EMDR Phase 1 History Taking Worksheet: Intake & Client Assessment

This professional clinical worksheet operationalizes Phase 1 (History Taking) of the Eye Movement Desensitization and Reprocessing (EMDR) 8-phase protocol. The layout provides a structured framework for comprehensive case conceptualization, ensuring that clinicians move beyond surface-level symptoms to identify the “architectural” origins of a client’s distress. By guiding the client through the identification of the Presenting Issue and Present Triggers, the tool assists in mapping the “Three-Pronged Protocol.” A critical clinical component of this worksheet is the “Affect Bridge” sequence, which prompts clients to utilize current emotional and somatic states as a neurological pathway to discover foundational Touchstone Events from childhood.

The structured layout is designed to support the Adaptive Information Processing (AIP) model by facilitating the early identification of the memory networks that require desensitization. Research in EMDR emphasizes that the precision of Phase 1 is a direct predictor of treatment efficacy; by documenting the Negative Core Belief (NC) and the desired Positive Cognition (PC) during the initial assessment, clinicians can build a focused trauma hierarchy. This worksheet further bridges the gap between past distress and future resilience through a dedicated Future Desired Outcome section, allowing the client to visualize adaptive behavioral templates before active bilateral stimulation begins.

This clinical resource draws significant inspiration from the standard history-taking protocols established by Francine Shapiro and the specialized case conceptualization frameworks refined by Marilyn Luber and Andrew Leeds. By operationalizing the assessment phase into a manageable, three-page format, the worksheet assists practitioners in maintaining high-fidelity adherence to evidence-based trauma care. This process is foundational for ensuring the therapeutic journey is grounded in a robust “Targeting Sequence,” leading to systematic resolution of historical trauma and the installation of a more empowered, integrated self-narrative.

How This Worksheet Can Be Used

Initial Case Formulation:
Therapists use the worksheet during intake to translate general distress into an EMDR-ready target map. It helps the clinician determine if the client’s ego strength and current stability are sufficient for moving into Phase 2 resourcing.

Identifying Touchstone Memories:
This tool serves as the primary script for the “Float-Back” or “Affect Bridge.” By linking current feelings to the “worst” and “earliest” events, the clinician can identify the root nodes of the trauma network that must be processed first.

Establishing Treatment Goals:
The “Future Desired Outcome” section is utilized to establish clear, behavioral clinical objectives. This ensures that the therapy is not just about reducing pain, but about building the client’s capacity to handle future challenges with mastery.

Benefits of the EMDR Phase 1 History Taking Worksheet

• Ensures high-fidelity adherence to Phase 1 of the standard EMDR protocol.
• Identifies the “Touchstone Events” necessary for root-cause trauma resolution.
• Facilitates the identification of the Negative Cognition (NC) and early Positive Cognition (PC) framing.
• Supports the Three-Pronged Protocol by addressing Past, Present, and Future components.
• Differentiates between immediate symptomatic triggers and historical feeder memories.
• Provides a professional framework for longitudinal treatment planning and case notes.

References

• Shapiro, F. (2017). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.
• Luber, M. (2009). Eye Movement Desensitization and Reprocessing (EMDR) Therapy Scripted Protocols. Springer Publishing Company.
• Leeds, A. M. (2016). A Guide to the Standard EMDR Therapy Protocols for Clinicians, Supervisors, and Consultants. Springer Publishing Company.
• Hase, M., et al. (2017). The Adaptive Information Processing Model: Support from the internal world of trauma. Frontiers in Psychology.