EMDR Not a Good Candidate: Who Should Avoid Eye Movement Desensitization Therapy

You’ve heard amazing things about EMDR therapy. Success stories fill social media and therapy forums. Everyone seems to be raving about eye movement desensitization and reprocessing. Now who is EMDR not a good candidate for?

But here’s what many people don’t realize: EMDR not a good candidate situations are more common than you think. Despite its popularity, this trauma therapy has important limitations and contraindications.

Some people should avoid EMDR entirely. Others need extensive preparation before starting treatment. Understanding these limitations could save you from potential setbacks or even harm.

In this guide, you’ll learn exactly who is not a good candidate for EMDR therapy. We’ll cover specific mental health conditions, medications, and situations that make EMDR unsuitable. You’ll also discover alternative trauma treatments that might work better for your situation.

Who Is Not a Good Candidate for EMDR Therapy

EMDR therapy has helped millions of people process traumatic memories. But this doesn’t mean it works for everyone with trauma.

Being not a good candidate for EMDR doesn’t reflect personal weakness. It simply means other treatment approaches might serve you better right now.

First, let’s understand what makes someone unsuitable for this therapy. Then we’ll explore specific conditions and situations where EMDR should be avoided.

What Makes EMDR Unsuitable for Some People

EMDR requires specific mental capacities to work safely. You need to stay grounded during bilateral stimulation while processing intense emotions.

Some mental health conditions interfere with this process. Active psychosis, severe dissociation, or uncontrolled mood swings can make EMDR dangerous.

Timing also matters significantly. People in crisis situations or those lacking basic coping skills aren’t ready for trauma processing.

Your trained EMDR therapist should carefully assess these factors before starting treatment. A rushed evaluation puts you at risk for re-traumatization.

The Importance of Proper EMDR Screening

Qualified mental health professionals use comprehensive screening protocols. They assess your current symptoms, mental health history, and support systems.

This evaluation process isn’t optional. EMDR has very low risks when properly administered, but the most common negative effects are negative thoughts or feelings between sessions.

A thorough assessment prevents these complications. Your therapist needs to understand your full mental health picture before recommending EMDR.

Red flags during screening should delay or prevent EMDR treatment. These include active substance use, unstable housing, or ongoing trauma exposure.

Common Misconceptions About EMDR Candidacy

Many people believe EMDR works for all trauma survivors. This misconception leads to inappropriate treatment recommendations and poor outcomes.

Social media often presents EMDR as a miracle cure. Real therapy is more complex than viral success stories suggest.

Another myth claims that anyone can do EMDR safely. Actually, specific training and certification requirements exist for good reasons.

Some people think you can rush into EMDR immediately after trauma. Research shows that premature processing can worsen symptoms instead of helping.

Mental Health Issues That Make EMDR Not Suitable

Certain mental health conditions create significant risks during EMDR processing. These aren’t minor concerns that can be overlooked.

Understanding these contraindications protects you from potential harm. Your safety always comes before any treatment goals.

Next, we’ll examine specific disorders that make EMDR inappropriate or dangerous.

Personality Disorders and EMDR Contraindications

Borderline personality disorder presents major challenges for EMDR therapy. The intense emotions and unstable relationships typical of this condition can interfere with trauma processing.

People with borderline personality often struggle with emotional regulation. EMDR’s bilateral stimulation can trigger overwhelming emotional responses that exceed their coping abilities.

Narcissistic personality disorder also complicates EMDR treatment. The grandiose thinking patterns and lack of empathy can prevent the genuine self-reflection needed for healing.

Clients with a bipolar disorder or personality disorder diagnosis are not good candidates for EMDR according to many clinicians. These conditions require specialized stabilization work first.

Bipolar Disorder and EMDR Therapy Risks

Bipolar disorder traditionally made someone not a good candidate for EMDR therapy. The concern was that intense emotional processing could trigger manic or depressive episodes.

Recent research has begun challenging this absolute contraindication. EMDR was once thought to be contraindicated in psychosis, but recent research has suggested that it might have utility and be practiced safely in this population, as well as in bipolar disorder.

However, up to 60% of patients with bipolar disorder have a history of traumatic events, which is associated with greater episode severity, higher risk of comorbidity and higher relapse rates.

Mood stability remains crucial before considering EMDR. Active manic or depressive episodes make trauma processing unsafe and ineffective.

Active Psychosis and Severe Mental Health Issues

Active psychosis makes someone clearly not a good candidate for EMDR therapy. Hallucinations, delusions, or severe reality testing problems prevent safe trauma processing.

During psychotic episodes, people can’t distinguish between memories and current reality. EMDR’s memory processing could worsen confusion and distress.

Schizophrenia and other psychotic disorders require stabilization before any trauma work. Antipsychotic medications and reality-grounding techniques come first.

Severe depression with psychotic features also contraindicates EMDR. The combination of mood symptoms and psychosis creates too much instability for trauma therapy.

When EMDR Not Appropriate: Substance Abuse and Addiction

Active substance abuse creates multiple problems for EMDR therapy. Drugs and alcohol interfere with memory processing and emotional regulation.

Sobriety provides the clear thinking necessary for effective trauma work. Without it, EMDR becomes ineffective or potentially harmful.

Let’s examine how different substances and addiction stages affect EMDR suitability.

EMDR Not Suitable for Active Addiction

People actively using drugs or alcohol are not good candidates for EMDR therapy. Substances impair the brain’s ability to process traumatic memories effectively.

Intoxication during sessions makes bilateral stimulation dangerous. You need full cognitive awareness to stay grounded during intense emotional processing.

Withdrawal symptoms also interfere with EMDR. Physical discomfort, mood swings, and cognitive fog prevent effective trauma work.

Most trained EMDR therapists require at least 90 days of sobriety before starting treatment. This allows your brain chemistry to stabilize sufficiently.

Medications That Interfere with EMDR Processing

Certain medications can make you temporarily not a good candidate for EMDR therapy. Benzodiazepines like Xanax or Ativan block the anxiety needed for memory processing.

These anti-anxiety medications prevent the natural fear response that helps consolidate traumatic memories. Without this response, EMDR loses much of its effectiveness.

High-dose antipsychotics also interfere with EMDR processing. They can blunt emotions so much that bilateral stimulation has minimal impact.

Some mood stabilizers affect memory formation and retrieval. Your prescribing physician and EMDR therapist should coordinate to optimize your medication regimen.

Withdrawal States and EMDR Timing

Medical detox requires complete focus on physical stabilization. During this phase, you’re definitely not a good candidate for EMDR therapy.

Withdrawal symptoms include anxiety, depression, and cognitive impairment. These directly interfere with trauma processing abilities.

Post-acute withdrawal syndrome can last months after stopping substances. Patience during this recovery phase prevents EMDR complications.

Your addiction specialist and mental health professional should coordinate care. Trauma therapy timing depends on your individual recovery progress.

Complex PTSD and When EMDR May Not Be the Best Choice

Complex PTSD involves prolonged, repeated trauma exposure. This creates different healing needs than single-incident trauma.

People with complex trauma often need extensive stabilization before any memory processing. Jumping into EMDR too quickly can cause re-traumatization.

Understanding these special considerations helps protect vulnerable trauma survivors.

Dissociative Disorders and EMDR Challenges

Dissociative identity disorder makes someone not a good candidate for standard EMDR protocols. The different personality states complicate memory processing significantly.

Depersonalization and derealization symptoms interfere with bilateral stimulation. You need to feel present in your body for EMDR to work effectively.

Dissociative episodes during EMDR sessions can become dangerous. You might lose awareness of your surroundings or therapeutic safety measures.

Specialized dissociation treatment should precede any trauma processing. This builds the internal cooperation necessary for safe memory work.

Developmental Trauma Considerations

Childhood trauma affects brain development in ways that complicate EMDR therapy. Early attachment injuries require different therapeutic approaches.

People with developmental trauma often lack basic emotional regulation skills. They need extensive preparation before facing traumatic memories directly.

The therapeutic relationship becomes especially important with early trauma. Trust-building often takes months or years before trauma processing begins.

Rushing into EMDR without adequate preparation frequently leads to treatment failures and increased symptoms.

When Intense Emotions Overwhelm EMDR Processing

Some people experience emotions so intensely that bilateral stimulation becomes overwhelming. This makes them temporarily not good candidates for EMDR therapy.

Your “window of tolerance” determines how much activation you can handle. Too much emotional intensity leads to shutdown or escalation.

Building distress tolerance skills comes before trauma processing. These techniques help you stay regulated during difficult emotions.

Self-soothing abilities are prerequisites for safe EMDR. Without them, sessions can spiral into crisis situations.

EMDR Not A Good Candidate: Physical and Cognitive Limitations

Physical limitations can prevent standard EMDR protocols from working effectively. These aren’t necessarily permanent barriers, but they require modifications.

Cognitive impairments also affect EMDR suitability. Memory processing requires certain mental capacities that some conditions compromise.

Let’s explore these practical considerations for EMDR therapy.

Eye Movement Limitations and EMDR Alternatives

Visual impairments don’t automatically make you not a good candidate for EMDR therapy. Alternative forms of bilateral stimulation can replace eye movements.

Tactile stimulation using handheld devices works well for people with vision problems. Sound-based bilateral stimulation offers another option.

Neurological conditions affecting eye movement require careful assessment. Multiple sclerosis, Parkinson’s disease, or stroke effects might interfere with standard protocols.

Your EMDR therapist should have training in alternative bilateral stimulation methods. This ensures you can still access treatment despite physical limitations.

Cognitive Impairments and EMDR Processing

Dementia and other cognitive disorders make people not good candidates for EMDR therapy. Memory processing requires intact cognitive functioning.

Intellectual disabilities may prevent understanding of EMDR concepts. The therapy requires abstract thinking about memories and emotions.

Traumatic brain injury affects both memory and emotional regulation. Severe cases need extensive neurological stabilization before considering trauma therapy.

Autism spectrum disorders don’t necessarily contraindicate EMDR. However, sensory sensitivities and communication differences require specialized approaches.

Medical Conditions Affecting EMDR Safety

Seizure disorders create safety concerns during bilateral stimulation. The rapid eye movements might trigger seizure activity in susceptible people.

Heart conditions can be problematic if EMDR triggers intense emotional responses. Cardiac stress during trauma processing requires medical clearance.

Pregnancy adds complexity to trauma therapy decisions. While not automatically contraindicating EMDR, it requires careful risk-benefit analysis.

Your medical doctor should clear you for EMDR if you have significant health conditions. This ensures your physical safety during emotional processing.

Therapeutic Readiness: EMDR Not A Good Candidate

Readiness for trauma therapy involves more than just wanting to feel better. Specific prerequisites ensure safe and effective treatment.

Being unprepared doesn’t make you permanently not a good candidate for EMDR therapy. It simply means you need more groundwork first.

Understanding these readiness factors helps you prepare appropriately for eventual trauma processing.

Lack of Therapeutic Relationship and Trust

Trust between you and your trained EMDR therapist is absolutely essential. Without it, trauma processing becomes re-traumatizing rather than healing.

Building therapeutic alliance takes time, especially for trauma survivors. Rushing into EMDR before establishing safety damages the treatment relationship.

Past betrayals by authority figures often complicate trust-building. You might need months of preliminary work before feeling safe enough for trauma processing.

Your therapist should never pressure you into EMDR before you’re ready. Genuine healing happens at your pace, not according to external timelines.

Insufficient Coping Skills and Resources

EMDR requires robust self-soothing abilities to handle intense emotions safely. Without these skills, you’re not a good candidate for trauma processing yet.

Grounding techniques help you stay present during difficult memories. These must be automatic responses before starting EMDR.

Support systems outside therapy provide crucial stability during treatment. Isolation or toxic relationships complicate trauma recovery significantly.

Crisis management skills prevent therapy sessions from becoming emergencies. You need clear plans for handling overwhelming emotions between appointments.

Crisis Situations and EMDR Timing

Active suicidal ideation makes you temporarily not a good candidate for EMDR therapy. Safety stabilization must come before trauma processing.

Ongoing traumatic situations require immediate protection, not memory processing. You can’t heal from trauma while still experiencing it regularly.

Housing instability, domestic violence, or financial crisis create too much current stress. These practical issues need addressing before focusing on past trauma.

Legal proceedings related to your trauma can complicate EMDR timing. Processing memories might affect testimony or legal strategies.

Alternative Trauma Therapies When EMDR Not A Good Candidate

Being not a good candidate for EMDR doesn’t mean you can’t heal from trauma. Many effective alternatives exist for trauma recovery.

Different approaches work better for different people and situations. Finding the right fit often takes some exploration.

Let’s examine evidence-based alternatives to EMDR therapy.

Cognitive Behavioral Therapy for Trauma

Cognitive behavioral therapy (CBT) offers excellent trauma treatment for many people. It focuses on changing thought patterns and behaviors rather than memory processing.

Trauma-focused CBT has extensive research support for PTSD treatment. It works well for people who prefer structured, goal-oriented approaches.

Cognitive processing therapy specifically addresses trauma-related thinking errors. This approach helps without requiring intense emotional processing.

Exposure therapy gradually reduces trauma-related avoidance. It builds confidence while respecting your control over the pacing.

Somatic and Body-Based Approaches

Somatic experiencing focuses on nervous system regulation rather than memory content. This makes it suitable for people who can’t tolerate traditional talk therapy.

Sensorimotor psychotherapy integrates body awareness with trauma processing. It’s particularly helpful for developmental trauma survivors.

Trauma-sensitive yoga provides gentle body-based healing. The mindful movement helps rebuild the connection between mind and body.

These approaches work well for people with dissociative symptoms or those who find talking about trauma too overwhelming.

Other Evidence-Based Trauma Treatments

Dialectical behavior therapy (DBT) teaches emotional regulation skills crucial for trauma recovery. It’s especially helpful for people with borderline personality features.

Internal family systems therapy addresses different parts of the personality affected by trauma. This approach works well for complex trauma survivors.

Accelerated resolution therapy combines elements from multiple approaches. It offers faster results than traditional therapy but slower than EMDR.

Narrative therapy helps people rewrite their trauma stories. This approach emphasizes personal agency and resilience.

For those dealing with complex trauma symptoms, specialized approaches that address both trauma and co-occurring conditions often work better than standard protocols.

Working with Mental Health Professionals to Determine EMDR Suitability

Finding the right mental health professional is crucial for accurate EMDR assessment. Not all therapists have adequate training in contraindications.

Proper evaluation takes time and shouldn’t be rushed. Quality assessment protects you from inappropriate treatment recommendations.

Here’s how to navigate this process effectively.

Questions to Ask Your Therapist About EMDR Candidacy

Ask about specific contraindications that might apply to your situation. A qualified therapist should explain these clearly without technical jargon.

Inquire about alternative treatments if EMDR isn’t suitable. Good clinicians always have backup plans for different client needs.

Request information about the assessment process timeline. Thorough evaluation usually takes several sessions, not just one appointment.

Ask about their training and certification in EMDR therapy. EMDR International Association provides therapist verification services.

Red Flags: When to Seek a Second Opinion

Be cautious if a therapist dismisses your concerns about EMDR suitability. Your questions deserve thoughtful, detailed answers.

Pressure to start EMDR immediately without adequate assessment is a major red flag. Proper screening takes time and patience.

Therapists who claim EMDR works for everyone lack understanding of contraindications. This ignorance puts clients at risk.

Missing obvious contraindications like active substance use suggests inadequate training. Seek consultation with a more qualified professional.

Preparing for Eventual EMDR if Currently Not Suitable

Being not a good candidate for EMDR therapy now doesn’t mean never. Many contraindications can be addressed with proper preparation.

Stabilization work builds the foundation for eventual trauma processing. This might include medication management, sobriety maintenance, or skill-building.

Regular reassessment determines when you might become suitable for EMDR. Your readiness can change as your mental health improves.

Building therapeutic relationship and trust creates the safety necessary for trauma work. This foundation makes everything else possible.

Many trauma survivors also struggle with anxiety disorders that require specialized treatment approaches. Understanding your insurance coverage for mental health services can help you access appropriate care without financial stress.

Frequently Asked Questions: EMDR Not a Good Candidate

Who is not a good candidate for EMDR therapy?

People with active psychosis, uncontrolled bipolar disorder, severe dissociative disorders, or active substance abuse are typically not good candidates for EMDR therapy. Those in current crisis situations, lacking basic coping skills, or unable to form therapeutic relationships also need alternative approaches.

Additionally, people taking high doses of benzodiazepines or those with severe cognitive impairments may need to wait before starting EMDR.

Why would someone be deemed unsuitable for EMDR?

Someone might be considered not a good candidate for EMDR due to safety concerns. If trauma processing could destabilize their mental health or trigger severe symptoms, alternative treatments are recommended.

Lack of therapeutic readiness, ongoing trauma exposure, or insufficient support systems also make EMDR unsuitable. The therapy requires specific prerequisites for safe and effective implementation.

Can EMDR make trauma symptoms worse?

Yes, EMDR can worsen symptoms if used inappropriately. People who are not good candidates for EMDR therapy may experience increased anxiety, depression, or emotional instability.

The most common negative effects are negative thoughts or feelings between sessions. Proper screening prevents more serious complications.

What are the dangers of EMDR therapy?

When used with inappropriate candidates, EMDR can cause re-traumatization, emotional flooding, or psychiatric destabilization. People with certain mental health conditions face higher risks.

Inadequately trained therapists may miss contraindications or fail to provide proper safety measures. This increases the likelihood of adverse reactions during treatment.

Who should not do EMDR treatment?

People with active substance abuse, uncontrolled psychiatric symptoms, or severe cognitive impairments should not do EMDR treatment. Those in crisis situations or lacking basic emotional regulation skills also need to wait.

Individuals with certain personality disorders, active psychosis, or severe dissociative symptoms require specialized preparation before considering EMDR.

When should EMDR not be used?

EMDR should not be used during active mental health crises, ongoing trauma exposure, or when someone lacks adequate coping skills. People taking medications that interfere with processing also need alternative approaches.

Insufficient therapeutic relationship, lack of support systems, or pregnancy complications may also contraindicate EMDR timing.

What are EMDR contraindications?

EMDR contraindications include active substance abuse, uncontrolled bipolar disorder, active psychosis, and severe dissociative disorders. High-dose benzodiazepine use also interferes with treatment effectiveness.

Medical conditions like uncontrolled seizure disorders or severe heart problems may require clearance before starting EMDR therapy.

Can people with bipolar disorder do EMDR?

Recently it has been suggested as a complementary therapy in a wide range of clinical conditions. In particular, affective disorders as bipolar disorder and major depressive disorder have a higher lifetime prevalence of traumatic or stressful life events.

However, mood stability is essential before starting EMDR. Active manic or depressive episodes make someone not a good candidate for trauma processing.

Is EMDR safe for everyone with PTSD?

No, EMDR is not safe for everyone with PTSD. While it’s highly effective for many trauma survivors, certain complicating factors make some people unsuitable candidates.

Complex PTSD, dissociative symptoms, or co-occurring disorders may require alternative or preparatory treatments before EMDR becomes appropriate.

What are alternatives to EMDR for trauma?

Cognitive behavioral therapy, dialectical behavior therapy, and somatic approaches offer excellent trauma treatment alternatives. Internal family systems therapy and accelerated resolution therapy also help trauma survivors.

Medication management, support groups, and crisis stabilization may be necessary before any trauma-focused therapy becomes appropriate.

How do you know if you’re ready for EMDR?

You’re ready for EMDR when you have stable mental health, adequate coping skills, and a strong therapeutic relationship. Basic emotional regulation abilities and support systems are also essential.

Your trained EMDR therapist should conduct thorough assessment over multiple sessions to determine your readiness for trauma processing.

Can EMDR be harmful if done incorrectly?

Yes, EMDR can be very harmful when done incorrectly. Inadequate screening, poor therapist training, or inappropriate timing can cause severe psychological complications.

This is why working with properly certified EMDR therapists and following established protocols is absolutely essential for safe treatment.

Conclusion

Being not a good candidate for EMDR therapy isn’t a permanent limitation or personal failure. It simply means that other treatment approaches might serve you better right now.

Understanding these contraindications protects you from potential harm and guides you toward more appropriate treatments. Your mental health professional should thoroughly assess your suitability before recommending EMDR.

Remember that many effective trauma treatments exist beyond EMDR. Cognitive behavioral therapy, somatic approaches, and other evidence-based methods can provide excellent healing opportunities.

If you’re currently not suitable for EMDR, focus on building the foundation for future trauma work. This might include stabilizing your mental health, developing coping skills, or strengthening your support system.

Most importantly, don’t lose hope about trauma recovery. With proper assessment, appropriate treatment selection, and qualified professional guidance, healing is possible regardless of which specific therapy you use.

If you’re considering therapy options, our complete guide to online therapy platforms can help you understand different treatment delivery methods. You might also benefit from reading about trauma-informed care approaches to better understand what to expect from treatment.

For more information about trauma treatment options, visit our comprehensive guide to anxiety therapy or explore our online therapy insurance coverage checker to understand your mental health benefits.