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How to Write Effective EMDR Progress Notes: Best Practices, Templates, and Examples
Why Detailed EMDR Notes Matter
Comprehensive EMDR notes are essential for ensuring structured, effective treatment and compliance with professional standards. Well-documented EMDR notes:
Help track client progress accurately through EMDR’s structured phases
Provide continuity of care across treatment sessions
Demonstrate compliance with ethical/legal obligations (e.g., HIPAA, confidentiality)
Justify the medical necessity and efficacy of EMDR interventions
Protect clinicians by ensuring transparency and accountability
EMDR Notes Best Practices
Follow these recommended best practices for writing effective EMDR session notes:
Timeliness: Write notes within 24–48 hours of each session for accuracy.
Objectivity and Neutrality: Document observable client behaviors and direct client quotes, avoiding subjective interpretations.
Correct: "Client teared up when discussing accident memory."
Incorrect: "Client was overly emotional."
Relevant Details Only: Focus your notes on meaningful content directly related to treatment.
Linking to Treatment Goals: Tie session activities explicitly back to client goals.
Documentation of Interventions and Responses: Clearly note EMDR techniques (e.g., bilateral stimulation, cognitive interweaves) and the client's reaction to each.
Concise and Organized Structure: Utilize clear formats like SOAP or DAP, short paragraphs, and bullet points for readability.
Essential Elements of EMDR Progress Notes
Due to EMDR's structured nature, ensure your notes include these specific elements:
Target Memory/Issue: Clearly state the traumatic memory or event addressed.
Negative Cognition (NC) and Positive Cognition (PC): Record the negative self-belief and the positive belief targeted during EMDR.
Validity of Cognition (VoC): Report the initial and final ratings (scale: 1–7).
Subjective Units of Distress (SUD): Document the client's distress before, during, and after processing (scale: 0–10).
Emotions and Body Sensations: Note significant emotions and physical sensations reported by the client.
Phase of EMDR and Interventions Used: Clearly document EMDR phases (e.g., Phase 4: Desensitization) and interventions (bilateral eye movements, tapping, safe-place technique, cognitive interweaves).
Client’s Responses Throughout Session: Include details like notable emotional reactions, new insights, and behavioral changes.
Outcome of Session: Summarize the result of the session, including ending SUD/VoC and client status.
Next Steps and Homework: Clearly outline the plan for the next session and interim assignments.
Structuring EMDR Notes: SOAP and DAP Formats
Two widely accepted progress note formats are SOAP and DAP. Here’s how to apply each to EMDR documentation:
SOAP Notes for EMDR
Subjective (S): Client’s statements, feelings, and subjective reports.
Objective (O): Observable behaviors, SUD/VoC ratings, interventions used, and real-time client responses.
Assessment (A): Clinical interpretation of progress, symptom changes, diagnostic impressions, and safety assessments.
Plan (P): Next session plan, homework assignments, referrals, and adjustments to the treatment plan.
EMDR SOAP Example:
Subjective: Client reported ongoing nightmares ("I kept seeing the accident") and high anxiety driving this week. Felt nervous about processing the target memory.
Objective: 90-minute EMDR session targeting client's 2018 accident. Initial SUD 7/10; after multiple bilateral eye movement sets, SUD decreased to 2/10. VoC increased from 3/7 ("I am safe now") to 5/7. Client became emotional mid-session; paused for grounding exercises. Client appeared calmer at session end, smiling and relaxed.
Assessment: Significant progress processing trauma memory evidenced by reduction in SUD level. Improved VoC indicates internalization of positive cognition. Continued anxiety around driving noted but improving coping strategies demonstrated. No safety or risk concerns reported.
Plan: Next session to continue EMDR targeting this memory until SUD=0 and VoC=7. Homework includes daily grounding and breathing exercises. Next appointment scheduled in one week.
DAP Notes for EMDR
Data (D): Combined client and therapist accounts of session events (client's statements, observed behaviors, EMDR interventions, ratings).
Assessment (A): Clinical evaluation of session events, progress made, changes in symptom severity, diagnostic notes, risk assessment.
Plan (P): Next session's plans, interventions, homework, and referrals if required.
EMDR DAP Example:
Data: EMDR session targeting client's car accident trauma. Client initially anxious (SUD 8/10 when visualizing trauma). Completed bilateral eye movement desensitization; client reported feeling "lighter" with final SUD at 2/10. Positive cognition "I have control" VoC improved from 3/7 to 5/7. Client emotional mid-session; therapist guided client through grounding exercises. Ended calm and stable.
Assessment: Notable progress demonstrated by significant distress reduction and improved confidence in positive cognition. Client appears to be integrating EMDR interventions effectively. Anxiety about driving still present but decreasing in intensity. No reported suicidal ideation or safety risks.
Plan: Continue EMDR next session to further decrease distress (target SUD=0). Homework: daily practice of grounding techniques. Follow-up scheduled for next week.
Ethical and Legal Considerations for EMDR Notes
Proper documentation of EMDR sessions ensures ethical and legal compliance. Best practices include:
Confidentiality: Follow HIPAA and other relevant privacy laws.
Accuracy and Timeliness: Ensure notes reflect sessions accurately and are recorded promptly.
Professional Language: Use clinical, objective terminology without assumptions or emotional bias.
Risk Documentation: Clearly note any risk assessments and safety considerations.
Final Thoughts on EMDR Documentation
Properly written EMDR clinical notes help therapists provide safer, more effective care while fulfilling ethical and professional obligations. Essential components include target issues, SUD and VoC ratings, EMDR-specific interventions, client responses, outcomes, and clear session plans. Organizing notes with SOAP or DAP formats can enhance clarity and ensure compliance.
Always remember: Clinical documentation should be professional, accurate, respectful, private, and timely. Ensuring your notes meet these standards demonstrates your competence and protects both you and your clients.
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Shanice
Author, Nudge AI
