EMDR Informed Consent: What Clients Need to Understand
A client can arrive for EMDR with a clear goal and considerable motivation to begin. During preparation, clinicians still need to assess whether the client has enough information about EMDR reprocessing to make an informed decision about participating. That assessment includes listening for the client’s expectations, questions, concerns, and willingness to proceed.
EMDR informed consent includes discussion of the proposed treatment, what clients may experience during reprocessing, possible risks or adverse effects, what may occur between sessions, and available treatment alternatives. Phase 2 also gives clinicians time to answer questions and clarify what the client expects from treatment. Information that emerges during this conversation can guide the clinician’s decisions before trauma processing begins.
What Are You Assessing During EMDR Informed Consent?
When you’re discussing EMDR informed consent, the next clinical step often depends on what you’re hearing from the client. Their responses can indicate whether the discussion has provided enough information for a decision or whether additional conversation is needed. I’m listening for how the client describes EMDR, what they expect from reprocessing, and whether they are willing to participate in the proposed treatment.
If the client can describe how EMDR will be used and expresses willingness to process trauma → Continue discussing what reprocessing may involve, including possible emotional reactions and between-session experiences.
If the client wants EMDR and has questions or concerns about trauma processing → Spend additional time answering questions and clarifying what the client may experience before proceeding.
If the client expresses reluctance after learning about reprocessing → Clarify treatment goals and discuss available treatment alternatives.
If the client has reviewed the proposed treatment, wants to proceed, and you’re evaluating the other conditions for reprocessing → Continue with the broader EMDR readiness assessment.
The conversation itself can provide useful clinical information. A client’s questions, expectations, hesitations, and description of what they expect from treatment can guide the clinician’s next decision. These responses may also identify topics that need further discussion during Phase 2.
What Should Clients Understand Before EMDR Reprocessing?
During Phase 2, clients are learning what EMDR is, how it will be incorporated into treatment, and what they may experience when reprocessing begins. The Preparation phase also includes preparing clients for the mechanics of EMDR, possible disturbances associated with reprocessing, self-regulation, and potential risks or side effects. Informed consent brings several of these areas into a focused discussion about the treatment the client is considering.
For informed consent purposes, I would want to know that the client has received enough information to make an informed choice. I would also want to hear how the client describes that information in their own words and what questions arise as we discuss it. Those responses can tell me where further explanation may be useful before reprocessing begins.
How EMDR Fits Into the Treatment Plan
Clients should have a basic description of why EMDR is being recommended and how it relates to the concerns they want to address. The explanation needs to be accessible to that particular client and provide room for questions and clarification. Clinicians can also check how the client expects EMDR to fit with the work they are already doing in therapy.
This can be a useful time to clarify the client’s treatment goals. A client seeking help with current stressors may have different goals from a client who specifically wants to address traumatic memories. Assess whether the client knows how EMDR will be integrated into their treatment plan and whether they want to process trauma. Their responses help clarify what they are agreeing to before the clinician begins reprocessing.
The evidence base can be part of this discussion when appropriate. EMDR has substantial empirical support for PTSD and is recommended as a first-line PTSD treatment in multiple clinical practice guidelines. This information can help clinicians explain why EMDR is being offered and provide context for discussing the range of possible individual responses to treatment.
What Trauma Processing May Involve
Clients also need some preparation for the experience of reprocessing. Depending on the client and target, this may include distressing emotions, physical sensations, images, sounds, thoughts, or associated memories. Discussing these possibilities gives clients a clearer description of the experience they are being asked to consider.
The clinician cannot predict exactly what material will emerge during reprocessing. Clients can be prepared for the possibility that associated memories may arise along with physical sensations, images, emotions, sounds, or other material connected with the memory being processed. Discussing this uncertainty before reprocessing gives the client an opportunity to ask questions about experiences they may encounter.
These conversations also give the clinician information about the client’s expectations and concerns. A client may have questions about emotional intensity, unexpected memories, physical sensations, or what happens when distress increases during a session. Their responses can guide further discussion before moving into Phase 4.
Possible Reactions During and Between Sessions
Possible emotional activation is another part of the informed consent conversation. Trauma processing can be uncomfortable, and clinicians can assess whether the client understands that emotional intensity may increase during or between sessions. Clients can also be prepared for the possibility that processing may continue after the formal therapy session has ended.
Research on adverse events in psychotherapy and PTSD treatment indicates that adverse events have not been assessed or reported consistently, including in the EMDR literature. The available evidence supports discussing the possibility of symptom increases and other adverse experiences while acknowledging the limitations of the research used to estimate those experiences. Clinicians therefore need to avoid predicting an individual client’s response with a degree of certainty that the evidence does not support.
During informed consent, clinicians can describe possible reactions using the available evidence and discuss how the client would respond if distress occurred during or after a session. This conversation can include existing coping capacities, available support, and how the client can contact or seek assistance when needed. It also provides an opportunity to identify concerns that require additional preparation before reprocessing.
Clinicians who want additional discussion of this clinical area can review Managing Reactions Between EMDR Sessions, which focuses specifically on between-session experiences and clinical planning. That article addresses reactions that may occur after reprocessing and considerations for supporting clients between appointments. It can be useful when planning how these experiences will be discussed and managed during treatment.
If you want a client-facing resource to support this part of the informed consent conversation, the Understanding Reactions to EMDR Therapy handout explains common processing reactions, possible between-session experiences, and when clients may need additional support. It also helps clients recognize reactions that can occur during processing and signs that warrant contacting their therapist. The handout can be reviewed during preparation and provided to clients as a reference as treatment progresses.
→ Understanding Reactions to EMDR Therapy
Helping Clients Give Accurate Feedback During EMDR
During EMDR, clients may assume they are supposed to have a certain kind of response. When we ask, “What do you notice?” they may feel pressure to produce an image, emotion, memory, or meaningful association. A similar dynamic can occur during preparation when we are asking whether a resource feels calming or whether an exercise is helping.
Clients can be told explicitly that they can report when nothing is coming up, when their mind has gone somewhere completely unrelated, or when a resourcing strategy is not helping. The clinician’s response can reinforce that accurate reporting provides useful clinical information. Establishing this expectation during preparation can make it easier for clients to describe their actual experience once reprocessing begins.
I include this in informed consent discussions because the client is agreeing to participate in a process that depends heavily on their subjective experience. Clients can be encouraged to give accurate feedback, ask questions, express discomfort, and report when something is not working. This also gives the clinician clearer information about the client’s experience and any concerns that may need to be addressed as treatment proceeds.
Assessing the Client’s Understanding and Willingness to Proceed
The informed consent conversation may reveal information that changes the treatment plan. A client’s initial request for EMDR may be based on expectations that become clearer once reprocessing is described in greater detail. Their response to that information gives the clinician additional data for deciding how to proceed.
Consider James, a 38-year-old client seeking EMDR following a recent car accident. He is experiencing intrusive memories, irritability, and sleep disruption and wants symptom relief quickly. He has read that EMDR can work quickly and arrives expecting to begin processing soon. He has no previous experience with trauma-focused therapy and relatively little experience identifying or regulating emotions.
As the clinician discusses the possibility of temporary distress and strong emotional activation, James says that he does not want to focus on distressing material and wants the problem resolved. His response provides additional information about his expectations, his perception of reprocessing, and his current willingness to participate. The clinician now has specific areas to explore before deciding whether to begin Phase 4.
I would continue the informed consent assessment by asking James to describe what he expects will happen during processing and what concerns he has about the experience. I would also clarify what he is currently willing to work with and whether there are aspects of reprocessing that he does not agree to at this point. The discussion should include the uncertainty inherent in processing, including the clinician’s inability to guarantee exactly what material will arise.
James’s responses support additional time in Phase 2, including continued discussion of what EMDR may involve and further preparation for managing emotional activation. If he remains uncomfortable with trauma processing, treatment can stay within the work he has agreed to while the clinician discusses other appropriate treatment options or referrals. His willingness to proceed can be revisited as treatment develops.
Information gathered during informed consent may also indicate that reprocessing should be postponed. When to Delay EMDR Trauma Processing addresses the broader clinical decisions involved when a clinician is considering delaying Phase 4. That discussion can be useful when concerns identified during consent extend into safety, regulation, dissociation, or other readiness considerations.
Discussing Treatment Alternatives
Clients should know that they can decline EMDR reprocessing. Informed decision-making includes information about reasonable alternatives that are relevant to the client’s presenting concerns and treatment goals. This gives clients an opportunity to ask questions about available approaches before deciding how they want to proceed.
For PTSD treatment, clinicians have other evidence-supported psychotherapies available. A network meta-analysis by Yunitri and colleagues compared the effectiveness and acceptability of psychotherapies for adults with PTSD, including EMDR and other trauma-focused treatments. Clinicians can use knowledge of appropriate treatment alternatives to support informed decision-making and make referrals when another treatment approach fits the client’s preferences.
The specific conversation will depend on the client’s diagnosis, treatment goals, clinical presentation, and the services available to them. The clinician may continue present-focused work, discuss another psychotherapy approach, or refer the client to a provider offering another appropriate trauma treatment. Treatment preferences may also change over time, and clinicians can continue discussing those preferences as therapy develops.
Documenting EMDR Informed Consent
Clinicians can document the EMDR informed consent discussion and the client’s decision about participating in treatment. Documentation can reflect the information reviewed, questions the client asked, concerns that arose, and the client’s willingness to proceed. When a separate EMDR consent form is not used, the clinical record can document that informed consent for EMDR was obtained.
Depending on the clinician’s setting and applicable requirements, the clinical record might address the information reviewed about EMDR, possible risks and reactions discussed, treatment alternatives reviewed, and the client’s decision about proceeding. Clinicians should follow the requirements that apply to their profession, jurisdiction, organization, and practice setting. The clinical guidance discussed here does not establish jurisdiction-specific legal or documentation requirements.
For clinicians who want a structured document to support this process, the EMDR Informed Consent Form reviews EMDR, potential benefits, possible risks and reactions, treatment alternatives, client responsibilities, opportunities for questions, and the client’s agreement to participate. It can be reviewed with the client as part of the informed consent process and retained according to the clinician’s documentation practices. Clinicians can also document client-specific questions, concerns, or decisions that arise during the conversation.
How Informed Consent Fits Into EMDR Readiness Assessment
Once the client has reviewed the proposed treatment and expresses willingness to proceed, the clinician continues assessing the other Phase 2 conditions relevant to beginning reprocessing. Information from the informed consent conversation may help direct that assessment. The client’s questions, concerns, and responses can indicate areas that need closer attention before Phase 4.
Readiness assessment may include safety and stability, emotional regulation, grounding, dual awareness, between-session coping, dissociation screening, stabilization and pacing, completion of Phase 1, preparation, and target sequencing. The clinician can assess these areas based on the client’s presentation and treatment plan, with particular attention to concerns identified during the informed consent discussion. How to Know When a Client Is Ready for EMDR provides additional discussion of readiness as an ongoing clinical judgment and the conditions clinicians may consider before beginning Phase 4.
For clinicians who want a structured way to review readiness, the free EMDR Client Readiness Checklist organizes the assessment into five domains: stability and safety, coping and emotional regulation, trauma and dissociation screening, motivation and consent, and clinical preparation. The motivation and consent section addresses the client’s knowledge of EMDR and its place in the treatment plan, willingness to process trauma, informed consent for EMDR, and awareness that trauma processing may increase emotional intensity. The remaining sections help clinicians review additional clinical information relevant to the decision to begin reprocessing.
→ EMDR Client Readiness Checklist
Continuing EMDR Preparation Before Reprocessing
Questions that arise during informed consent can identify areas that need additional attention in Phase 2. A client may need additional psychoeducation about EMDR, further discussion of what reprocessing can feel like, stronger self-regulation skills, additional work with dissociation, or time to consider whether trauma processing fits their current treatment goals. The clinician can use that information to determine what preparation is indicated before returning to the question of reprocessing.
Clients with complex trauma histories, dissociative symptoms, limited affect tolerance, difficulty maintaining dual attention, or concerns about between-session stability may need additional Phase 2 assessment and preparation before reprocessing. The clinician can assess the specific capacities or concerns that are relevant to the client’s presentation and adjust preparation and pacing accordingly. Information gathered during informed consent can identify the next area for clinical attention and inform the broader readiness assessment that follows.
For clinicians who want additional training in these Phase 2 decisions, EMDR Phase 2: Preparation, Stabilization, and Readiness for Trauma Processing is a 4-hour continuing education course covering informed consent, research and adverse-event considerations, readiness assessment, dissociation, regulation, dual attention, preparation strategies, and common processing difficulties. The course offers 4 EMDRIA Credits and continuing education credit through an APA-approved sponsor. It is designed as supplemental education for licensed mental health professionals who have completed or are completing formal EMDR training and want additional instruction in clinical decision-making before trauma reprocessing begins.
→ EMDR Phase 2: Preparation, Stabilization, and Readiness for Trauma Processing
EMDR Preparation Resources for Clinicians
Informed consent occurs within the preparation work clinicians complete before trauma reprocessing. Related clinical decisions include assessing dissociation, developing regulation capacities, evaluating dual attention, planning for between-session reactions, adapting preparation strategies, and determining readiness for Phase 4. Clinicians may need different preparation resources depending on the question that emerges during treatment.
The EMDR Preparation & Stabilization Hub brings these resources together so clinicians can continue with the clinical area relevant to the client they are treating. It provides a central location for additional EMDR preparation content and clinician tools. Clinicians can use the hub when an informed consent conversation identifies a preparation question that requires further assessment or intervention.
→ EMDR Preparation & Stabilization Hub
Conclusion
Informed consent can continue as the client develops a clearer picture of what EMDR reprocessing may involve. Questions may become more specific after discussing emotional activation, associated material that can emerge during processing, or possible experiences between sessions. These conversations give the clinician additional information about the client’s expectations and willingness to proceed.
Information that emerges during informed consent can guide subsequent treatment decisions. Questions about the processing experience may call for further discussion, concerns about managing activation may indicate additional preparation, and changes in the client’s willingness may call for reassessment or changes in pacing. Some clients may decide that another treatment option better fits their current goals or preferences.
Informed consent can be revisited when the client’s questions, description of the treatment, concerns, or willingness to proceed change. The clinician can document these conversations as treatment develops and use the information to guide subsequent clinical decisions. This keeps the client’s current participation decision connected to the treatment being proposed at that point in therapy.
Research References
de Jongh, A., de Roos, C., & El-Leithy, S. (2024). State of the science: Eye movement desensitization and reprocessing (EMDR) therapy. Journal of Traumatic Stress. https://doi.org/10.1002/jts.23012
Hoppen, T. H., Lindemann, A. S., & Morina, N. (2022). Safety of psychological interventions for adult post-traumatic stress disorder: Meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events. The British Journal of Psychiatry, 221(5), 658–667. https://doi.org/10.1192/bjp.2022.111
Klatte, R., Strauss, B., Flückiger, C., & Rosendahl, J. (2025). Adverse events in psychotherapy randomized controlled trials: A systematic review. Psychotherapy Research, 35(1), 84–99. https://doi.org/10.1080/10503307.2023.2286992
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
van Schie, K., & van Veen, S. C. (2026). Adverse effects of EMDR therapy: A neglected but urgent area of inquiry. Current Opinion in Psychology, 67, 102155. https://doi.org/10.1016/j.copsyc.2025.102155
Yunitri, N., Chu, H., Kang, X. L., Jen, H. J., Pien, L. C., Tsai, H. T., Kamil, A. R., & Chou, K. R. (2023). Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: A network meta-analysis of randomised controlled trials. Psychological Medicine, 53(13), 6376–6388. https://doi.org/10.1017/S0033291722003737
