What EMDR Supervision Actually Looks Like — And Why It Makes Your Care Better

By Kevin St Jacques, PsyD, LMHC — Clinical Director, NWMHA

When people hear that they'll be working with a supervised intern, one of two things usually happens. Either they're relieved because of the price, or they're quietly worried about what supervision actually means for the quality of care they'll receive.

I want to address that worry directly. Because the supervision model at NWMHA isn't a compromise on quality. In some ways, it's a higher standard than what most private practice clients receive.

What supervision looks like in a typical private practice

In a standard private practice setting, a licensed therapist sees clients independently. They make clinical decisions alone. They write notes alone. If a case is complicated or something unusual happens, they might consult informally with a colleague — or they might not. There is no structural requirement for ongoing oversight of their clinical work once licensure is obtained.

This is normal. It's how most therapy works. But it's worth being honest about: once a therapist is licensed, the systems designed to catch clinical errors are largely gone.

What supervision looks like at NWMHA

At NWMHA, every intern's clinical work is reviewed regularly in formal supervision with a licensed, experienced clinician. This isn't a formality. It's a working clinical conversation about each case — what's happening, what the treatment plan is, whether the approach is working, and what to adjust if it isn't.

Before an intern works with a client on trauma material in EMDR, the case has been discussed. The targets have been reviewed. The treatment plan has been examined by someone with years of clinical experience. The intern is not making these decisions alone.

When something unexpected comes up in a session — and in trauma work, things come up — there is an experienced clinician available to consult with. Not eventually. Immediately.

Two sets of eyes on your case

Here's what this means practically for clients working with one of our interns: you have two clinicians invested in your care. The intern who is in the room with you, who is building a relationship with you and learning your history and showing up consistently. And the supervisor who is reviewing that work, catching anything that needs to be caught, and ensuring the clinical decisions being made are sound.

That's not a consolation prize. In complex trauma work, that's an advantage. Two clinicians thinking about a case together will reliably catch things that one clinician thinking alone will miss.

What I look for in supervision

When I supervise an intern's EMDR cases, I'm looking at several things. Whether the preparation phase was thorough enough before trauma processing began. Whether the targets being addressed are sequenced correctly. Whether closure is being done at the end of every session. Whether the intern is tracking the client's window of tolerance and adjusting accordingly.

I'm also listening for things that aren't in the notes — the intern's read on the client's emotional state, what they noticed that didn't make it into writing, what felt uncertain to them. That uncertainty is information. A supervisor who creates space for interns to voice what they don't know catches problems before they become patterns.

Why this model matters for EMDR specifically

EMDR requires more clinical judgment than many other therapy approaches. It's not simply a technique — it's a structured protocol with a specific sequence for good reasons, and the reasons matter. Moving too fast through preparation can leave a client without the internal resources they need to process safely. Skipping closure leaves trauma material open and uncontained. Targeting memories in the wrong order can activate material the client isn't ready to work with.

A well-supervised intern learns to make these judgments carefully, with the safety net of an experienced clinician reviewing their work. A licensed therapist practicing without oversight can develop blind spots that no one ever catches.

We built this model because we believe oversight should be structural, not occasional. And because the clients who trust us with their trauma deserve clinical care that is held to a standard someone is actually watching.

Supervision isn't about having less experienced clinicians. It's about building in the oversight that makes good care consistent.

Interested in working with an NWMHA intern? Apply for an intake — sliding scale from $35. We respond within 3 business days. →

Why We Started a Training Center — What We Kept Hearing About EMDR Scared Us

By Kevin St-Jacques, PsyD and Linda Smith, LMHC — Northwest Mental Health Alliance

This is not an easy article to write. It requires us to say something uncomfortable about a field we love and a therapy we've built our practice around.

But we think it needs to be said. Because the pattern we kept seeing — across clients, across consultation sessions, across intake after intake — was too consistent to ignore. And staying quiet about it felt like a choice we couldn't make.

So here it is: a lot of EMDR being practiced right now is not being done correctly. And some of it is causing real harm.

What we started hearing

It didn't happen all at once. It accumulated.

Clients would come to us after working with another EMDR therapist — sometimes for months — describing sessions that didn't sound like EMDR. A therapist who did bilateral stimulation for twenty minutes straight without stopping to process what came up. Sessions that jumped directly into trauma material without any preparation, assessment, or resourcing. Clients who left sessions feeling worse than when they arrived, with no closure, no grounding, no way to put things back in a container before driving home.

Some of them had been retraumatized. Not because EMDR doesn't work — it does. But because what they received wasn't actually EMDR. It was bilateral stimulation applied to trauma without the protocol that makes it safe and effective.

EMDR is a structured, eight-phase protocol. Bilateral stimulation is one component of it. Bilateral stimulation alone, without the rest of the protocol, is not EMDR.

We also heard this from the other direction — from therapists who came to us for consultation. What they described in their sessions sometimes stopped us cold. Skipping the history-taking phase because it felt slow. Moving into active trauma processing without establishing any sense of safety or internal resources for the client. Not completing closure at the end of sessions, leaving clients emotionally flooded and ungrounded.

These weren't bad therapists. Many of them genuinely cared about their clients. They had completed EMDR training. They believed they were doing EMDR correctly. They just hadn't been taught what correctly actually looked like — and the gap between what they learned and what the protocol requires was significant.

Why this happens

EMDR basic training is a 5-6 day course. That’s it. For a structured, eight-phase treatment protocol designed to address some of the most complex presentations in clinical practice.

To be clear: that training is a beginning. EMDRIA — the governing body for EMDR — requires many hours of consultation beyond basic training before a therapist can become certified. Twenty hours of working with an approved consultant who can watch your clinical work, identify gaps, and help you develop genuine competence.

Most therapists who complete basic training never pursue that consultation. There's no requirement to. There's no enforcement mechanism. A therapist can complete a basic training and begin billing for EMDR the following Monday, indefinitely, with no further oversight.

The credential "EMDR trained" tells you almost nothing about whether a therapist knows how to do EMDR well.

What we decided to do

We'd been running our practice for years when we made the decision to formalize what we were already doing informally: training therapists to a higher standard than the field requires.

The training center at NWMHA exists because we couldn't find what we needed in the existing landscape. Basic training courses that send therapists out the door with a certificate and minimal supervised practice. Continuing education that teaches technique without clinical judgment. A culture in the field that treats EMDR as a skill to add rather than a discipline to develop.

We wanted something different. A program where interns and clinicians learn EMDR from the ground up, under close supervision, with ongoing consultation built into the model rather than treated as optional. Where the standard isn't "did you complete the training" but "can you actually do this safely and effectively."

What this means for clients

Every clinician at NWMHA — including our graduate therapists — practices under a model of ongoing clinical oversight. Cases are reviewed regularly. Consultation is built into the week, not an occasional add-on. We review transcripts of sessions and notes. When something unusual comes up in a session, there is a licensed, experienced clinician to consult with — immediately, not eventually.

This is not standard practice. In most private practice settings, a therapist sees clients alone, writes notes alone, and makes clinical decisions alone. At NWMHA, no one is working in isolation.

We built it this way because of what we kept hearing. Because clients deserve to know that the EMDR they're receiving has been taught carefully, supervised closely, and held to a standard that goes beyond the minimum the field requires.

That's what the training center is for. That's why it exists.

If you've had EMDR before and it didn't feel right — or didn't work — we'd like to talk to you. What you experienced may not have been the full protocol. There's a difference, and it matters.

Apply for an intake at NWMHA — we respond within 3 business days. →