EMDR Treatment Plan Template (Free PDF)
An editable phase-by-phase EMDR treatment plan template — goals, target sequence, outcome measures, risk factors, and medical-necessity language on one printable document.
Free PDF for EMDR clinicians. Get it by email.
What's in the EMDR treatment plan template
A structured, phase-by-phase EMDR treatment plan written in the documentation language insurers, supervisors and licensing boards expect. The template walks through the eight standard phases of EMDR — history, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation — and gives a working place to record goals, target sequence, outcome measures, risk factors, and a medical-necessity statement on a single document.
This is a clinician working document, not a client-facing form. Most therapists complete the first version after Phase 1 history-taking, then revise it every 4–6 sessions as targets resolve and new material surfaces. The PDF leaves explicit space for the revision number and next-review date so the plan stays current.
Who it's for
EMDR clinicians who need a defensible written plan for insurance review, supervision, or licensing board audit. Clinicians who bill in-network and need medical-necessity language that satisfies payer documentation requirements. Supervisees and EMDRIA Certification candidates whose consultants want to see a structured plan rather than narrative session notes. Clinicians in private practice who simply want a clean operational backbone for each EMDR course of treatment.
It is not a substitute for a full biopsychosocial assessment — it sits alongside one. The Phase 1 history-taking worksheet is the natural input to this template; the Progress Note template is the session-by-session companion.
How clinicians use the template
After Phase 1 history-taking, complete the first version of the plan. Fill in the diagnosis, the presenting concern in the client's own words, and 2–4 measurable treatment goals tied to outcome measures (PCL-5, PHQ-9, GAD-7, DES-II — see the Outcome Measures Tracker for cadence guidance).
Then sketch the target sequence — the past memories, present triggers, and future templates that will be reprocessed, in planned order. The Phases 3–6 grid has six rows; for longer courses of EMDR, use additional sheets and increment the revision number. The risk-factor checklist surfaces the things most often missed in EMDR planning (substance use, medical contraindications, dissociation, current stressors that may delay reprocessing).
The medical-necessity statement at the bottom uses evidence-based language drawn from APA, ISTSS, VA/DoD and WHO trauma-treatment guidelines. Most payers accept it as-is; adapt the language to your jurisdiction and your client's diagnosis as needed.
What makes this plan EMDR-specific
Generic CBT or psychodynamic treatment plans don't capture the structural reality of EMDR — that work proceeds along an explicit target sequence rather than through weekly themes, and that each target moves through measurable Phase 3 → Phase 6 stages. This template's Phases 3–6 grid is the operational backbone of an EMDR course of treatment, not an afterthought.
The phase-by-phase structure also makes the work auditable. A reviewer looking at a row should be able to see the target memory, the negative cognition, the candidate positive cognition, and the SUD/VoC scores at start and at completion. That granularity is what distinguishes an evidence-based trauma-focused intervention from generic supportive therapy in a payer's eyes.
What's inside the PDF
- Client and clinician header (initials, DOB, plan date, revision, next review)
- Diagnosis (primary + secondary) and presenting concern in client's own words
- Treatment goals grid (4 rows: goal, outcome measure, baseline, target)
- Phase 1 estimated sessions and outcome-measure inventory
- Phase 2 preparation checklist (Calm Place, Container, RDI, stop signal)
- Phases 3–6 target sequence grid (6 rows: target, NC, PC, SUD, VoC)
- Phase 7 closure plan (between-session resources, incomplete-session protocol)
- Phase 8 reevaluation cadence and treatment-completion criteria
- Risk factor and contraindication checklist
- Coordination-of-care fields (prescribing clinician, other providers)
- Medical necessity statement
- Client + clinician signature block
Common questions about the EMDR treatment plan
How often should the plan be revised? Every 4–6 sessions, or whenever a target resolves, a new target surfaces, or the cluster shifts. The header has a revision number and next-review date for exactly this reason.
Will insurance accept this? Most US commercial payers accept the medical-necessity language as written for clients with PTSD, complex trauma, anxiety, or depression diagnoses. Adapt the diagnosis-specific clauses to match your client's primary diagnosis and your jurisdiction's specific requirements.
Do I need a separate plan for each cluster? If you're working through multiple negative-cognition clusters in sequence, most clinicians use one plan and renumber the target rows as new clusters come into focus. If the clusters are addressed in genuinely separate phases of treatment, a fresh plan per cluster is cleaner.
How does this differ from the Target Sequence Plan worksheet? The Target Sequence Plan focuses tightly on the past/present/future grid that drives reprocessing. The Treatment Plan is the broader clinical document — diagnosis, goals, risk factors, payer language — with a Phase 3–6 grid that mirrors the TSP. Most clinicians use both; the TSP is the working document for Phase 1 prep, the Treatment Plan is the document filed with the chart.
Related on the EMDR guide
Frequently asked questions
Is this a substitute for a biopsychosocial assessment?
No — the treatment plan sits alongside a full intake. The Phase 1 history-taking worksheet is the natural input.
Will most US insurers accept the medical necessity language?
The language is drawn from APA, ISTSS, VA/DoD, and WHO trauma treatment guidelines and is widely accepted. Adapt to your jurisdiction and your client's primary diagnosis.
How often should I update the plan?
Every 4–6 sessions, or whenever a target resolves or new material surfaces. The template has a revision number and next-review date.
Can I use this for non-PTSD diagnoses?
Yes — EMDR is increasingly used for anxiety, depression, complex grief, and chronic pain. Adapt the medical necessity statement to match the diagnosis and cite the relevant evidence base.
References
- Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.
- Leeds, A. M. (2016). A Guide to the Standard EMDR Therapy Protocols for Clinicians, Supervisors, and Consultants (2nd ed.). Springer.
- Hase, M., Balmaceda, U. M., Ostacoli, L., Liebermann, P., & Hofmann, A. (2017). The AIP model of EMDR therapy and pathogenic memories. Frontiers in Psychology, 8, 1578.
- World Health Organization (2013). Guidelines for the Management of Conditions Specifically Related to Stress. WHO.