Self-reported EMDR Skills and Competency Check-In for Consultees in the Process of Completing their Certification Hours
This form is for consultees in the process of completing their certification hours. This form is for those who have been working closely with Sam on the certification process and have already explicitly established that Sam is your primary consultant for the EMDR certification process.
Name
First Name
Last Name
Pronouns:
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Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Review my consultation policies, consent to services, and guidelines and agree to the terms. Read them here: https://www.mantramentalhealthllc.com/professional-consultation. Please email me if you feel it'd be helpful to review these policies one-on-one/verbally.
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I fully read the content of the above website and agree to and understand it's terms.
Please attest to your agreement and understanding of the requirements set forth in my polices regarding using Sam as your primary consultant for certification or for becoming a consultant. Policies: https://www.mantramentalhealthllc.com/professional-consultation
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I have read and understand the requirements and expectations for having Sam as my primary consultant for certification
I have read and understand the requirements and expectations for having Sam as my primary consultant for the consultant status process
This is not applicable (I have another primary consultant or I'm not seeking certification or consultant status at this time).
Consultee self-reported skills
Please complete the below questions surrounding your EMDR skills/knowledge
Gathering client history (Phase 1)
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around this portion of the process.
Working with and adapting to different populations
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around adapting to different populations.
Resourcing and Preparation (Phase 2)
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around resourcing.
Assessing client appropriateness for EMDR therapy
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around this portion of the process.
Assessing client preparedness for reprocessing
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around this portion of the process.
Assessing/screening for dissociation
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around screening for dissociation.
Preparation and Resourcing (Phase 2) with dissociative clients
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around working with dissociative clients.
Explaining the EMDR therapy process to clients
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around this portion of the process.
Clinician's understanding of the mechanics of EMDR (e.g. seating, distance, stop signal, etc)
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around these mechanics.
Staying "out of the way" while reprocessing with clients
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have re: staying "out of the way".
Dealing with the ‘looping’ and ‘stuck processing’? (e.g. change direction, speed or amount of eye movements; change modalities; cognitive interweave)
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have re: looping or being stuck in processing
Closure at the end of a session with an incomplete target
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around this portion of the process.
Treatment/target planning for EMDR
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around this portion of the process.
Applying the standard EMDR 8 phase protocol
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1 (not confident at all)
2
3
4
5 (very confident)
If you reported a 4 or below, please explain what is keeping you from feeling confident or what questions you have around applying the standard 8 phase protocol.
Discussion/presentation of cases in consultation
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1 (not confident at all)
2
3
4
5 (very confident)
Please provide info on how your EMDR practice has evolved since your basic training:
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What requirments do you still need to fulfill to complete your certification process? (how many consult hours, advanced topics training hours, finishing your independent licensure, etc).
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Please sign below attesting to your understanding and agreement of the consultation and services agreement as well as attesting that all information provided here is true, accurate, and complete.
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