Adapting the standard EMDR protocol for clients with mild mental retardation: Some guidelines and implications


EMDR as a psychotherapeutic approach has been shown to be effective. However, there is a paucity of studies examining the efficacy of EMDR for clients diagnosed with mild mental retardation. The DSM-IV defines mild mental retardation as below average intelligence (IQ between 70 and 55) along with some deficiencies in adaptive functioning skills demonstrated before age 18. The purpose of our clinical project was to explore the applicability of EMDR for our adult clients (n = 12; mean age 22.5) diagnosed with mild mental retardation by adapting the standard protocol. Studies showed that individuals with mental retardation learn and retain information more effectively when materials are presented to them in a visual, concrete, and interactive manner while utilizing the principles of positive reinforcements.

The prevalence of mental health problems and the wide range of clinical symptoms among these individuals have been reported in several studies. Additionally, these adults are misunderstood as being overly limited in their ability to reap any therapeutic benefit from counseling interventions. Prout and Strohmer (1998), for instance, argued that adults with mental retardation do benefit from counseling interventions. However, they stressed the need for more sophisticated or modified use of psychotherapeutic interventions. Psychotherapeutic techniques and models should be modified, if feasible, in regards to language and cognitive levels commensurate with the clients’ background.

Based on our clinical observations, the following are some examples of proposed guidelines to assist the EMDR clinicians in thinking more creatively when adapting the standard protocol.

1) Considerable amount of preparation at the onset of EMDR is necessary, as it plays a pivotal role in ensuring a successful outcome.

2) Visual depiction of the SUDs and VOCs on a scale of 0 through 5, or 0 through 10, depending on the client’s cognitive abilities is beneficial. Use of “faces” to depict concretely various levels of distress should be made.

3) The concepts of PC and NC may be too abstract for some in this population. We assist clients by operationally defining those concepts with the list of commonly used PCs and NCs in simpler language.

4) Coping resources are sometimes limited for these adults. Clients will benefit from having multiple reinforcements of self-soothing skills thorough the installation of the “safe place” and “resources”.

5) Positive reinforcements (e.g., frequent verbal reminders) should be used regularly in sessions throughout treatment. However, be mindful of clients’ desire to please the clinician.

6) Role-playing should be used when feasible throughout treatment, e.g., during the installation of future templates, as it heightens more sensory, affective, and behavioral modes of learning rather than verbal modality alone.

Based on the treatment outcomes reported by our clients, EMDR is an effective treatment option, as evidenced by sustained reduction in their level of distress to traumatic memories. Findings from this clinical project have practice and research implications. First, the standard protocol should be adapted for use with adults with mild mental retardation to achieve optimal gain. Second, empirical research is needed to provide further evidence for the efficacy of EMDR for adults with mild mental retardation.






Rhonda Miller
Kim H. Tay

Original Work Citation

Miller, R., & Tay, K. H. (2009, August). Adapting the standard EMDR protocol for clients with mild mental retardation: Some guidelines and implications. Poster presented at the 14th EMDR International Association Conference, Atlanta, GA



“Adapting the standard EMDR protocol for clients with mild mental retardation: Some guidelines and implications,” Francine Shapiro Library, accessed November 28, 2020,

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