, body sensations, negative beliefs, and current disturbance associated with the memory. At times, the narrative portion of the memory is readily available while other components are difficult for the client to access.
A client might describe a frightening event in considerable detail and then report, “I know it was horrible, but I don’t feel anything when I talk about it.” Another may identify a negative belief intellectually but have difficulty connecting it with an emotional or somatic response. A third client may initially report little disturbance and later experience substantially different access to the same material.
Several clinical processes can contribute to these presentations, so one observation should not be treated as evidence of dissociation. The clinician can instead look at whether similar disconnection appears repeatedly during history taking, preparation, and contact with emotionally activating material. A repeated pattern may indicate that dissociation should be considered as one possible contributor to how the client is accessing the memory.
Information Available Across Self-States
For some clients, access to memories, emotions, beliefs, or perspectives may vary depending on their current state. Clinicians working from an ego state perspective may conceptualize these experiences in terms of different self-states. If you use IFS language, you may describe these experiences as different “parts” having access to different information.
Information discussed clearly in one session may feel distant or inaccessible in another. A client may also notice that certain memories, emotions, beliefs, or perspectives become easier to access when a particular self-state, or “part,” is more present. These shifts become especially relevant to treatment planning when they occur repeatedly or when they change the information available for target selection.
The clinician can consider whether the information currently available provides a sufficient basis for target selection or whether additional assessment would clarify the pattern. Tracking changes across sessions may provide a more complete picture than relying on what is accessible during one appointment. This also allows the clinician to document variability without assuming that information unavailable in one state is absent altogether.
The Dissociation Pattern Tracker & Clinical Guide provides a structured way to organize observations across sessions. It covers patterns related to intrusion, disconnection, memory continuity, body awareness, and parts or self-state responses so clinicians can examine how dissociation is presenting over time. This can be useful when the treatment-planning question has shifted from whether dissociation is present to how the observed pattern is affecting assessment, preparation, and access to trauma-related information.
→ Dissociation Pattern Tracker & Clinical Guide
When Does Dissociation Call for Additional Assessment or Preparation?
Dissociative experiences occur across a broad range of presentations. Occasional absorption, spacing out, or temporary detachment does not carry the same clinical implications as substantial autobiographical amnesia, recurrent loss of time, pronounced depersonalization or derealization, or significant discontinuity in awareness and experience. Clinicians need to clarify what the client is actually experiencing before deciding how the symptom should influence EMDR treatment planning.
When clinicians use dissociation screening measures, individual responses should be explored in context rather than interpreted in isolation. A reported memory gap, for example, may require clarification about substance use, medication effects, sleep-related experiences, or other possible explanations before it is understood as dissociative. Follow-up questions can help the clinician determine whether a response reflects a broader pattern of dissociation or another explanation that needs to be considered.
Formal screening can contribute additional information when the clinical presentation raises questions about dissociation. The Dissociative Experiences Scale (DES-II) is a screening measure, and Leeds, Madere, and Coy (2022) discuss limitations of relying on the DES-II alone when screening for dissociative disorders in EMDR therapy. Measures such as the Multidimensional Inventory of Dissociation (MID) may provide more detailed information when further assessment is indicated.
Screening results still need to be interpreted alongside the clinical presentation. The clinician can consider the pattern, frequency, severity, context, and clinical consequences of the reported experiences while also examining what occurs during treatment. A screening score alone does not determine whether a client is ready for reprocessing or which target should be selected.
During EMDR preparation, clinicians can also observe what happens as attention moves toward distressing material. Does the client remain oriented to the current environment while discussing a difficult memory, and can they notice internal experience without substantially losing connection with the present? Repeated difficulty maintaining present orientation or dual attention may indicate that additional preparation or closer assessment of dissociation is needed before proceeding with a particular target.
EMDR Target Selection When the History Is Still Developing
A developing history does not require the clinician to wait for every possible memory to become available before beginning target selection. Treatment planning can begin with information the client can currently access while clearly distinguishing known experiences from areas that remain uncertain. This allows target selection to develop without asking the clinician or client to fill gaps in the history.
Clinicians may organize information such as:
current symptoms and presenting concerns
known distressing experiences
periods when symptoms first appeared or became worse
recent situations that activate the same symptom cluster
negative beliefs or themes that appear repeatedly
developmental periods with limited or uncertain recall
areas where memory access appears inconsistent
potential targets that need further assessment before being incorporated into the treatment plan
This distinction between known and uncertain information can be especially useful when dissociation is present. The clinician can document which connections are supported by the client’s history and which remain tentative. The treatment plan can then be revised as additional information becomes available instead of treating the first version of target selection as final.
For example, a client may experience intense shame in relationships but be unable to identify an early memory connected with the belief, “There’s something wrong with me.” The clinician may still identify recent and intermediate experiences that activate the same belief and consider whether those experiences belong in the treatment plan. Earlier history can remain unclear without assuming that an inaccessible origin memory must exist.
This approach also helps keep dissociation assessment and target selection from becoming the same clinical task. The clinician can organize accessible targets while separately evaluating whether the client’s memory discontinuity or state-dependent access needs further assessment. Each source of information contributes to the treatment plan without requiring certainty that the entire history has already been identified.
The EMDR Target Selection: Clinician Worksheet provides structured prompts for organizing symptoms, onset, periods of greatest disturbance, recent activation, negative beliefs, and potential target memories. It also includes several target selection approaches that can be used when a straightforward chronological history is not available. Once the clinician has considered how dissociation may be affecting access to the history, the worksheet can help organize the target-selection information that is currently available.
→ EMDR Target Selection: Clinician Worksheet
Dissociation, Target Selection, and Readiness for Reprocessing
Selecting a potential EMDR target and determining readiness to process that target are related clinical decisions, but they answer different questions. A clinician may have a well-defined target and still determine that additional preparation is indicated. A client may also have an incomplete trauma history while demonstrating sufficient capacity to remain present, maintain dual attention, communicate changes in internal experience, and work with an accessible target.
This distinction helps prevent dissociation from becoming an automatic reason to postpone reprocessing indefinitely. The presence of dissociative symptoms tells the clinician to understand the presentation more carefully, but it does not answer the readiness question by itself. Readiness still depends on the broader clinical picture and on what happens when the client approaches the material that may be processed.
Once a potential target has been selected, the clinician can examine how the client responds when that material becomes more active. Can the client maintain enough present orientation to remain connected to both the traumatic material and the current environment? Can changes in activation, awareness, or state be noticed and communicated before the client becomes substantially disconnected from the present?
The answers may differ across targets and across stages of treatment. A client may be able to work with one memory while another requires additional preparation because it produces a different dissociative response. Readiness can therefore be reassessed as treatment progresses instead of being treated as a one-time decision made before reprocessing begins.
When dissociation is affecting preparation as well as target selection, the Dissociation-Informed EMDR Preparation: Clinical Decision Toolkit provides a broader way to organize those decisions. The toolkit includes the Dissociation Pattern Tracker & Clinical Guide, along with additional tools for connecting dissociative patterns with preparation capacity, stabilization planning, pacing, and readiness considerations. This can be useful when the clinician has identified how dissociation is presenting and needs to determine how those patterns should inform preparation and readiness for trauma processing.
→ Dissociation-Informed EMDR Preparation: Clinical Decision Toolkit
Developing Clinical Judgment Around Dissociation in EMDR
Dissociation assessment in EMDR treatment planning rarely comes down to one symptom, one screening score, or one difficult response during preparation. The clinician is integrating information across time, including the client’s history, dissociative symptoms, autobiographical memory continuity, present orientation, access to internal experience, and responses as emotionally activating material is approached. Patterns that repeat across these different sources of information usually provide a stronger basis for treatment decisions than one observation in isolation.
The same principle applies to target selection. A client who cannot identify an earliest memory may still provide enough information to select a reasonable starting target, while a client who provides a detailed trauma history may still demonstrate dissociative disconnection that deserves further assessment. The amount of historical detail available and the client’s readiness for trauma processing are related pieces of the clinical picture, but one does not automatically determine the other.
It can help to keep the clinical questions separate. Target selection asks which experiences appear connected with the presenting problem, while dissociation assessment examines disruptions or discontinuities in areas such as awareness, memory, identity, emotion, perception, and bodily experience. Readiness assessment then considers whether the client currently has sufficient capacity to approach traumatic material while maintaining the present orientation and dual attention needed for the work.
When dissociative presentations extend beyond the clinician’s training or experience, additional education, consultation, or referral may be appropriate. The goal is to understand the presentation well enough to make responsible decisions about assessment, preparation, pacing, and reprocessing. Clinical judgment develops through the integration of these observations rather than through a single rule about whether dissociation is present.
For clinicians who want a more detailed review of dissociation assessment, stabilization, dual attention, preparation strategies, and readiness decisions, the EMDR Phase 2: Preparation, Stabilization, and Readiness for Trauma Processing course covers these areas in greater depth. The course provides 4 CE credits through Cannon Psychology, an APA-approved sponsor of continuing education for psychologists, and 4 EMDRIA credits. It is designed as supplemental continuing education for licensed mental health professionals who have completed or are completing formal EMDR training.
→ EMDR Phase 2: Preparation, Stabilization, and Readiness for Trauma Processing
Additional articles, preparation resources, and clinician tools are organized in the EMDR Preparation and Stabilization Hub. The hub includes material related to dissociation, dual attention, preparation capacity, readiness, and adaptations when standard preparation strategies are not working as expected. It can be used as the next reference point when the clinical question extends beyond dissociation and target selection.
→ EMDR Preparation and Stabilization Hub
Conclusion
Dissociation can affect the information available during EMDR history taking and treatment planning in several ways. Memory may be fragmented, autobiographical continuity may be limited, emotional or somatic information may be difficult to access, or clinically relevant information may become available differently across self-states or, in IFS language, “parts.” When these patterns are present, target selection may need to remain provisional while the clinician continues gathering information.
Clinicians can still work with what is currently available. Known memories, current symptoms, recent triggers, negative beliefs, and periods of symptom escalation can all contribute to target selection without requiring the clinician to fill in missing history or assume that every memory gap reflects dissociation. New information can be incorporated into the treatment plan as the clinical picture develops.
Dissociation also needs to be considered separately from readiness for a particular target. Questions about present orientation, dual attention, preparation capacity, and the client’s response to activation can be assessed as treatment progresses. Keeping these clinical questions distinct allows dissociation to inform EMDR treatment planning without treating it as either an automatic barrier to reprocessing or an explanation for every gap in the client’s history.
Research References
Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174(12), 727–735. https://doi.org/10.1097/00005053-198612000-00004
International Society for the Study of Trauma and Dissociation. (2020). Trauma-related dissociation: An introduction (Fact Sheet III). International Society for the Study of Trauma and Dissociation.
Leeds, A. (2016). A guide to the standard EMDR therapy protocols for clinicians, supervisors, and consultants. Springer Publishing Company.
Leeds, A. M., Madere, J. A., & Coy, D. M. (2022). Beyond the DES-II: Screening for dissociative disorders in EMDR therapy. Journal of EMDR Practice and Research, 16(1), 25–38. https://doi.org/10.1891/EMDR-D-21-00019
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols and procedures (3rd ed.). Guilford Press.
