EMDR EUROPE ACCREDITED CLINICAL SUPERVISOR/ CONSULTANT COMPETENCY BASED FRAMEWORK EMDR EUROPE PRACTICE SUB-COMMITTEE – DECEMBER 2009 (RATIFIED VERSION) APPLICATION FORM TO BE COMPLETED IN MICROSOFT WORD (OR EQUIVALENT), PRINTED OUT, SIGNED WHERE APPROPRIATE, SCANNED, AND SENT AS EMAIL ATTACHMENT TO: EMDR Association UK & Ireland info@emdrassociation.org.uk PLEASE NOTE THAT ONLY ELECTRONICALLY COMPLETED DOCUMENTATION WILL BE CONSIDERED. IN ORDER FOR YOUR APPLICATION TO BE CONSIDERED THOROUGHLY, PLEASE ENSURE THAT ALL NECESSARY INFORMATION IS PROVIDED. THANK YOU. ALISON RUSSELL - CHAIR EMDR UK & IRELAND ACCREDITATION COMMITTEE EMDR Europe Clinical Supervisor/ Consultant Evidence Checklist Part A: EMDR Europe Minimum Requirements Part B: EMDR Clinical Practice Part C: EMDR Supervision and Teaching Skills & EMDR Consultation of Consultation (20 Hours) Applicant’s Details Name: Click here to enter text. Address 1: Click here to enter text. Address 2: Click here to enter text. Address 3: Click here to enter text. Mobile Tel: Click here to enter text. Email: Click here to enter text. Name of EMDR Europe Accredited Clinical Supervisor/ Consultant/Trainer supporting this application: Click here to enter text. EMDR Europe Clinical Supervisor/ Consultant’s email address: Click here to enter text. EMDR Europe Practice Sub-Committee Ratified Version December 2009/updated 06012015 Page - 1 - EMDR Europe Clinical Supervisor/ Consultant Evidence Checklist PART A: EMDR EUROPE MINIMUM REQUIREMENTS TICK BOXES IN RIGHT COLUMN TO CONFIRM 1. The applicant is a member of the appropriate EMDR National Association. 2. To your knowledge the Applicant adheres to the Professional and Ethical Standards as defined by both the applicant’s professional registration body and the EMDR National Association, and consistently promotes integrity in the science, teaching and clinical practice of psychotherapy and in particular that of EMDR. 3. That the applicant is engaged in a minimum of 16 hours per week working as a clinical psychotherapist (including supervising). 4. As a Clinical Supervisor/Consultant you have seen copies of the applicant’s professional registration certificates, and where necessary evidence of their indemnity insurance. 5. The applicant has been working as accredited EMDR Europe Practitioner for at least three years. 6. The applicant has treated a broad range of clients of varying diagnoses and complexity. 7. The applicant has conducted a minimum of 300 EMDR sessions since becoming an EMDR Europe Accredited Practitioner. 8. The applicant has treated a minimum of 75 clients using EMDR since becoming an EMDR Europe Accredited Practitioner. 9. The applicant has demonstrated competency in both their provision of clinical supervision/ consultation and their clinical work, and has engaged in a minimum of 20 hours clinical supervision/ consultant with an EMDR Europe Accredited Consultant. 10. You have seen the second reference in support of the applicant’s application. 11. You have seen the Certificate of Competency from the EMDR Europe Consultants training, and had feedback from a Consultant Trainer regarding the applicant. 12. You can confirm that since becoming an EMDR Europe Accredited Practitioner the applicant has undertaken a minimum of 24 hours EMDR-related Continuing Professional Development (CPD) and is aware of current EMDR research. 13. You can confirm that you have witnessed a minimum of three DVDs, or in-vivo sessions, of the applicant’s professional practice, of which one must be clinical, the second showing the provision of individual EMDR clinical supervision, and the third showing the provision of Group EMDR clinical supervision. (Minimum of 6 hours to meet the standard). EMDR Europe Practice Sub-Committee Ratified Version December 2009/updated 06012015 ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Page - 2 - RECORD OF CLINICAL CONTACTS [Form to be used for both EMDR Europe Practitioners and Consultants] CLIENT'S NUMBER & INITIAL PRESENTING PROBLEM 1. Click here to enter text. 2. Click here to enter text. 3. Click here to enter text. 4. Click here to enter text. 5. Click here to enter text. 6. Click here to enter text. 7. Click here to enter text. 8. Click here to enter text. 9. Click here to enter text. 10. Click here to enter text. 11. Click here to enter text. 12. Click here to enter text. 13. Click here to enter text. 14. Click here to enter text. EMDR Europe Practice Sub-Committee Ratified Version December 2009/updated 06012015 DATE FIRST SEEN NUMBER OF SETTING WHERE SESSIONS TREATMENT TOOK PLACE Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. 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Click here to enter text. 74. Click here to enter text. 75. Click here to enter text. Totals Clients Seen: Name and Signature of EMDR Europe Clinical Supervisor Click here to enter text. EMDR Europe Practice Sub-Committee Ratified Version December 2009/updated 06012015 DATE FIRST SEEN to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. NUMBER OF SETTING WHERE SESSIONS TREATMENT TOOK PLACE enter text. Click here to Click here to enter text. enter text. Click here to Click here to enter text. enter text. Click here to Click here to enter text. enter text. Click here to Click here to enter text. enter text. Click here to Click here to enter text. enter text. Click here to Click here to enter text. enter text. Name and Signature of Applicant Date Click here to enter text. Click here to enter text. Page - 8 - PART B: EMDR CLINICAL PRACTICE EMDR CLINICAL SUPERVISOR/ CONSULTANT ACCREDITATION REFERENCE GUIDELINE AND CHECKLIST EMDR CLINICAL SUPERVISOR/ CONSULTANT COMMENTS PLEASE PROVIDE DETAILED COMMENTS IN SUPPORT OF EACH COMPETENCY PART A: Section A: Click here to enter text. Standard EMDR protocol and procedure 1. History Taking – Past, Present & Future, AIP Case conceptualisation, target sequencing plan 2. Preparation 3. Assessment o Image o Negative cognition o Positive cognition o Validity of Cognition (VoC) o Emotions o SUD o Body location 4. Processing (Desensitisation) i. Strategies for blocked processing/ Acceleration/ Deceleration ii. Blocking Beliefs iii. Cognitive Interweaves 5. Installation of positive cognition 6. Body scan 7. Closing techniques o Complete session o Incomplete session 8. Re-evaluation Section B: Evidence of knowledge and experience of scripted protocols for specified populations and knowledge of research: 1. EMDR, Dissociation and Complex Post Traumatic Stress Disorder (C-PTSD) 2. EMDR with Phobias 3. EMDR and Clients with addictive behaviours 4. EMDR and Clients with Pain 5. EMDR Protocols for acute trauma (Recent Events Protocol) 6. EMDR & Traumatic Bereavement, Grief & Mourning Click here to enter text. EMDR Europe Practice Sub-Committee Ratified Version December 2009/updated 06012015 Page - 9 - PART C: SUPERVISING AND TEACHING SKILLS & CONSULTATION OF CONSULTATION (20 HOURS) EMDR CLINICAL SUPERVISOR/ CONSULTANT ACCREDITATION REFERENCE GUIDELINE AND CHECKLIST EMDR CLINICAL SUPERVISOR/ CONSULTANT COMMENTS PLEASE PROVIDE DETAILED COMMENTS IN SUPPORT OF EACH COMPETENCY Basic approach and attitude towards supervisees, duties and responsibilities: Development of a co-operative clinical supervision alliance with supervisees Demonstration of a high level of professional attitude and competence Click here to enter text. Rapport-building with supervisees Create a safe atmosphere within clinical supervision Providing adequate and constructive feedback to supervisees Developing an effective attunement and adequate coaching style Ability to transfer of knowledge effectively Psychotraumatology Focuses in supervision on following issues: Practice of the Standard EMDR Protocol Correct application of the protocol Acknowledge recognition of other approaches, treatment plans and interventions Demonstrate an ability to answer supervisees’ questions effectively, considering the following: a. Explore and clarify the question b. Answer from a theoretical background c. Answer on a practical level d. Give specific hints and suggestions for specific case e. Teach about differential diagnosis and / or alternative treatments Identify and effectively manage group processes EMDR Europe Practice Sub-Committee December 2009 EMDR Europe Practice Sub-Committee Ratified Version December 2009/updated 06012015 Page - 10 - EMDR Clinical Supervisor/Consultant Signature: Please print name: Click here to enter text. Date Click here to enter text. Applicant’s Signature: Date Click here to enter text. Second Reference in Support of an Application for EMDR Europe Accreditation This reference forms part of the application process for accreditation as an EMDR Europe Clinical Supervisor/ Consultant I support this application for EMDR Europe Accreditation as an EMDR Europe Clinical Supervisor/ Consultant for: Name of Applicant: Click here to enter text. I know the applicant from the following context: Head of Service/ Clinical Manager Professional Colleague Academic Colleague Clinical Supervision Group member ☐ ☐ ☐ ☐ I can confirm the applicant’s experience in the practice of EMDR, and that the applicant’s professional practice is in accordance with the ethical guidelines of their respective professional organisation. Please print name: Click here to enter text. Signature: Date: Click here to enter text. EMDR Europe Practice Sub-Committee Ratified Version December 2009/updated 06012015 Page - 11 -