Who should avoid EMDR? Essential Safety Suitability Criteria

EMDR (Eye Movement Desensitisation and Reprocessing) is widely celebrated for its ability to unlock the brain’s natural healing potential. However, like any powerful clinical intervention, it is not a “one-size-fits-all” solution. In my Stockton-on-Tees practice, a crucial part of the initial assessment involves answering an important question: Who should avoid EMDR? Suitability Criteria must be met before we begin the deep work of trauma processing.

As an NHS-trained clinician (MSc), my primary ethical duty is your safety. While EMDR is a Proven and Expert-led method for treating PTSD, certain life circumstances or clinical conditions require us to pause, stabilise, or choose a different therapeutic path. In this deep dive, we will explore the essential Safety guidelines that determine if now is the right time for you to engage in this work.

Immediate Stability: Who should avoid EMDR? Suitability Criteria for Crisis

The first and most important group of people who should temporarily avoid the active processing phases of EMDR are those currently in an acute crisis. If you are experiencing active suicidal thoughts, homelessness, or are in an ongoing abusive relationship, your nervous system is in “survival mode.” Active EMDR processing requires a baseline of external safety and internal stability.

When considering “who should avoid EMDR? Suitability criteria” often point toward “Timing.” In my Billingham clinic, we don’t necessarily say “no” to these clients forever; instead, we focus on Phase 1 and 2 of the protocol—Stability and Resource Development. We wait to begin the “Eye Movement” phase until your life circumstances allow for a safe space to process the past without being overwhelmed by the present.

Medical and Psychological Factors: Who should avoid EMDR? Suitability Criteria and Health

There are specific medical conditions that require a cautious, Expert approach. For instance, individuals with severe heart conditions or those who have recently suffered a stroke should consult their physician before starting EMDR, as the emotional intensity can temporarily increase physical stress.

From a psychological perspective, those with severe dissociative disorders or certain types of psychosis require a very specific, modified approach. Following the NICE guidelines and EMDR Europe standards, a thorough assessment is required to ensure the client has enough “grounding” skills to avoid becoming lost in a dissociative state during processing. As an HCPC Registered professional, I use these standards to protect my clients from unnecessary distress.

Ongoing Substance Use: Who should avoid EMDR? Suitability Criteria and Addiction

Active, heavy substance use is another factor in the “who should avoid EMDR? Suitability criteria” discussion. Because EMDR relies on the brain’s ability to “re-file” memories, being under the influence of substances that alter cognitive function—such as high levels of alcohol or sedative medications—can block the therapy’s effectiveness. More importantly, if a client uses substances to numb the very emotions we are trying to process, it can lead to dangerous “flooding” when the numbing agent wears off.

In these cases, I work collaboratively with clients to find a window of sobriety or a reduction in usage that allows the brain to do the work effectively and safely.

Conclusion: Determining Your Readiness

So, who should avoid EMDR? Suitability criteria are designed not to exclude people from healing, but to ensure that when you do start, you are set up for a Successful and Powerful outcome. Healing is a marathon, not a sprint, and sometimes the most professional thing a therapist can do is tell a client, “Not quite yet.”