I live with lupus. I have for most of my adult life. I also work with clients who live with chronic and invisible illness — and I've been doing this long enough to notice how different EMDR looks with this population compared to what's typically taught in basic training.

I want to talk about some of those differences.

The window of tolerance is already working harder

If you've completed EMDR Basic Training, you've probably heard that you need consultation hours before you can apply for EMDRIA certification. You may have a vague sense of what that means. You may also have some confusion about what it actually involves — and who you need to get it from.

Let's clear that up.

What EMDR consultation is

"Is my client ready?"

It's the question EMDR clinicians ask most during consultation.

Ready implies a threshold. A line. A moment where the client crosses from not-ready to ready, like flipping a switch. It implies there's a correct answer that exists independently of the clinician's judgment — that if you run the right checklist, you'll know.

Clinical reality doesn't work that way.

Most EMDR clinicians know the Window of Tolerance diagram. Three zones — hyperarousal, the window, hypoarousal — drawn on a whiteboard or pulled up on a tablet during Phase 2. We explain fight or flight. We explain freeze. We explain that the window is where we're trying to work.

And then we move on.

What I want to talk about is what happens after the diagram.

Here's the thing about EMDR's Phase 3 Assessment questions….

And then we get into clinical practice and realize: the first time a client hears "what words go best with that image that express your negative belief about yourself?