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EMDR Progress Notes: Templates, Examples & Documentation Tips for Every Phase

Q: Is a separate "Informed Consent" required for EMDR?

While not always legally mandated beyond standard consent, it is clinical best practice. Document that the client was informed about the risk of "high emotional arousal" and "post-session processing." Note their agreement to use the Safe/Calm Place and their understanding that they can stop bilateral stimulation at any time.

Q: How do I document "Looping" or "Processing Blocks" in Phase 4?

When a client stays stuck at a high SUD, document the specific "interweave" used (e.g., cognitive, imaginative). Note the shift from "processing" to "active intervention." This demonstrates medical necessity by showing the clinician’s active role in moving the client past a neurological stalemate rather than just passive observation.

Q: How should I document "Atypical" Bilateral Stimulation (BLS)?

If using tactile buzzers, tapping, or audio tones instead of eye movements, document the specific modality and the clinical reason for the choice (e.g., "visual fatigue" or "client preference"). Consistently recording the type of BLS used ensures continuity of care if the client transitions to another provider.

Writing effective EMDR progress notes requires more than capturing session details — it involves documenting targets, cognitions, and measurable change across each phase of treatment. This guide shows you how to write EMDR progress notes step by step, with a structured EMDR note template, real session examples, and practical guidance for documenting SUD and VOC scores, assessment questions, and treatment progress. Whether you're refining your documentation for clinical clarity or audit readiness, you'll learn exactly what to include in every EMDR session note.

Dr. October Boyles, DNP, MSN, BSN, RN

Last Updated: March 30, 2026

Clinician documenting EMDR progress notes in ICANotes during therapy session with client in background

What You'll Learn

How EMDR therapy works and what sets it apart from traditional talk therapy
The eight phases of EMDR treatment and what happens during each stage
What to include in your EMDR progress notes for each phase
How to use an EMDR note template to standardize your documentation
Key EMDR assessment tools like the VOC and SUD scales and how to track them over time

Contents

What EMDR Therapy Is and How It Works
EMDR Note Template: What to Include in Every Session
Phase 1: EMDR History Taking Questions & Treatment Planning
Phase 2: How to Prepare Clients for EMDR
Phase 3: EMDR Assessment Questions, VOC & SUD Scales
Phases 4–7: EMDR Treatment Documentation
Phase 8: EMDR Re-Evaluation
EMDR Progress Note Examples
Frequently Asked Questions About EMDR Documentation
How ICANotes Can Help With EMDR Progress Notes

Accurate and consistent documentation is critical for effective EMDR therapy. Whether you're tracking client progress through each of the eight phases, preparing for audits, or ensuring continuity of care, a structured approach to your EMDR progress notes can streamline your workflow and strengthen your clinical record. A well-written EMDR progress note captures essential details from each session — including targets, cognitions, SUD and VOC ratings, and client response — helping ensure that your documentation reflects both the therapeutic interventions used and the client's movement across treatment.

This guide walks through what to document during every phase of EMDR, provides a ready-to-use EMDR note template, and includes EMDR progress note examples you can reference as you build your own documentation practice.

What EMDR Therapy Is and How It Works

Created by psychologist Francine Shapiro in the late 1980s, Eye Movement Desensitization and Reprocessing (EMDR) therapy was originally developed to treat post-traumatic stress disorder (PTSD). At the core of EMDR is the Adaptive Information Processing (AIP) model, also developed by Dr. Shapiro, which posits that PTSD symptoms and the symptoms of similar disorders stem from past experiences that the brain has not fully processed. The memories connected to those experiences remain loaded with the beliefs, emotions, and physical sensations that occurred at the time of the triggering event. Recalling the experience can unleash those unpleasant emotions, thoughts, and sensations, bringing on symptoms.

EMDR is notably different from other treatment modalities. Rather than asking a client to reflect on or discuss a traumatic experience in detail, an EMDR therapist guides the client through bilateral stimulation — most commonly guided eye movements — while the client focuses on the target memory. The goal is to change the brain's relationship with the memory so that recalling it no longer triggers a distress response.

EMDR is an example of short-term therapy. Sessions typically take place once or twice a week, and clients often complete treatment in six to 12 sessions, with some clients benefiting from fewer. Unlike CBT and other modalities that typically use 45-minute sessions, the average EMDR session runs about 90 minutes. The American Psychological Association (APA) conditionally recommends EMDR therapy as a PTSD treatment. For a deeper look at the research behind that recommendation, see our guide to EMDR effectiveness and how EMDR trauma therapy works.

EMDR therapy consists of eight phases: History Taking and Treatment Planning, Preparation, Assessment, Desensitization, Installation, Body Scan, Closure, and Re-Evaluation.

The 8 Phases of EMDR Therapy

EMDR treatment follows a structured eight-phase process that helps clinicians move from case conceptualization and preparation to reprocessing, closure, and ongoing re-evaluation.

History Taking

Identify presenting problems, past experiences, current triggers, and future goals to guide treatment planning.

Preparation

Build trust, explain the process, and strengthen stabilization skills such as grounding and Safe/Calm Place.

Assessment

Clarify the target image, negative and positive cognitions, emotions, body sensations, and baseline SUD/VOC ratings.

Desensitization

Use bilateral stimulation while the client focuses on the target so distress can decrease over time.

Installation

Strengthen the client’s positive cognition until it feels more fully true and integrated.

Body Scan

Check for any residual physical distress and process any remaining activation connected to the target.

Closure

End the session with stabilization, debriefing, and clear guidance for between-session experiences.

Re-Evaluation

Review what shifted since the last session and decide whether the same target needs more work or is resolved.

What EMDR Therapy Is and How It Works

A consistent EMDR note template helps streamline documentation while ensuring that every clinically relevant detail is captured across sessions. Rather than rebuilding your note structure each time, a standardized framework allows you to quickly document key elements such as target memories, negative and positive cognitions, SUD and VOC ratings, interventions used, and the client’s response to processing.

Using a structured approach also makes it easier to track progress over time, demonstrate medical necessity, and maintain continuity of care—especially when clients move between phases of EMDR treatment. The template below outlines the core components you should include in every EMDR progress note, regardless of which phase you are documenting.

Pro Tip: Using a consistent EMDR note template makes it easier to document SUD and VOC changes across sessions and demonstrate medical necessity during audits.

EMDR note template showing fields for progress notes including target memory, cognitions, SUD and VOC ratings, and interventions

Session Information

Field	Description
Date	Date of session
Client Name/ID	Client identifier
Session Number	Sequential EMDR session number (e.g., 1, 2, 3)
Current Phase	Which EMDR phase was addressed (e.g., Phase 4 – Desensitization)
Prong Addressed	Past memory, present trigger, or future template

Target & Cognitions

Field	Description
Target Memory/Issue	The specific memory, trigger, or future scenario addressed
Image	The image the client associates with the target
Negative Cognition (NC)	The client’s negative self-belief (e.g., “I am not safe”)
Positive Cognition (PC)	The client’s desired positive belief (e.g., “I can protect myself”)
VOC Rating	Validity of Cognition, rated 1 (completely false) to 7 (completely true)
SUD Rating	Subjective Units of Disturbance, rated 0 (no disturbance) to 10 (worst disturbance)
Emotions	Emotions the client reported during the session
Body Sensations	Physical sensations the client noticed

Intervention & Clinical Notes

Field	Description
Bilateral Stimulation Type	Eye movements, taps, auditory tones, etc.
Interventions Used	Safe/Calm Place exercise, cognitive interweave, containment, or other interventions used
Client Response	Shifts in imagery, affect, cognitions, or body sensations during processing
Clinical Impressions	Your assessment of client progress, affect tolerance, and engagement
SUD Post-Processing	SUD rating at end of session
VOC Post-Processing	VOC rating at end of session
Closure Method	How the session was closed (debriefing, containment exercise, Safe/Calm Place, etc.)

Planning

Field	Description
Client Status at End	Stable, mildly activated, or requires follow-up
Plan for Next Session	Target, phase, or additional interventions to address
Other Planned Treatments	Any concurrent therapies, such as CBT or medication management

Using a structured template like this across all sessions makes it easier to track SUD and VOC trends over time, demonstrate medical necessity for audits, and maintain continuity if the client transitions to another provider.

Phase 1 - EMDR History Taking Questions and Treatment Planning

The first phase of EMDR — History Taking and Treatment Planning — typically spans one to two sessions. During this phase, you gather a comprehensive history from the client and identify the targets that will guide treatment.

EMDR history taking generally follows a three-pronged approach. You'll explore disturbing memories from the past, issues and triggers in the present, and the client's future goals and desired responses.

Questions to Ask During EMDR History Taking

Begin by asking the client what problem they want to address. From there, explore details such as when the issue happens, who's involved, when it first started, and what about it upsets the client most.

Next, ask the client to identify disturbing events in their past and provide a general age or timeframe for each. In your progress notes, lay these events out on a timeline so you can easily visualize the client's history and identify patterns.

Then examine how past events affect the client's present. Key questions include:

When was the last time you experienced this issue?
How did you feel when it happened? What did you experience in your body?
What was the worst part of the situation — an image, smell, noise, emotion, or sensation?
What negative beliefs do you have about yourself in relation to this situation?

Finally, address the client's future orientation with questions like:

When do you see this situation happening again?
How would you like to respond if it occurs in the future?

What to Document in Phase 1

In your progress notes for history taking sessions, record the client's identified targets and organize them on a timeline. Note the presenting problem, the client's negative and positive self-beliefs, the most distressing memory or memories identified, current triggers, and future goals. This documentation becomes the foundation for your EMDR treatment plan and guides which targets you'll address first.

It's important to remember that one feature setting EMDR apart from other modalities is that the client doesn't need to go into extensive detail about their most challenging memory. You can ask questions and take notes, but a complete narrative of the event isn't necessary for treatment to be effective.

Phase 2: How to Prepare Clients for EMDR

After gathering the client's history, the Preparation phase focuses on building trust, explaining the EMDR process, and equipping the client with self-regulation strategies they can use during processing.

Think of this phase as trust-building. If clients don't feel safe with you and confident in the process, therapy won't be as effective. One of the primary tools used in preparation is the Safe/Calm Place exercise, which helps clients establish an internal resource they can access when they feel activated during or between sessions.

The Safe/Calm Place Exercise

Walk your client through the following Safe/Calm Place Exercise steps:

Identify the image. Ask the client to describe a place they find safe and calming. Document their description.
Explore sensations. Ask what emotions and sensations they experience when thinking of that place. Record any images, sounds, smells, or physical feelings they describe.
Deepen the experience. Ask the client to go deeper into the emotions and sensations.
Introduce bilateral stimulation. Have the client think of their calm place and the sensations it creates, then ask them to follow your finger with their eyes. You may need to repeat this several times.
Establish a cue word. Ask the client to summarize their safe/calm place with a single word. Write this word down — it's their cue word for future sessions.
Test self-cueing. Ask the client to think of their cue word on their own and note how they feel.

What to Document in the Preparation Phase

In your EMDR progress notes for the Preparation phase, record the client's Safe/Calm Place description, their cue word, the bilateral stimulation method used, and the client's response to self-cueing. Also note any other stabilization or grounding techniques introduced and whether the client appears ready to move into the Assessment phase. If additional preparation sessions are needed, document why and your plan for the next session.

Phase 3: EMDR Assessment Questions, VOC & SUD Scales

Once the client has been prepared, you move into the Assessment phase. This is where you establish the baseline measurements that will guide and track treatment progress using two key scales: the Validity of Cognition (VOC) scale and the Subjective Units of Disturbance (SUD) scale.

Assessment Questions to Ask

Before applying either scale, the client needs to identify a specific, distressing image from the target experience. Ask the client to describe a mental picture or image from the event and note their response. Then guide them through the following:

Identify the Negative Cognition (NC). Ask the client to state a negative self-belief connected to the experience. Examples include "I am bad," "I can't be loved," "I am weak," or "I am not safe."
Identify the Positive Cognition (PC). Ask the client to choose a positive belief they'd like to hold instead. Ideally, this is the reverse of the negative belief — for example, "I am good," "I am loveable," "I am strong," or "I can protect myself." The goal is to give the client a sense of control.
Rate on the VOC scale. Ask the client to rate how true the positive belief feels on a scale of 1 to 7, where 1 is completely false and 7 is completely true.
Rate on the SUD scale. Ask the client to rate how disturbing the target memory feels on a scale of 0 to 10, where 0 is no disturbance and 10 is the worst disturbance they can imagine.

EMDR SUD and VOC scales showing subjective units of disturbance from 0 to 10 and validity of cognition from 1 to 7

Tracking SUD and VOC Across Sessions

The VOC and SUD scales are your primary tools for measuring progress through treatment. Document the client's ratings at the beginning and end of each processing session. Over the course of treatment, the SUD should decrease (ideally reaching 0) and the VOC should increase (ideally reaching 7). Tracking these ratings session over session gives you a clear picture of whether processing is progressing or whether a different approach is needed.

Phases 4-7: EMDR Treatment Documentation

The treatment phases — Desensitization (Phase 4), Installation (Phase 5), Body Scan (Phase 6), and Closure (Phase 7) — may span multiple sessions. How you document each depends on how far the client progresses in a given session.

Phase 4: Desensitization

The goal of desensitization is to transform the target memory from something distressing into something that no longer activates the client. During this phase, you ask the client to focus on the target image and their negative cognition while performing bilateral stimulation, such as following your finger with their eyes. You'll guide them through multiple sets, checking in on their SUD rating after each one.

What to document: Record the target memory, the bilateral stimulation method, the number of sets completed, any shifts in the client's imagery or affect, the SUD rating at the start and end of the session, and the planned focus for the next session. The goal is to bring the SUD down to 0 — though for some clients, a 1 or 2 may be an acceptable endpoint.

Phase 5: Installation

While desensitization focuses on reducing SUD, the Installation phase aims to strengthen the client's positive cognition and increase their VOC rating.

Start by checking in with the client about their positive cognition. Is it still relevant, or has a more fitting belief emerged? Document any changes. Then ask the client to hold the positive cognition in mind while performing bilateral stimulation. After each set, ask them to rate the positive cognition on the VOC scale again. Continue until the client reaches a 7.

If the client consistently plateaus at the same rating, ask what's keeping them from fully believing the positive cognition. You may need to pause installation for the session and document the block for follow-up.

What to document: Record the positive cognition (and any changes), VOC ratings before and after each set, any identified blocks, and whether installation is complete.

Phase 6: Body Scan

Move to the Body Scan phase only when the client's SUD is 0 and their VOC is 7. Have the client think of the target image and their positive belief, then ask them to scan their body and note any remaining distress or tension. If distress is present, use bilateral stimulation to process it.

What to document: Record any body sensations the client reported, the bilateral stimulation used, and whether the body scan was completed successfully or requires further processing.

Phase 7: Closure

Closure happens at the end of every session, regardless of whether the client completed all treatment phases. If processing is incomplete, you may need to perform a containment exercise to stabilize the client before they leave.

If the session is complete (SUD of 0, VOC of 7, clean body scan), focus on debriefing. Let the client know they may continue to process the session material after they leave, and encourage them to record any thoughts, feelings, or dreams that come up. If additional sessions are planned, make a plan for the next one.

What to document: Record the closure method used (debriefing, containment, Safe/Calm Place), the client's status at the end of the session (stable, mildly activated, etc.), any instructions given to the client, and the plan for the next session.

Phase 8: EMDR Re-Evaluation

Re-Evaluation occurs at the beginning of each session after the first. During this phase, you touch base with the client to assess what has come up since the previous session — new memories, dreams, emotional shifts, or changes in how they experience the target issue.

What to document: Record the client's report of between-session experiences, any changes in SUD or VOC from the previous session's target, whether the previous target requires continued processing or is resolved, and your plan for the current session based on the client's presentation.

How EMDR Processing Typically Progresses in Session

During the middle phases of EMDR, clinicians often move through a repeatable workflow that helps reduce distress, strengthen adaptive beliefs, and confirm that the target has been fully processed.

Target

Identify the memory, image, cognition, and baseline SUD/VOC ratings.

→

Bilateral Stimulation

Guide the client through sets while monitoring shifts in affect, imagery, and sensation.

→

SUD Decreases

Track reduction in emotional disturbance as the target becomes less activating.

→

VOC Increases

Strengthen the positive cognition until it feels more believable and integrated.

→

Body Scan

Check for residual physical distress and process any remaining activation.

→

Closure

Stabilize the client, debrief the session, and prepare for between-session processing.

In documentation, this sequence helps clinicians show not only what interventions were used, but also how the client responded and whether the target appears resolved.

EMDR Progress Note Examples

Using structured EMDR note templates helps ensure consistency, supports medical necessity, and improves treatment planning. Below are two examples illustrating how to document different phases of treatment.

Example 1: Desensitization Session (Phase 4)

Date 06/06/2025

Client Name Jane Doe

Session # 5

Phase Phase 4 – Desensitization

Target Memory Childhood car accident (age 10)

Negative Cognition "I am not safe."

Positive Cognition "I can protect myself."

VOC (pre-processing) 3

SUD (pre-processing) 8

Intervention Summary

Client was guided through bilateral stimulation (eye movements) focused on the target memory. Processing included three full sets with brief assessments of cognition and affect between sets. Client displayed signs of distress during initial sets (increased breathing rate, tearfulness) but remained within the therapeutic window of tolerance.

Client Response

Client reported a shift in imagery mid-session, describing a sense of "watching the scene from above" rather than reliving it. Emotional intensity decreased steadily across sets. SUD reduced to 4 by end of session. VOC remained at 3, but client verbalized greater connection to the positive cognition.

Clinical Impressions

Client is engaging well in the desensitization process and demonstrating affect tolerance and increasing cognitive restructuring. Continued focus on this target is recommended for next session to further reduce SUD and reinforce adaptive belief.

Plan

Resume desensitization on same target in next session. Monitor for emerging related material. Prepare for transition to Phase 5 (Installation) once SUD reaches 0 or 1.

Example 2: Installation & Body Scan Session (Phases 5–6)

Date 06/13/2025

Client Name Jane Doe

Session # 7

Phase Phase 5 – Installation / Phase 6 – Body Scan

Target Memory Childhood car accident (age 10)

Negative Cognition "I am not safe."

Positive Cognition "I can protect myself."

VOC (pre-processing) 5

SUD (pre-processing) 0

Intervention Summary

SUD was confirmed at 0 from re-evaluation. Proceeded to Installation phase. Client held the positive cognition "I can protect myself" in mind during four sets of bilateral stimulation (eye movements). VOC increased from 5 to 6 after the first two sets and reached 7 after the fourth set. Client was then guided through a body scan while holding the target image and positive cognition in mind.

Client Response

Client reported mild tightness in her shoulders during the body scan. One additional set of bilateral stimulation was used to process the sensation. Upon rescanning, client reported no remaining distress. Client appeared calm and stated she felt "lighter" than she had in prior sessions.

Clinical Impressions

Installation and body scan were completed successfully for this target. Client demonstrates strong affect tolerance and adaptive processing. This target memory appears fully resolved (SUD 0, VOC 7, clean body scan).

Closure

Debriefing conducted. Client was informed that additional processing may occur between sessions and was encouraged to journal any thoughts or feelings that arise. Client was stable at the end of the session.

Plan

Begin re-evaluation of next target (workplace conflict, identified in Phase 1) at next session. Assess readiness for desensitization on new target.

Frequently Asked Questions About EMDR Documentation

Is a separate "Informed Consent" required for EMDR?

What should the therapist say when checking the VOC during the installation phase?

During the Installation phase, the therapist asks the client to hold the target image and positive cognition together in mind, then rate how true the positive belief feels on a scale of 1 (completely false) to 7 (completely true). A typical prompt might be: "When you think of the original experience, how true do the words [positive cognition] feel to you now, on a scale of 1 to 7?" The therapist repeats this check after each set of bilateral stimulation until the client reaches a VOC of 7.

How do you explain EMDR to clients?

When preparing clients for EMDR, explain that it's a structured therapy designed to help the brain process distressing memories so they no longer trigger strong emotional or physical reactions. You might say something like: "During EMDR, I'll ask you to briefly focus on a difficult memory while following my finger with your eyes. This bilateral stimulation helps your brain reprocess the memory so it becomes less distressing over time." Emphasize that they won't need to describe the event in detail, which often puts anxious clients at ease.

What is assessed during EMDR Phase 1 history taking?

During Phase 1, the clinician gathers the client's history across three time frames: past disturbing memories, present-day triggers and symptoms, and future goals. The therapist identifies target memories, maps them on a timeline, explores the client's negative and positive self-beliefs related to those experiences, and determines which target to address first in treatment. This phase typically takes one to two sessions.

What three things should the clinician ask the client to notice when beginning desensitization?

When starting the desensitization phase, the clinician asks the client to hold three things in mind simultaneously: the target image associated with the disturbing memory, the negative cognition (their negative self-belief about the experience), and any body sensations they notice while focusing on the image and belief. The client maintains awareness of all three while performing bilateral stimulation.

How long does EMDR therapy take?

EMDR is a short-term therapy. Sessions typically occur once or twice a week and run about 90 minutes each — longer than the standard 45-minute therapy session. Most clients complete treatment in six to 12 sessions, though some may benefit from fewer. The total length depends on the complexity of the client's history and the number of target memories identified during Phase 1.

What's the difference between SUD and VOC in EMDR?

SUD (Subjective Units of Disturbance) measures how distressing a target memory feels to the client on a scale of 0 to 10, where 0 is no disturbance and 10 is the worst imaginable. VOC (Validity of Cognition) measures how true the client's positive self-belief feels on a scale of 1 to 7, where 1 is completely false and 7 is completely true. During treatment, the goal is to bring SUD down to 0 and VOC up to 7. Clinicians track both ratings across sessions to measure processing progress.

What does a completed EMDR session look like?

A fully completed EMDR processing session ends with the client achieving a SUD of 0, a VOC of 7, and a clean body scan — meaning they can hold the target memory and positive cognition in mind without noticing any residual distress or tension in their body. The therapist then conducts a debriefing, letting the client know they may continue processing after the session and encouraging them to note any thoughts, feelings, or dreams that arise. See the EMDR progress note examples above for detailed documentation of both in-progress and completed sessions.

How do I document "Looping" or "Processing Blocks" in Phase 4?

How should I document "Atypical" Bilateral Stimulation (BLS)?

How ICANotes Can Help With EMDR Progress Notes

Accurate EMDR session notes are essential for tracking a client's progress through each phase of treatment, but detailed documentation shouldn't come at the cost of session flow. ICANotes simplifies the process with intuitive, structured EMDR note templates that guide you through documenting key clinical details — including targets, triggers, SUD and VOC ratings, cognitions, and client responses.

These templates help ensure your EMDR progress notes are both comprehensive and compliant, whether you're documenting a straightforward desensitization session or a complex multi-phase appointment. Schedule a demo to see how ICANotes can support your EMDR documentation needs.

Clinician using ICANotes EMDR therapy notes software to document patient progress during a therapy session

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Simplify clinical charting

Stay organized with appointment scheduling

Reduce no-shows with automated reminders

Improve client engagement with a secure patient portal

Provide flexible care with HIPAA-compliant telehealth

Dr. October Boyles

DNP, MSN, BSN, RN

Dr. October Boyles is a behavioral health expert and clinical leader with extensive expertise in nursing, compliance, and healthcare operations. With a Doctor of Nursing Practice (DNP) and advanced degrees in nursing, she specializes in evidence-based practices, EHR optimization, and improving outcomes in behavioral health settings. Dr. Boyles is passionate about empowering clinicians with the tools and strategies needed to deliver high-quality, patient-centered care.