What should EMDR session notes include?

EMDR session notes should document: (1) which phase(s) were addressed this session; (2) the target memory or touchstone — specific event, image, NC (negative cognition), PC (positive cognition), emotion, body sensation location; (3) SUD at start of processing and at close of session (with note if SUD did not reach 0); (4) VoC at start and at close (with note if VoC did not reach 7); (5) BLS type used (eye movements, taps, tones) and any adjustments made; (6) client's processing — major themes, channels followed, any abreaction; (7) dissociation or blocking response if observed and how it was managed; (8) closure procedure if session was incomplete; (9) risk assessment; (10) plan for next session. EMDR notes need to capture the arc of a reprocessing session, not just that it occurred.

How do you document an incomplete EMDR session (SUD did not reach 0)?

When a reprocessing session ends with SUD above 0 (the target memory was not fully processed in one session), document: (1) SUD at end of session with note that session was incomplete; (2) closure procedure used — which container/calm place exercise, client's response; (3) client's emotional state at end of session — 'client was not at baseline before leaving'; (4) any safety plan or between-session contact agreement; (5) plan to return to same target next session. Documenting the incomplete closure is clinically and ethically important — EMDR guidelines specify that clients should not leave a session in an activated state without a closure procedure. The documentation should make clear that closure was attempted and what the client's state was at the time of leaving.

What are SUD and VoC and how do you track them in notes?

SUD (Subjective Units of Disturbance) is a 0-10 self-report scale measuring the disturbance associated with the target memory or image (0 = neutral/no disturbance, 10 = highest possible disturbance). VoC (Validity of Cognition) is a 1-7 scale measuring how true the positive cognition feels in connection with the target memory (1 = completely false, 7 = completely true). In session notes, document SUD at the start of processing (after assessment), SUD after each set of BLS if clinically relevant, and SUD at end of session. Document VoC at Phase 3 (installation check) and at Phase 5 (installation). Tracking these across sessions shows the trajectory of reprocessing and whether the target is resolving.

How do you document dissociation during EMDR reprocessing?

Dissociation during EMDR reprocessing should be documented specifically: (1) what was observed — client became unresponsive to instructions, time distortion reported, depersonalization/derealization, 'spacing out'; (2) when in the session it occurred and what seemed to precede it; (3) how it was managed — BLS stopped, grounding used (which technique), pace slowed, switched to resource installation; (4) client's response to management; (5) whether session continued with reprocessing or moved to closure. If dissociation is a recurrent issue, document the pattern and any protocol modifications (e.g., titration, using shorter BLS sets, adding trauma-informed stabilization before reprocessing). Do not document simply 'client dissociated' — describe what was observed and what was done.

EMDR Session Documentation: Templates, SUD/VoC Tracking, Phase Notes, Examples

EMDR session notes present unique documentation challenges: the treatment is phase-structured, uses specific measurement tools (SUD, VoC), and a single session can span multiple phases or stay within one. Generic BIRP or SOAP formats don’t capture what EMDR actually requires.

Short answer: EMDR documentation requires noting which phase(s) were covered, the target memory with its full assessment components (NC/PC/emotion/body sensation/SUD/VoC), BLS type used, the arc of reprocessing, SUD and VoC at close, closure procedure if session was incomplete, and plan for next session. Track SUD and VoC across sessions — they are the primary clinical measures of progress in EMDR.

EMDR’s 8 Phases: What to Document in Each

Phase	Name	Documentation focus
1	History and treatment planning	Target list, trauma history, EMDR readiness, contraindications
2	Preparation	Safe/calm place installation, BLS introduction, dissociation baseline, containment resources
3	Assessment	Target memory, NC, PC, VoC, emotion, body sensation, SUD at baseline
4	Desensitization	BLS sets, processing channels, abreaction, SUD trajectory, blocking responses
5	Installation	PC installation, VoC progression to 7
6	Body scan	Body sensations cleared, any residual
7	Closure	Incomplete session procedure, containment, client state at end
8	Reevaluation	SUD and VoC at start of next session, new material that emerged between sessions

Phase 1–2 Documentation: History and Preparation

Target List

EMDR TARGET LIST (Phase 1)
Compiled: _________

TARGET MEMORIES (prioritized):
1. ___________________________  Estimated SUD: ___
2. ___________________________  Estimated SUD: ___
3. ___________________________  Estimated SUD: ___
[Continue as needed]

Touchstone memory (earliest / most disturbing): ________________
Feeder memories (if applicable): ______________________________

EMDR readiness:
Affect regulation skills sufficient: □ Yes  □ In progress
Stabilization phase complete: □ Yes  □ Ongoing
Dissociation assessed: □ Yes  Result: ________________________
Medical / contraindications reviewed: □ Yes  Notes: __________

Safe/Calm Place Installation (Phase 2)

RESOURCE INSTALLATION — PHASE 2
Safe/calm place identified: __________________________________
BLS used for installation: □ Yes  Type: ____________________
Client's response: __________________________________________
Cue word / anchor: __________________________________________
Client demonstrated access independently: □ Yes □ Needs practice
Containment exercise: □ Yes  Type: __________________________

Phase 3 Assessment: Target Memory Template

EMDR ASSESSMENT — PHASE 3

Date: _______  Session #: ___  Target #: ___
Target memory (specific image / moment): ______________________
___________________________________________________________

NEGATIVE COGNITION (NC): ___________________________________
POSITIVE COGNITION (PC): ___________________________________
VoC (validity of PC, 1-7): ___

EMOTION(S): ________________________________________________
SUD (disturbance, 0-10): ___
BODY SENSATION / LOCATION: _________________________________

Phase 4 Desensitization: Reprocessing Note

DESENSITIZATION — PHASE 4

BLS type used: □ Eye movements  □ Taps  □ Tones  □ Mixed
BLS speed: □ Standard  □ Slow  □ Fast
Sets completed (approximate): ___

PROCESSING ARC
Starting SUD: ___
[Document major channels, themes, associations that emerged —
 not every cognition, but the arc of processing]

Processing themes: __________________________________________
Major channel(s) followed: __________________________________

Blocking response / incomplete processing:
□ None
□ Blocking noted: __________________________________________
  Management: ______________________________________________

Abreaction:
□ None
□ Present: ________________________________________________
  Management: ______________________________________________

Dissociation:
□ None observed
□ Observed: _______________________________________________
  Management: ______________________________________________
  Session continued: □ Yes  □ No — moved to closure

SUD at end of processing: ___
□ SUD = 0 (session complete — proceed to Phase 5)
□ SUD > 0 (session incomplete — proceed to closure / Phase 7)

Phase 5–6: Installation and Body Scan

INSTALLATION — PHASE 5
PC installed: _____________________________________________
VoC at installation: ___  →  VoC at end: ___
□ VoC = 7  □ VoC < 7 — note: _____________________________
BLS used: □ Yes

BODY SCAN — PHASE 6
Body scan completed: □ Yes  □ No — reason: __________________
Residual sensations: □ None  □ Present: _____________________
Additional BLS: □ Yes  □ No
Body scan clear at end: □ Yes  □ No — residual: _____________

Phase 7: Closure (Complete and Incomplete Sessions)

CLOSURE — PHASE 7

Session type at close:
□ Complete — SUD = 0, VoC = 7, body scan clear
□ Incomplete — SUD > 0 or session time ended before resolution

INCOMPLETE SESSION CLOSURE
SUD at closure: ___  (target SUD was: ___)
Closure procedure used: □ Container  □ Safe/calm place  □ Other: __
Client's response to closure: _________________________________
Client's emotional state at end of session (describe):
___________________________________________________________
□ Client at or near baseline before leaving
□ Client not at baseline — safety plan reviewed: □ Yes

Between-session contact:
□ Not indicated
□ Agreement to contact if distressed: ______________________

PLAN FOR NEXT SESSION
□ Return to same target (SUD: ___)
□ New target — reason: ____________________________________
□ Additional stabilization before reprocessing

Phase 8: Reevaluation

REEVALUATION — PHASE 8 (at start of next session)

SUD for prior target: ___  (was ___ at close of last session)
New material that emerged between sessions:
□ None  □ Dreams: ___________  □ New memories: ______________
□ Other: _________________________________________________

Target status:
□ Fully processed — SUD = 0 confirmed, VoC = 7
□ Incomplete — continuing
□ New target identified

Full Session Note Template: Reprocessing Session

EMDR SESSION NOTE

DATE: _______  SESSION #: ___  DURATION: ___ min
PHASE(S) ADDRESSED THIS SESSION: ___________________________

REEVALUATION (if prior session was incomplete)
Prior SUD: ___  SUD today on same target: ___
New material: _____________________________________________

ASSESSMENT (Phase 3 — if new target)
[See Phase 3 template above]

DESENSITIZATION (Phase 4)
[See Phase 4 template above]

INSTALLATION (Phase 5)
PC: ______________________  VoC start: ___  VoC end: ___

BODY SCAN (Phase 6)
□ Clear  □ Residual: _______________________________________

CLOSURE (Phase 7)
□ Complete session  □ Incomplete — closure procedure: ________
Client state at end: ________________________________________

RISK ASSESSMENT
SI/SH: □ None  □ Present: _________________________________
Additional safety concerns: _________________________________

PLAN
Next session: _____________________________________________
Target: ___________________________________________________

SUD and VoC Tracking Across Sessions

Track these across sessions to show reprocessing trajectory:

Session	Target	SUD start	SUD end	VoC end	Complete?
1	Target A	9	6	—	Incomplete
2	Target A	5	0	6	Phase 5–6
3	Target A	0 confirmed	—	7	Complete
4	Target B	8	4	—	Incomplete

This table belongs in the client’s treatment record or the «Important Information» section of the client card — not rewritten from session notes every time.

Filled Example: Phase 3–6 Reprocessing Session

Client: 34F, PTSD following a car accident 18 months ago (passenger, highway collision, no physical injury but witnessed severe injury to driver). 6 prior EMDR sessions. Session 7 — Target 1 (the moment of collision) was partially processed (SUD = 3 at close of Session 6). Reevaluation today.

Reevaluation (Phase 8): SUD on Target 1 (moment of collision, image of windshield shattering): 2. No new material emerged between sessions. Client reports one intrusive dream — similar content, but “further away, like watching a film.” Proceeding to desensitization.

Assessment (Phase 3) — same target, updated:

Image: windshield shattering, glass in slow motion
NC: “I am helpless”
PC: “I survived. I can handle what comes.”
VoC: 4 (up from 3 at last session)
Emotion: fear + helplessness
Body: tightness in chest, throat constriction
SUD: 2

Desensitization (Phase 4): BLS: eye movements, standard speed. 12 sets.

Processing arc: SUD 2 → 1 after 3 sets (client reported “it’s getting quieter, like the volume is turning down”). Set 4–7: client followed a channel to the aftermath — arriving at the hospital, calling her husband, “I remember thinking: I have to stay calm.” Affect shifted from fear to grief. SUD measured at set 7: 1. Set 8–10: client described a moment of noticing she was safe in the car seat in the office — “this is now, not then.” Spontaneous bilateral body sensation (shoulders dropped). Set 11–12: image of the accident appeared “like a photograph, not a film — it doesn’t move anymore.” SUD: 0.

No blocking response. No abreaction. No dissociation observed.

Installation (Phase 5): PC: “I survived. I can handle what comes.” VoC: 4 at start of installation. BLS × 4 sets. VoC: 7. Client stated: “It actually feels true now.”

Body scan (Phase 6): Chest and throat scanned — both clear. Brief BLS × 1 set. Scan repeated: clear.

Closure (Phase 7): Complete session. SUD = 0, VoC = 7, body scan clear. Client at baseline. Discussion of what to expect between sessions — “processing continues after EMDR.” Brief psychoeducation on possible dreams or emerging memories.

Risk: No SI/SH. No safety concerns.

Plan: Session 8 — reevaluation of Target 1. If confirmed resolved (SUD = 0), move to Target 2 (the first night in hospital, inability to reach her parents). SUD for Target 2 estimated at 7.

In TheraMemory, the client card’s «Important Information» section works well for storing the EMDR target list with current SUD for each target, current phase, and installed resources — visible at the start of every session so reevaluation is instant.

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EMDR Session Documentation: Templates, SUD/VoC Tracking, and Phase Notes

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