Who Is Not a Good Candidate for EMDR Therapy?

You may have heard about EMDR and wondered whether it could help you work through trauma, PTSD, or difficult memories.

The honest answer is that EMDR can be helpful for many people, but it isn’t necessarily the right starting point for everyone.

Some people may benefit from stabilization, coping-skills work, or another form of therapy before beginning trauma processing. This can include people experiencing an active crisis, significant dissociation, active psychosis, unstable substance use, or circumstances that make it difficult to feel safe and grounded during treatment.

That does not necessarily mean EMDR is permanently off the table. In many situations, it simply means preparation or stabilization may need to come first.

A trained therapist can help you understand whether EMDR is appropriate for where you are right now and what kind of support may be helpful before trauma processing begins.

In this guide, we’ll cover:

• Who may not be a good candidate for EMDR right now
• When EMDR may need to be delayed or adapted
• What therapists assess before beginning EMDR
• Physical and cognitive considerations
• What EMDR readiness actually means
• Alternatives to EMDR for trauma
• How to find a therapist who can help you determine the right next step

When Is EMDR Not Recommended?

EMDR may need to be delayed, adapted, or approached with additional preparation when someone is experiencing:

• An active mental health crisis
• Active psychosis or difficulty distinguishing present reality from traumatic memories
• Significant or unmanaged dissociation
• Unstable substance use or very early recovery
• Severe difficulty staying grounded during emotional processing
• An unsafe or highly unstable living situation
• Ongoing trauma or abuse
• Acute safety concerns
• Significant medical or neurological considerations that require additional assessment

These circumstances do not automatically mean someone can never participate in EMDR.

The important question is often what needs to be in place for trauma processing to be safe and appropriate right now?

A qualified therapist can help assess your individual circumstances and determine whether EMDR makes sense now, whether preparation should come first, or whether another treatment approach may be a better fit.

What Therapists Assess Before Starting EMDR

Before beginning EMDR, a qualified therapist should look at more than whether you’ve experienced trauma.

They may consider your current symptoms, emotional stability, support system, safety, treatment goals, coping skills, and any other mental health or medical factors that could affect treatment.

Emotional Stability

You do not need to feel perfectly stable before starting therapy.

However, it is important to have enough emotional regulation and grounding capacity to work with difficult memories without becoming completely overwhelmed.

If those skills are still developing, therapy may begin with stabilization and coping strategies before trauma processing.

Current Life Circumstances

If you are currently experiencing ongoing abuse, housing instability, an acute crisis, or another immediate safety concern, those issues may need attention before intensive trauma processing begins.

Addressing immediate safety is not a detour from therapy. It can be an important part of treatment.

Dissociation and Grounding

Dissociation can involve feeling detached from yourself, your memories, your emotions, or your surroundings.

Dissociative symptoms exist on a spectrum, and having them does not automatically mean EMDR is inappropriate. More significant dissociation may require additional stabilization, grounding, or specialized clinical support before trauma processing begins.

The goal is to make sure you have enough support and grounding to remain present during treatment.

Substance Use and Recovery

Substance use and early recovery can affect a person’s ability to manage emotional distress and participate consistently in trauma-focused treatment.

Rather than applying one rule to everyone, a therapist should consider your current recovery, stability, coping skills, and overall treatment needs.

If substance use is an active concern, treatment may initially focus on safety, recovery support, stabilization, and building coping skills.

Coping and Self-Regulation Skills

EMDR can bring up strong emotions and memories.

Having grounding and self-regulation strategies can help you manage difficult emotions during and between sessions. These skills can also be developed as part of therapy.

You do not have to arrive with every coping skill already in place.

The Therapeutic Relationship

Feeling safe enough with your therapist to communicate when something feels overwhelming matters.

A good therapist should be willing to slow down, answer questions, explain the process, and adjust treatment based on your needs.

Trust and therapeutic fit are important parts of trauma treatment.

What Needs to Be in Place Before EMDR Begins

EMDR readiness is not about being perfect or having every part of your life figured out.

Instead, readiness is about having enough stability and support to participate safely in trauma processing.

Depending on the person, that may include:

• A basic ability to stay grounded
• Emotional regulation skills
• A safe therapeutic relationship
• Enough stability between sessions
• A plan for managing distress
• Appropriate support for co-occurring mental health concerns
• A treatment plan that matches your current needs

For some people, these foundations develop quickly. For others, they may take more time.

Either way, preparation is still therapy.

Mood and Emotional Stability

For people managing conditions that affect mood, including bipolar disorder, a therapist may want to consider current mood stability before beginning trauma processing.

This does not mean a diagnosis automatically rules out EMDR.

Instead, the timing and treatment plan should take the person’s current symptoms, stability, medications, support, and overall clinical needs into account.

Stability work is not a detour from healing. For many people, it is an important part of building a foundation for deeper trauma work.

Active Psychosis

If someone is currently experiencing hallucinations, delusions, or significant difficulty distinguishing present reality from traumatic memories, EMDR may not be appropriate at that time.

Trauma processing requires enough present-moment stability to engage with difficult memories while remaining grounded.

When active psychosis is present, stabilization and appropriate psychiatric support may need to come first.

This is a timing consideration, not necessarily a permanent decision about whether trauma therapy can ever be appropriate.

Personality Disorders

A personality disorder diagnosis does not automatically mean that someone cannot participate in EMDR.

The more important considerations include current symptoms, emotional regulation, safety, dissociation, coping skills, treatment goals, and readiness for trauma processing.

Some people may benefit from building emotional regulation and distress-tolerance skills before or alongside trauma-focused work.

A therapist should develop a treatment plan based on the individual rather than the diagnosis alone.

Substance Use and Early Recovery

If substance use is currently interfering with safety, stability, or emotional regulation, trauma processing may not be the first priority.

Early recovery can be a time for building coping skills, strengthening support systems, stabilizing daily life, and addressing substance use directly.

Those are meaningful parts of treatment.

Once greater stability is established, trauma-focused treatment may become more appropriate depending on the person’s needs and clinical situation.

Current Crisis or Ongoing Trauma

Processing past trauma while present-day trauma is still happening can be difficult and may not be the safest starting point.

If you are currently experiencing abuse, acute suicidality, severe housing instability, or another immediate crisis, treatment may initially focus on safety, stabilization, and practical support.

That does not mean therapy has to wait.

Getting immediate support and creating greater stability can itself be an important part of the healing process.

Medications

Your medications are part of the overall clinical picture and should be discussed with your therapist.

Some medications or combinations of medications may affect how a person experiences trauma-focused treatment. Your therapist may consider your medication history and, when appropriate, coordinate with your prescribing provider.

Do not change or stop medication because of information in an article about EMDR. Medication decisions should be made with the healthcare professional who prescribes it.

Physical and Cognitive Considerations

One thing many people do not realize about EMDR is that the therapy can be adapted.

The name Eye Movement Desensitization and Reprocessing can make it sound as though eye movements are always required. Eye movements are one form of bilateral stimulation, but other methods may be used depending on the therapist’s training and the client’s needs.

Physical or cognitive differences do not automatically mean that trauma therapy is unavailable.

Visual Impairments

If tracking eye movements is difficult or impossible, a therapist may consider other forms of bilateral stimulation depending on their training and the individual’s circumstances.

If you have a visual impairment, mention it during your initial consultation so your therapist can discuss available options with you.

Seizure Disorders

If you have a seizure disorder or another neurological condition, discuss this with your therapist and medical provider.

Your therapist may consider adaptations to the EMDR protocol or whether additional medical guidance is appropriate.

A medical condition should be assessed individually rather than treated as an automatic reason that trauma therapy cannot be considered.

Cognitive Impairments and Traumatic Brain Injury

Cognitive differences, memory difficulties, or a history of traumatic brain injury may affect how trauma therapy is approached.

A therapist can assess your ability to engage with the treatment and determine whether adaptations or another therapeutic approach would be more appropriate.

The goal is to match treatment to your needs rather than forcing you into a rigid protocol.

Intellectual Disabilities and Autism Spectrum Conditions

Intellectual disabilities and autism spectrum conditions do not automatically rule out EMDR.

However, communication needs, sensory sensitivities, processing differences, predictability, and pacing may all influence how therapy is delivered.

Finding a therapist experienced in adapting treatment to neurodivergent clients can be especially important.

Pregnancy

Pregnancy does not automatically mean that EMDR is inappropriate.

However, pregnancy can be an important consideration when determining the timing and type of trauma-focused treatment.

If you are pregnant and considering EMDR, discuss your circumstances with your therapist and healthcare providers so you can make an informed decision about treatment.

Heart Conditions and Significant Medical Concerns

If you have a significant medical or cardiac condition, discuss it with your therapist and healthcare provider before beginning intensive trauma processing.

EMDR can involve strong emotional responses, so your overall health and individual circumstances should be considered as part of treatment planning.

The through-line is simple: physical and cognitive differences can change how therapy is approached without automatically determining whether healing is possible.

What “Being Ready” Actually Means

“Am I ready for therapy?”

It is one of the most common questions people have before reaching out.

Readiness for EMDR is not a fixed threshold that you either meet or do not meet. It is a set of circumstances that a therapist can help you evaluate and, when necessary, build toward.

A Therapeutic Relationship You Feel Safe In

Feeling safe with your therapist matters.

Trauma survivors may have experienced situations where trust was broken, so developing a therapeutic relationship can take time.

A good therapist should not pressure you into trauma processing before you feel sufficiently safe and prepared.

Building trust is not separate from the work. It can be an important part of the work.

Coping Skills and Self-Soothing

EMDR can bring up difficult emotions and memories during and between sessions.

Grounding, self-soothing, emotional regulation, and distress-tolerance skills can help you manage those experiences.

You do not need to master these skills before contacting a therapist. Developing them may be one of the first goals of treatment.

Life Circumstances That Allow for Some Stability

Your life does not need to be calm or uncomplicated before you begin therapy.

However, if you are dealing with immediate safety concerns, ongoing trauma, or a severe crisis, those concerns may need to be addressed before intensive trauma processing.

A therapist can help you identify what needs attention first.

A Note on Crisis

If you are in immediate danger or experiencing a mental health emergency, seek immediate crisis or emergency support rather than relying on an online article to determine what treatment you need.

In the United States, you can call or text 988 to reach the Suicide & Crisis Lifeline.

If you are not in immediate danger but are struggling, reaching out to a qualified mental health professional can help you understand what kind of support makes sense for your situation.

What If You’re Not Ready for EMDR?

Not being ready for EMDR does not mean you are not ready for therapy.

Another treatment approach may be the best place to begin.

Depending on your needs, therapy may initially focus on:

• Emotional regulation
• Coping skills
• Stabilization
• Anxiety or depression
• Relationship patterns
• Dissociation
• Substance use recovery
• Current life stressors
• Trauma preparation

Once greater stability and readiness are established, EMDR may become an option later.

The goal is not to start EMDR as quickly as possible.

The goal is to find the treatment approach that fits where you are now.

Other Paths to Trauma Healing

EMDR is one approach to trauma treatment. It is not the only option.

Depending on your symptoms, history, goals, and preferences, a therapist may recommend another approach or a combination of approaches.

Cognitive Behavioral Therapy and Trauma-Focused CBT

Cognitive Behavioral Therapy, including trauma-focused variations, can help people understand connections between thoughts, emotions, and behaviors.

Some people appreciate the structured and goal-oriented nature of CBT-based treatment.

Cognitive Processing Therapy

Cognitive Processing Therapy is a trauma-focused approach that helps people examine beliefs and thoughts connected to traumatic experiences.

It may be an option for people looking for a structured trauma treatment.

Dialectical Behavior Therapy

DBT focuses on skills such as mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

For some people, developing these skills can provide an important foundation for addressing trauma.

Somatic and Body-Based Approaches

Some trauma treatments incorporate awareness of physical sensations and responses alongside emotional and cognitive work.

These approaches may be worth discussing if you find traditional talk therapy difficult or if you want treatment that includes greater attention to the body.

Internal Family Systems

Internal Family Systems, or IFS, explores different “parts” of a person’s internal experience and can be used to explore emotions, relationships, and trauma.

Some people find this approach helpful when they experience internal conflict or feel disconnected from parts of themselves.

Accelerated Resolution Therapy

Accelerated Resolution Therapy, or ART, is another therapy that may be considered for certain trauma-related concerns.

A qualified therapist can help determine whether it fits your needs and treatment goals.

Narrative Therapy

Narrative Therapy explores the stories people hold about themselves and their experiences.

For people working through identity, grief, meaning, or the impact of trauma on their sense of self, this may be another approach worth exploring.

How to Find the Right Therapist

You do not have to determine your entire treatment plan before reaching out.

A good therapist should take time to understand your history, current circumstances, symptoms, goals, and preferences before recommending a specific approach.

What Good Assessment Looks Like

A thorough assessment is more than a checklist.

A skilled therapist should ask questions, listen carefully, consider your current circumstances, and explain why a particular treatment approach may or may not be appropriate.

Good assessment should help you understand your options rather than make you feel pressured into one treatment.

Questions to Ask a Potential Therapist

You are allowed to ask questions before deciding whether a therapist is the right fit.

Consider asking:

• What does your assessment process look like before starting EMDR?
• How do you determine whether someone is ready for EMDR?
• What would you recommend if EMDR is not the right starting point for me?
• What other trauma-focused approaches do you use?
• How do you work with dissociation or complex trauma?
• What should I expect during the first few sessions?

A therapist who welcomes these questions can help you feel more informed about your options.

Red Flags to Be Aware Of

Not every therapist who offers EMDR will approach treatment in exactly the same way.

Pay attention if a therapist:

Rushes toward trauma processing without adequate assessment. A thoughtful therapist should consider your individual circumstances before beginning intensive trauma work.

Dismisses your concerns or questions. You should feel comfortable asking why a treatment is being recommended.

Claims EMDR works for everyone. No single therapy is the right fit for every person or every situation.

Has no alternative when EMDR is not appropriate. A therapist who works with trauma should be able to discuss other treatment options when needed.

Promises a specific outcome or timeline. Therapy outcomes vary from person to person, and no ethical therapist can guarantee that you will be “healed” within a specific number of sessions.

Finding the Right Fit

Therapeutic fit matters.

You should feel able to communicate honestly with your therapist, ask questions, discuss concerns, and tell them when something does not feel right.

It is okay if the first therapist you speak with is not the right fit.

Finding the right therapist is part of the process.

At The Empowering Space, our team includes therapists with different specialties, approaches, and clinical perspectives. Our intake process is designed to help connect you with a therapist who may be a good fit for your needs.

What the First Conversation Looks Like

Reaching out to a therapist does not mean you have committed to treatment.

It can simply be an opportunity to explain what you are experiencing, ask questions, and learn about your options.

You do not need to have your entire story organized.

You do not need to know exactly which type of therapy you need.

You can start with questions.

From there, you and your therapist can determine whether working together makes sense and what the next step should look like.

Frequently Asked Questions About EMDR

Who Is Not a Good Candidate for EMDR Therapy?

Someone experiencing an active crisis, significant unmanaged dissociation, active psychosis, unstable substance use, or serious difficulty staying grounded may need additional preparation or stabilization before beginning EMDR.

These circumstances do not necessarily mean EMDR can never be considered. They may simply mean that another form of support should come first.

Why Would Someone Be Deemed Unsuitable for EMDR?

A therapist may recommend waiting or using another approach when someone does not currently have enough stability, safety, grounding, or support to manage trauma processing.

The goal is not to exclude someone from treatment. It is to determine what type of care is most appropriate at that point in their healing process.

Can EMDR Make Trauma Symptoms Worse?

Trauma processing can temporarily bring up difficult emotions, memories, or symptoms.

This is one reason assessment, preparation, pacing, and therapist training matter.

If you experience a significant increase in distress during treatment, tell your therapist. Treatment can be slowed down, adapted, or reconsidered based on your needs.

What Are the Risks of EMDR Therapy?

As with other trauma-focused therapies, EMDR can bring up distressing memories and emotions.

The therapist should assess whether the treatment is appropriate, explain what to expect, monitor your response, and adjust the pace when necessary.

If you have questions about the potential risks of EMDR for your specific circumstances, discuss them directly with a qualified therapist.

Who Should Not Do EMDR Treatment?

People experiencing active psychosis, significant instability, an acute crisis, or severe difficulty staying grounded may need stabilization or another treatment approach before beginning EMDR.

People with other mental health, medical, cognitive, or substance-use concerns may also require individualized assessment.

A diagnosis by itself does not always determine whether EMDR is appropriate.

When Should EMDR Not Be Used?

EMDR may need to be delayed or reconsidered during an acute mental health crisis, ongoing unsafe circumstances, active psychosis, significant instability, or when a person does not yet have enough grounding and coping support for trauma processing.

A therapist can help determine whether preparation, another treatment approach, or EMDR is the most appropriate next step.

What Are EMDR Contraindications?

There is not one universal checklist that can determine whether every person should or should not receive EMDR.

A qualified therapist should consider factors such as current symptoms, safety, dissociation, substance use, medical and neurological concerns, medications, emotional stability, and the person’s ability to remain grounded during treatment.

Some situations may require additional preparation, coordination with other healthcare providers, or a different treatment approach.

Can People With Bipolar Disorder Do EMDR?

A bipolar disorder diagnosis does not automatically mean that EMDR is inappropriate.

Current mood stability, symptoms, medications, support, and overall treatment needs should be considered before beginning trauma processing.

If you have bipolar disorder and are considering EMDR, discuss your current symptoms and treatment plan with a qualified mental health professional.

Is EMDR Safe for Everyone With PTSD?

EMDR can be helpful for many people with PTSD, but it is not automatically appropriate for everyone at every point in treatment.

Co-occurring conditions, dissociative symptoms, current life circumstances, medications, and overall stability can affect how trauma treatment should be approached.

A thorough assessment can help determine whether EMDR is appropriate and what preparation may be needed.

What Are Alternatives to EMDR for Trauma?

Several approaches may be used to treat trauma-related symptoms, including trauma-focused CBT, Cognitive Processing Therapy, DBT, somatic approaches, IFS, ART, and Narrative Therapy.

The best approach depends on your individual symptoms, history, goals, preferences, and current circumstances.

How Do You Know If You’re Ready for EMDR?

Readiness generally involves having enough emotional stability, grounding ability, support, and therapeutic safety to participate in trauma processing.

You do not have to determine this entirely on your own.

That is one of the reasons an initial assessment is important. A qualified therapist can help you understand whether EMDR makes sense now or whether another form of support should come first.

Can EMDR Be Harmful If Done Incorrectly?

As with any clinical treatment, the quality of assessment, training, treatment planning, and implementation matters.

Trauma processing that moves too quickly or is not appropriate for a person’s circumstances may increase distress.

This is why it is reasonable to ask a potential therapist about their training, assessment process, experience, and what they do when EMDR is not the right fit.

Your Next Step Doesn’t Have to Be a Big One

You may have come to this article wondering, “Is EMDR right for me?”

The honest answer is that it depends.

It depends on where you are right now, what you are experiencing, what support you have, and what type of treatment best matches your needs.

EMDR might be the right option.

It might be something you work toward after building greater stability.

Or another form of therapy might be a better fit.

None of those possibilities mean you are failing at healing.

A good therapist can help you understand your options without rushing you into a treatment that does not fit.

What Healing Actually Looks Like

Healing rarely follows a perfectly straight line.

Sometimes the first step is trauma processing.

Sometimes it is learning how to regulate overwhelming emotions.

Sometimes it is creating safety.

Sometimes it is simply finding a therapist you trust enough to begin talking.

You do not need to have everything figured out before you reach out.

You can start with a question.

Find Your Therapist

At The Empowering Space, we work with people at different stages of their healing journeys and with a range of concerns and treatment goals.

If you are unsure whether EMDR is right for you, you do not have to figure that out alone.

Our therapist matching process can help you identify a clinician whose experience and approach may fit your needs.

Find Your Therapist →

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An initial conversation can help you understand your options and decide what the next step should be.