Contract Agreement for EMDR Group Consultation with Bonita Ashe, LPCC-CIT

This agreement outlines the expectations regarding group consultation toward EMDRIA Certification in EMDR.

Consultation groups for clinicians seeking EMDRIA Certification are structured as follows:

• According to EMDRIA requirements, the maximum group size for EMDRIA Certification consultation is 8 consultees. I prefer to run a smaller group and the maximum number of participants I allow in the group at any one time is 4 consultees. I have chosen to limit the group size to a maximum of 4 consultees so that everyone in the group has an opportunity to present case material during each meeting.

• Consultees must attend 10 sessions and present current/recent case material on all 8 Phases in order to obtain documentation for their hours of group consultation toward EMDRIA Certification.

• If a scheduled group consultation session is missed, the consultee may schedule a 30-minute individual session (for an additional fee of $10) to make up the missed case presentation review.

• Consultees are expected to come prepared to present case material, complete with notes on that case. Cases will be presented using the EMDR case presentation form (I will provide this to you as I want those who participate in the group to all use the same form). Not all group participants are able to present full cases in every group meeting. My goal is that each participant will discuss some aspect of their clinical work in each meeting. You may schedule a case presentation in advance of the group meeting to help ensure the opportunity to present a full case.

• Do not include any information that will identify the case you are presenting.

• The group will meet for 60 minutes (groups of 2) or 120 minutes (groups of 4) and meetings will be held via Zoom on the following dates:

Thursday Evenings - Eastern Standard Time (Subject to Change)

Format of Consultation (subject to revision)

Session 1: Introductions
• Payment in full is due when signing the agreement (I will send a Square Invoice).
• Discuss Chapter 1 from Getting Past Your Past, by Francine Shapiro.
• Discuss informed consent for EMDR, introducing EMDR to clients, and your intake interview/process.

Sessions 2-10:
• Phase-focused questions and review (20 minutes)
• Case Presentation 1 (20 minutes) – on indicated Phase(s)
• Case Presentation 2 (20 minutes) – on indicated Phase(s)
All case presentations should include (at minimum) the information indicated on the Case Presentation Sheet provided at Session 1, with detailed information regarding the Phase(s) assigned.

The following items are due (sent via email, fax, or mail) at least 1 week prior to Session 1:
• This agreement, signed and dated.
• A copy of your EMDR basic training completion certificate (If not already sent for individual consultation).

Consultee Information

Full Name*

First NameLast Name

Degree*

License Type*

License Number*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Name of Work Setting*

Name of EMDR Training Organization (i.e. Institute, HAP, etc)*

Number of EMDR clients you see per week*

Are you able to utilize EMDR in your work setting?*

YesNo

Are there other therapists utilizing EMDR in your work setting?*

YesNo

Types of clients and presenting issues with which EMDR will be utilized:*

If you have a Supervisor who is providing supervision towards licensure, please provide his/her name and contact information. Consultant and Supervisor will speak briefly at the beginning of consultation, and as needed.*

Prior to learning EMDR, which psychotherapy models were you typically utilizing?*

How long have you been practicing therapy?*

How long have you been practicing EMDR?*

With what aspects of EMDR are you most comfortable?*

What aspects of EMDR are currently most difficult for you?*

Fees

Consultation groups for clinicians seeking EMDRIA Certification meet 10 times for 60 minutes (groups of 2) or 120 minutes (groups of 4) each for a total fee of $350 paid via Square invoice at or before the first group.

Notes/How Paid:

Please submit your completed consultation agreement (this form) at least one week prior to the first group consultation session.

I have read and understand and agree to the above conditions and expectations.

Consultee Name*

Date*

Date

Consultee Signature*

Consultant Name

Date*

Date

Contract Agreement for EMDR Group Consultation with Bonita Ashe, LPCC-CIT

Consultant Signature