EMDR Consent Form CONSENT FOR EYE MOVEMENT DESENSITIZATION AND REPROCESSING TREATMENT I have been advised and understand that Eye Movement Desensitization and Reprocessing (EMDR) is a treatment approach that has been widely validated with civilian PTSD. Research on other applications of EMDR is now in process. I have also been specifically advised by my therapist, Rivkah Kaufman, LMHC, of the following: - Distressing, unresolved memories may surface through the use of the EMDR procedure. - Some clients have experienced reactions during the treatment sessions that neither they nor the administering clinician may have anticipated, including a high level of emotion and/or physical sensation. - Subsequent to the treatment session, the processing of incidental material may continue, and other dreams, memories, flashbacks, feelings, sensations, etc, may surface. Before commencing EMDR treatment, I have thoroughly considered all of the above. I have obtained whatever additional input and/or professional advice I deemed necessary or appropriate to familiarize myself with the treatment, and by my signature below, I hereby consent to receiving EMDR. My signature on the Acknowledgment and Consent is free from pressure or influence from any external person or entity. Name * First Name Last Name Date * MM DD YYYY Client Initials * Note: this will serve as your signature Thank you!
