How to use these pages
These original worksheets organize clinical reasoning; they are not validated diagnostic instruments, readiness scales, risk-prediction tools, or substitutes for EMDR training. Copy the fields into a secure clinical record or an editable document and expand the space as needed. A blank field may mean “not assessed,” “not relevant,” or “unknown”; specify which. Do not turn the worksheets into a numerical pass–fail test.
Use the client's own language where it clarifies meaning, but record only what is necessary. Separate direct report, clinical observation, collateral information, and inference. Protect identifying details in teaching or consultation copies. Follow relevant confidentiality, recordkeeping, consent, and safeguarding requirements in the jurisdiction where care is provided.
The worksheets support the full treatment plan. Completing one does not authorize active memory processing or establish competence to provide it. Refer to the relevant assessment, readiness, and condition-specific chapters when a field raises a concern.
Worksheet One The presenting problem and the job of treatment
Client identifier: [Enter a secure identifier]
Clinician and service: [Enter name and role]
Date and review date: [Enter dates]
Client's description of the problem: [Use their words]
What the client wants to be able to do: [Describe a practical, personally meaningful activity or choice]
Recent example of the problem: [Situation → interpretation → emotion or bodily response → action → immediate consequence → longer-term consequence]
Assessed diagnosis or clinical indication: [State established, provisional, or not yet established]
Assessment supporting that indication: [Interview, measures, records, and their limitations]
Physical, social, cultural, developmental, and environmental factors: [Include current circumstances rather than only history]
Current danger or urgent care needs: [Describe findings and actions; do not enter only a risk label]
Other conditions or processes requiring their own care: [Specify treatment or further assessment]
Why consider EMDR for this indication: [State the evidence and the individualized rationale]
Evidence limitations and reasonable alternatives discussed: [Record what the client understood and preferred]
What would make another approach preferable: [Identify a real decision condition]
Guidance. Write a formulation that could be wrong and therefore improved. “Trauma is the cause” is too broad. “The recalled assault scene appears to contribute to the panic that follows this particular sound” is a hypothesis that can be examined.
Worksheet Two The candidate target record
Candidate identifier: [Use a short, non-graphic label]
Type of material: [Known remembered event / present trigger / imagined future scenario / other; specify]
Source and certainty: [Client recall / collateral report / inference / dream / image of uncertain origin]
What is known and what remains uncertain: [Keep these separate]
Bounded moment or aspect under consideration: [Enough detail to identify it without unnecessary exposure]
Client's current meaning of that material: [Do not require a stock phrase]
Emotion and bodily experience: [Describe in accessible language]
Relationship to today's difficulty: [Specify the hypothesized link]
Evidence supporting the link: [Client recognition, trigger pattern, repeated observation, or other evidence]
Competing explanation: [What else might account for the difficulty?]
What would weaken this target rationale: [Identify a finding that would prompt revision]
Why this candidate rather than another: [Relevance, client preference, feasibility, and expected functional benefit]
Why it may not be appropriate now: [Current danger, unclear indication, unmet assessment need, client preference, or other reason]
Relevant protocol-specific assessment and ratings: [Record only within training and the chosen protocol; note adaptations]
Provisional decision: [Proceed with agreed assessment or preparation / consider as a treatment target / defer / choose another approach / seek consultation]
Guidance. Do not convert a bodily sensation into evidence that an event occurred. Do not describe imagined material as recovered fact. A target can be clinically relevant without explaining every symptom or requiring a claim about the earliest cause.
Worksheet Three The past–present–future map
Map entry 1 — Past
Material or situation: [Known remembered event]
Proposed clinical link: [How it may contribute]
Desired change: [Memory-related change]
Status or next action: [Assess, select, defer, or not relevant]
Map entry 2 — Past
Material or situation: [Additional candidate if needed]
Proposed clinical link: [Distinct or overlapping link]
Desired change: [Desired change]
Status or next action: [Rationale for order]
Map entry 3 — Present
Material or situation: [Specific trigger]
Proposed clinical link: [Reminder, current threat, habit, or uncertain]
Desired change: [Observable response]
Status or next action: [Assessment or intervention]
Map entry 4 — Present
Material or situation: [Second situation]
Proposed clinical link: [Same process or another process]
Desired change: [Observable response]
Status or next action: [Next step]
Map entry 5 — Future
Material or situation: [Likely upcoming situation]
Proposed clinical link: [Skill, choice, or remaining alarm]
Desired change: [Realistic adaptive action]
Status or next action: [Rehearsal and practical support]
What needs action outside memory processing: [Current danger, processes needing a different intervention, or material without a justified memory-processing link]
Sequence rationale: [Why this order fits the person now]
Client's preference or disagreement: [Record openly]
Guidance. Past–present–future is an organizing framework, not a requirement to locate a childhood memory for every problem. A future scenario should include uncertainty and available choices, not a promise that distress or danger can never recur.
Worksheet Four Readiness and delivery conditions
Understanding and informed choice: [What the client understands about purpose, alternatives, uncertainty, and the right to stop]
Usable communication and pause signal: [Describe what works for this person]
Present orientation and participation: [Observed strengths and difficulties; do not infer readiness from calm appearance alone]
Dissociation assessment or specialist questions: [Findings, uncertainty, and consultation plan]
Current medical and psychiatric concerns: [Responsible clinician and required action]
Practical circumstances: [Housing, transport, privacy, caregiving, work, and communication safety]
Between-session support: [Realistic resources, limitations, and agreed actions]
Accessibility needs: [Language, interpreter, sensory environment, processing time, communication format, physical access]
Clinician competence and supervision: [Relevant training, scope, and consultation arrangements]
Specific preparation needed, if any: [Name the barrier and the intervention]
How preparation will be reviewed: [Observable indicators and a review point]
Conditions that would change today's plan: [Describe actions, not merely labels]
Guidance. Readiness is not a permanent trait. Neither a diagnosis nor a questionnaire score should become an automatic gate. If a need is outside the clinician's competence, name the required expertise and maintain continuity while arranging it.
Worksheet Five Coordinated care and safety actions
Client's consent for information sharing: [Who, what, purpose, and limits]
Lead contact for coordination: [Name and role]
Medical responsibility: [Who monitors and manages relevant physical issues]
Psychiatric or medication responsibility: [Who assesses and manages relevant concerns]
Condition-specific treatment responsibility: [PTSD, addiction, eating disorder, or other care]
Current safety concerns and individualized formulation: [Context, changes, protective factors, and needs]
Agreed safety actions and available contacts: [Use the person's local care pathway]
What happens if the first support is unavailable: [Practical alternative]
How conflicting recommendations will be resolved: [Named process]
Next coordination point: [Date or clinically meaningful event]
Guidance. This worksheet does not replace the service's emergency procedures or a collaboratively developed safety plan. NICE advises against using global risk scores to predict suicide or repeated self-harm or to decide who receives care. [35]
Worksheet Six Reevaluation and decision record
Date and treatment focus since last review: [Enter details]
Client's account of benefit: [Include unexpected gains]
Client's account of difficulty or unwanted effects: [Invite concerns directly]
Selected memory or material: [What changed, what remained, and whether the same aspect was assessed]
Condition-specific outcome measure: [Name, version, timeframe, date, result, and interpretation]
Functional outcome: [What the person actually did or could not do]
Opportunity to test change: [Was the relevant situation encountered?]
Other conditions and current circumstances: [Improved, unchanged, worsened, or not assessed]
New safety or medical information: [Finding and action]
Does the original hypothesis still fit: [Evidence for and against]
Decision and shared rationale: [Continue / change target / adapt delivery / add other care / pause / consult / refer / end]
What will be reviewed next: [Outcome, method, and review point]
Guidance. The PCL-5 is a monitoring and screening resource, not a stand-alone diagnostic verdict. [38] Whatever measure is used, interpret it alongside functioning, safety, the person's account, and appropriate clinical assessment.
Worksheet Seven Future response and ending plan
Likely situation: [Choose one concrete example]
Early cue the person can recognize: [Noticing without demanding perfect control]
What can and cannot be controlled: [Separate own actions from others' behavior]
Preferred response: [A realistic action consistent with the person's values]
Skills, accommodations, or supports required: [Identify what must exist outside imagination]
If the situation becomes unsafe or overwhelming: [Appropriate alternative or support]
Remaining difficulty identified during rehearsal: [New assessment or treatment question]
Agreed real-world step, if appropriate: [Proportionate, safe, and chosen]
Signs that further help may be useful: [Specific changes]
How to reaccess care: [Local pathway and practical details]
What remains unfinished at ending: [State honestly]
Quick reference for a difficult targeting decision
If there is current danger: assess and act on it; do not reduce it to an old alarm.
If the indication is unclear: clarify assessment before searching for a memory.
If the target is compelling but poorly linked: examine its relevance to the client's actual goal.
If no earlier memory comes to mind: do not imply that one must exist or attempt to recover it.
If participation or orientation becomes unclear: pause the demand for recall, assess, and revise the immediate plan.
If one condition improves and another does not: distinguish processes and continue appropriate condition-specific care.
If preparation continues indefinitely: specify the unresolved barrier, review what has been tried, and consider consultation or another approach.
If a rating improves but life does not: examine opportunity, avoidance, skills, environment, and other maintaining processes.
If an adaptation is needed: preserve consent and purpose, document the change, and check whether it helps.
If the therapist feels certain but the client does not: return to collaboration. A confident rationale is not a substitute for the client's informed choice.
Source notes and how to read the evidence
The references in these chapters have different jobs. Guidelines support treatment pathways and broad practice recommendations. Randomized trials address defined interventions in selected samples. Consensus papers can inform specialist practice or accessibility but do not have the same evidential role as controlled outcome studies. Original worksheets, scripts, fictional cases, and formulation questions in this book are teaching tools, not empirically validated decision algorithms.
PTSD and comorbidity. Read the 2023 VA/DoD PTSD guidance alongside the condition-specific guidance relevant to the person. A recommendation not to exclude people because of comorbidity does not remove the need to assess an acute crisis or the competence of the treating service. [30]
Complex dissociation. The cited ISSTD guideline was published in 2011 and concerns adult dissociative identity disorder; its specialist consensus should not be presented as new evidence or generalized to every dissociative symptom. [34]
Population and method limits. The childhood-abuse sequencing trial and the psychosis trial support carefully bounded conclusions about their studied populations. They do not prove that the same sequence is best for every person. Autism adaptation findings from a Delphi survey describe professional consensus, not guaranteed treatment effects. Consult the cited studies and their eligibility criteria before extending a conclusion. [12] [33] [37]
Current use. Source availability and guidance can change. The accompanying reference record identifies exact titles, links, the claims used here, and access or scope limitations. Before implementing a clinical pathway, confirm current local guidance, professional requirements, and relevant specialist advice. The enduring task is to make the treatment rationale explicit enough to share, examine, and improve.