EMDR includes structured procedures, but their delivery also involves a therapeutic relationship and ongoing assessment of how a person responds. Relationship research and process measurement can therefore complement studies of symptom outcomes. They should not be mistaken for trials demonstrating which procedure works best.
Hase and Brisch's 2022 perspective describes the relationship in EMDR through an attachment-informed framework. It highlights the therapist's sensitivity and responsiveness within the treatment structure. As a perspective article, it proposes a way to understand practice rather than experimentally proving that framework. 1)
A 2025 survey by Hase and colleagues examined EMDR therapists' views and experiences in relation to this account. Its findings provide a professional perspective, but the respondents were therapists; they are not a representative sample of patients receiving EMDR. The survey does not establish that a particular relationship model causes better treatment outcomes. 2)
Ramallo-Machín and colleagues' 2024 study investigated a Processing Difficulties Scale in a sample of 228 patients with different psychiatric diagnoses. The resulting 17-item measure grouped observations into four factors: good processing; lack of generalisation or absence of change; poor emotional processing; and loss of dual attention. 3)
The study reported encouraging psychometric findings and associations with other measures. These are preliminary findings about measuring aspects of the process. They do not establish a diagnostic test, an automatic rule for selecting treatment, or validation of the scale for IEMT and EMI.
A therapist may observe repeated responses, little change, difficulty staying oriented to the present, or change within a session that does not extend to daily life. These observations can prompt review of the formulation, the task and the therapeutic interaction. Labelling an observation does not establish its cause.
For example, an association between dissociation scores and a processing dimension cannot show that dissociation invariably prevents successful therapy. The study itself describes a more complex pattern than a single rule linking one patient characteristic to poor processing. 4)
These sources offer useful questions for any careful account of a therapy: how was engagement understood, what was observed, how was the intervention adjusted, and did change generalise beyond the session? However, adopting those questions in IEMT is different from claiming that EMDR research validates IEMT's patterns of chronicity or other model-specific constructs.
The eight-phase EMDR structure places preparation, closure and re-evaluation alongside processing. Descriptions of the therapeutic relationship help explain how those elements fit together, while outcome studies remain necessary to evaluate benefit. 5)