Clinical Supervisor’s Approval of Basic EMDR Training for Registered Intern or Graduate Student

Thank you for participating in our course

The Basic EMDR Training Program is open to licensed practitioners, registered interns and to those who are in a graduate program in the mental health field and are being supervised by a licensed clinician in a clinical internship.

The following information is important for you to know:

1. The boundaries of clinical applications of EMDR for anything other than PTSD have not yet been confirmed by controlled research. The cautions presented in the training are based primarily on anecdotal reports by trained clinicians.

2. It is not unusual for a target memory to be linked to other unexpected, potentially disturbing material or memories.

3. A prerequisite for receiving a Certificate of Attendance is the completion of the three practica at the seminar, where clinicians will give and receive EMDR under small group supervision. The practice experience is for educational purposes only and not for personal therapy.

4. Case material presented didactically or on video may be disturbing to those with unresolved personal issues. Regarding numbers 3 and 4

• Clinicians presently engaged in personal therapy must seek permission from their therapist before participating in the training; and

• Those who presently have a dissociative disorder should not participate in the training without clearing it with Lynda Ruf prior to the training; and

• Those with limiting or special medical conditions (such as but not limited to pregnancy, heart condition, ocular difficulties, etc.) must consult their medical professionals prior to participating in this training.

5. Since the processing of targeted incidents may continue after training, other dreams, memories, etc. may surface. In such cases, it is the responsibility of the participant to seek and obtain appropriate assistance. Providing such assistance is neither a part of nor an extension of the training. Clinicians who wish to continue with personal EMDR work can request referral information from Lynda Ruf.

6. The experiential workshops Part 1 and Part 2 are for clinical and research purposes only and will not qualify the participant to train others in EMDR.

7. A Certificate of Attendance will be issued only to those who attend the full training and participate in the practica. A Certificate of Completion will be issued only to those who complete the full training, participate in all the practica, and complete the ten hours of consultation.

By completing the information below with your professional contact information and providing your signature, you confirm that you have read the description of EMDR and the method of training, and you affirm the decision of your supervisee to participate in the training described and to use the clinical knowledge acquired in the training, as appropriate, in the clinical work that you supervise, and you confirm that you supervise the supervisee at the organization listed on the Participant Agreement Form.