SAFE EMDR Training Consultation Form
Please do not give any identifying information about the client.  Only identify by Case #1, #2 or #3. These need to be actual cases that you are working with.  It is important that you practice with your clients and required by EMDRIA that you practice with clients prior to days 4-6.  

Notes about consultation:  Each participant is required to present at least 1 case they have been working with between days 1-3 and days 4-6 of the training.  You will be meeting in small groups for consultation for a total of 10 hours in the 2nd 3 days of the training. It is very important that you fill this out for at least 1 and up to 3 cases.  

We will be inviting and demonstrating nonviolence and the use of our SAFE model practices for the consultation.

Instructions for the group:  Each participant can present their case.  The group is invited to be mindful about the present moment experience as they hear the clinician present the case.

1.  After the case is presented the group is invited to have a moment of silence and stillness, noticing any images, metaphors or movements that come to mind.  

2.  Participants are invited to write down their experiences, the lead consultant shares what came up for them as the presenter listens in silence.  

3.  If time permits other members of the group may share what images, metaphors or movements came to mind for them.  

4.  Presenter then asks clarifying questions.  

5.  Presenter reflects on the feedback, noticing the new perspective.  

6.  Presenter may say how they see the path moving forward with the client.  

7.  Expression of appreciation and gratitude for the group.  

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Email *
Your Full Name
Please do not give any identifying information about the client or diagnosis, it is not necessary.  You may submit up to 3 forms for your case consultation.  Please identify them by number only, 1-3.  
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Which of the 8 phases have you completed with this case?
How do you conceptualize this case using the AIP?  How are the client's past experiences influencing the present?  Please include a verbatim summary.
What is the client's "Answer", what does the client do well?
How are you feeling stuck with this client?  
How do you see your answer surfacing with this client?
When you think about working with this client, what do you notice right now in your body?   Does that feel familiar?  
What are you curious about as you bring up this case?  
What specific areas of concern or confusion do you have?
A copy of your responses will be emailed to the address you provided.
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