When children are living in a residential treatment center (RTC), the therapist may be working to stabilize the child and the episode of care may be short. The therapist may not be able to move to the trauma processing phases of EMDR, yet EMDR is still important to use with children in RTCs. After completing the Client History and Treatment Planning Phase and establishing clinical rapport, I would spend time in the Preparation Phase with positive affect tolerance and RDI focused on installing mastery experiences. For children in RTCs, trauma processing of the EMDR Phases 3 + may be too much and the therapist may need to focus on the Preparation Phase for a period of time. What is the goal of this episode of care for the child? Many children are in RTCs because they struggle with affect regulation and need to learn affect regulation and emotional literacy. Psychoeducational training while installing successes with RDI and mastery can be extremely beneficial, but it may take some successes in therapy before the kids are ready to proceed with trauma processing. When I have children who balk at desensitization, I know that I need to provide more resources to continue. I need to help the child be ready for trauma processing. Children in RTCs are often in high stress situations and may need to focus on coping with issues in RTC. So, in case conceptualization, I might ask the child about something that's happening at the RTC that's bothering them and then do a future template focused on the child handling the situation in a different way. I need to determine if there is anticipatory anxiety and/or missing skills and information as I continue by installing the future template of the child's definition of being successful at the RTC.
Living in an RTC is an ideal opportunity to move through the phases of EMDR with children. If I have taught the child 2 portable self-soothing techniques that the child is reportedly using (and I check with staff about the child's success on the unit) then I most likely will move forward to reprocess any minor traumas while teaching the child to contain the more severe traumas from the past. Before targeting any significant past traumas, I explain to the residential staff what they might expect from the child and how to provide additional support for the child during this difficult process.
This brief overview is intended to encourage therapists to consider how to conceptualize the use of various phases of the EMDR protocol when the child is living in a residential treatment center.