Using EMDR With Complex Clients When You Don’t Know Where to Start
Some clients arrive in therapy carrying far more complexity than others. They may face significant barriers to rebuilding their mental health and quality of life. Others present with fewer entrenched difficulties and less disadvantage, which often makes their therapeutic pathway more straightforward.
For clients with fewer challenges, the pathway for using EMDR therapy often feels more straightforward. Targets tend to be clearer, and the role EMDR will play in their overall care is easier to define.
In contrast, therapists can feel overwhelmed, uncertain, confused, or even anxious when trying to determine how EMDR fits into treatment for clients who face significant barriers to mental health. The complexity of these presentations can make it difficult to know where to begin and how to use EMDR in a way that genuinely supports the client’s broader therapeutic needs.
In this blog, I’m sharing a perspective that helps shift this overwhelm and empowers EMDR therapists to proceed with confidence.
What Creates the Overwhelm and Uncertainty for Therapists
There are several reasons therapists feel overwhelmed or uncertain when working with clients who face multiple barriers. Sometimes, the sheer number of factors the client needs support with makes it hard to know where to begin, regardless of the therapy model. Choosing the first therapeutic goal can be challenging when there is so much to address, when the client experiences intense emotional highs and lows, has a history of high‑risk behaviours, or has tried many interventions in the past without success.
Another factor is the way EMDR therapy is sometimes marketed as an all‑powerful cure‑all. When we consider the complexity of these clients’ difficulties, this kind of claim understandably feels unrealistic and can make EMDR appear to be a poor fit.
A Perspective Shift to Reduce the Overwhelm & Find Clarity
I sometimes find the saying “she can’t see the forest for the trees” helpful in these situations. When we feel overwhelmed or uncertain about a client’s formulation and treatment plan, it can be because we are struggling to see the bigger picture (the forest). At other times, the difficulty comes from trying to isolate the smaller components of the problem (the trees) to focus the treatment around, especially when the number of “trees” feels unmanageable.
For clients like this, it is important to clarify how EMDR therapy fits within the broader structure of their treatment. In some situations, it can be helpful to view EMDR as a trauma‑processing tool rather than the entire therapeutic approach. This framing allows us to identify the specific elements of the client’s distress and stuckness that are connected to past trauma or difficult experiences. In doing so, we are selecting particular “trees” to focus on in a way that supports the client’s overall therapeutic journey “the forest”. It also gives us the flexibility to use EMDR for targeted components of the treatment plan without making EMDR the whole plan.
This perspective is also useful to avoid stepping outside of the therapist scope by trying to solve problems that are beyond the capacity of therapy. It allows us to consider what therapy can help with and where case management and support workers in the community may be better suited to the problem at hand.
Final Thoughts
Working with clients who face multiple barriers can leave EMDR therapists feeling unsure about where to begin and how EMDR fits within a complex treatment landscape. By stepping back to view the “forest” of the client’s broader needs and then identifying the specific “trees” that EMDR can meaningfully address, therapists can reduce overwhelm and regain clarity. EMDR does not need to solve every problem to be valuable. When used as a targeted trauma‑processing tool within a wider support network, it becomes both effective and ethically grounded. This perspective helps therapists stay within scope, collaborate confidently with other services, and use EMDR in a way that genuinely supports the client’s overall therapeutic journey.
Nadene van der LInden is a Clinical Psychologist, EMDRAA accredited EMDR Consultant & Therapist, ISST Certified Advanced Therapist and Supervisor in Schema Therapy and Psychology Board Approved Supervisor.
