By the time several candidate memories have been identified, the therapist may feel pressure to choose the right one. The client may feel the same pressure: “If we start in the wrong place, will we waste treatment?” A useful response is to explain that a starting point is a reasoned clinical choice, not a prediction that one memory will unlock everything. The choice should be specific enough to act on and provisional enough to review.
The clinician and client are balancing relevance, readiness, preferences, context, and the demands of the proposed work. None should be replaced by a single rule such as “always start with childhood” or “always choose the highest distress rating.” UCL's competence framework describes different starting points, including an earliest relevant memory, a recent memory driving the presentation, and a negotiated starting point when the client is apprehensive. [8]
Choose a starting target and name the next decision
Compare candidate targets by their relationship to the main complaint, their current activation, their scope, and the client's willingness to work with them. ‘First, worst, recent’ can organize inquiry, but it does not replace case formulation. Sometimes a foundational past event makes the clearest starting point; sometimes a bounded recent trigger offers a more direct and tolerable entry. Explain the choice in plain language.
Treatment-Planning Script: “You have identified three scenes. The performance review brings up the same ‘I will be humiliated’ response that stops you asking questions now. We could begin there, then check what changes in your next meeting. Does that match your experience, or does another scene feel more important?”
Before starting, write one prediction: “Processing the review scene may reduce freezing when asking a supervisor for clarification.” Write one observable test: “Client asks a needed question rather than spending the afternoon hiding uncertainty.” This keeps a positive change in the target connected to the practical goal.
At reevaluation, follow the result. If the scene remains active, assess whether processing is incomplete or a different aspect has emerged. If the scene has shifted but the meeting still triggers fear, assess that present cue. If fear has decreased but the person does not know how to formulate a question, rehearse the skill. If the supervisor is actually punitive, address the current context. None of these outcomes requires declaring EMDR a failure or finding an ever-deeper memory.
Clinical focus: A good next target answers a specific remaining question. “There must be more trauma” is not a formulation; “the moment the supervisor raises their voice still produces the same trapped response” is a clinically testable observation.
Establish the reason for each candidate
Tessa, a fictional architect, wants help with panic before presentations. Her map contains a humiliating classroom presentation, a recent client meeting in which she lost her place, and an upcoming professional interview. The therapist does not need to treat all three as equivalent options. The classroom event is a past memory Tessa associates with being watched. The client meeting is a recent episode closely linked with current impairment. The interview is a future demand, not an event that has already occurred.
Before selecting, the therapist can ask what each candidate contributes to the formulation. Is the connection based on Tessa's report, the clinician's inference, or both? Does the candidate fit the agreed goal? Is it sufficiently identified for the proposed work? What remains uncertain? These questions prevent a target list from becoming a queue that must be processed in the order it was written.
Assessment Script
“We have identified several experiences that may matter. The classroom presentation feels connected to being watched, and the recent meeting seems especially active now. How do those possibilities fit for you?”
“What concerns do you have about beginning with either of them?”
“What would help us decide whether this is a useful starting point?”
The therapist should explain the clinical rationale as well as invite preference. Collaboration is not abandonment of professional judgment. If a proposed choice raises safety or scope concerns, those concerns need to be discussed plainly rather than hidden behind the phrase “It is up to you.”
Avoid confusing importance with starting priority
An experience can be deeply important without being the first selected target. Tessa's classroom memory may carry substantial meaning, but she may not yet want to address it. The therapist can explore her concern without assuming it is avoidance that must be overcome. She may worry about becoming disconnected, feel unsure of the therapeutic relationship, or simply prefer to begin with a more recent episode whose relevance is clear.
Conversely, selecting a seemingly less distressing event solely because it appears easy can avoid the central problem. A low rating does not necessarily mean the memory is accessible or therapeutically useful. It may reflect distance, disconnection, limited relevance, or a genuinely less disturbing experience. The decision requires the client's description and the broader assessment, not just the number.
Clinical focus
Separate three questions: “Does this matter?”, “Does it relate to our goal?”, and “Is this the next appropriate work?” A yes to the first two does not automatically answer the third. Documenting the distinction makes a deferred target less likely to disappear from the plan or become a source of unspoken pressure.
Select with a clear but modest hypothesis
Suppose Tessa and her therapist choose the recent client meeting after completing the relevant assessment and preparation. Their rationale is that it is clearly remembered, closely tied to current difficulty, acceptable to Tessa, and appropriate within the treatment plan. They do not promise that processing it will resolve every presentation-related problem. They agree to assess how the memory and daily functioning respond before deciding what comes next.
A concise note might read: “Selected recent client meeting in relation to presentation panic. Client prefers this starting point; earlier classroom event remains a candidate. Plan to reevaluate memory-related distress, preparation behavior, and response to ordinary presentation cues.” The note explains the choice without claiming that its outcome is known.
The upcoming interview also requires attention. Tessa may need practical preparation and a realistic plan for the event. A deadline should not become an excuse to rush work beyond readiness or to promise symptom elimination before the interview. Clinical and practical needs can be addressed together without treating them as interchangeable.
Define what reevaluation will examine
Reevaluation is not just asking whether the target's distress rating fell. The therapist also needs to know what changed outside the session and what did not. EMDRIA describes reevaluation as an ongoing part of the eight-phase approach rather than an optional final check. [2] The client's account of functioning helps determine whether the original formulation remains useful.
Assessment Script
“Since our last meeting, what has been different, if anything?”
“What do you notice now when you think about the experience we addressed?”
“What happened in situations connected with the goal we agreed on?”
“Were there changes that felt unhelpful, difficult to manage, or different from what you expected?”
The invitation to report difficulties should be as genuine as the invitation to report improvement. Tessa may say the client meeting feels less charged but that she still avoids preparing slides. That is useful information, not proof that treatment failed or that she selected incorrectly. The clinician can investigate what is maintaining the remaining avoidance.
Reconsider for a reason
Changing direction is appropriate when new information alters the risk assessment, the client withdraws consent, the formulation no longer fits, treatment effects require attention, or an important current condition has changed. It may also be appropriate when the clinician recognizes a competence limit or the need for another intervention. UCL's metacompetences emphasize responsiveness to client feedback while maintaining coherent treatment. [6]
Reconsideration should not become habitual target switching whenever work becomes uncomfortable. If a target remains unfinished, the clinician should assess and manage that fact within the relevant protocol and training rather than simply replacing it with a more appealing memory. Equally, “staying with the plan” should not mean overriding a stop request or ignoring signs that the work is no longer appropriate.
The therapist can say, “Something important has changed in what we understand. Let us review the plan before deciding the next step.” This conveys responsiveness without implying that the client has done anything wrong. It also models a useful relationship to uncertainty: a treatment plan can be accountable without being rigid.
Target selection is therefore a cycle of understanding, choosing, observing, and revising. Its success is not demonstrated by the elegance of the first hypothesis. It is demonstrated by whether the clinician can explain the decisions, hear correction, and keep the work connected to the life the client is trying to regain or build.