Hey there,

One of the biggest challenges I see therapists struggle with in EMDR is holding all the pieces of a complex case in mind at once.

I mean, think about what you’re juggling during an assessment.

You’ve got:

• childhood traumas
• adult adverse events
• external and internal triggers
• negative beliefs in four different domains
• current symptoms that serve various functions

…and the list goes on.

So when you’re trying to figure out where to start with target sequencing, or explain to a client how their past connects to their present difficulties, it’s easy to feel overwhelmed by the sheer amount of information.

Fortunately we have a tool for that:

​The EMDR Case Formulation Tool.

This framework was developed by Ines Santos, a clinical psychologist in the UK, and published in the Journal of EMDR Practice and Research in 2019. Essentially, it’s a visual diagram that maps out 6 key elements of the Adaptive Information Processing model and shows how they relate to each other.

What makes this framework especially useful is that it gives you a way to see the whole picture at once.

You can draw connections between a childhood memory of being humiliated by a teacher and a current belief of “I’m defective”…

…which gets triggered in work situations involving feedback.

which manifests as avoidance of performance reviews and chronic anxiety about being fired.
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Essentially, it allows you to map out how multiple trauma memories feed into the same negative belief, or how one memory connects to different symptom clusters (depending on which aspect of the experience gets activated).

It doesn’t matter how you use it either.

• You can fill it out on your own after an assessment session to organize your thinking
• You can draw it collaboratively with a client during a session to help them understand how their past experiences are influencing their current struggles
• You can use it in supervision or consultation to quickly convey the key dynamics of a case
• Or you can use it for treatment planning, identifying which memories are causing the most current disturbance and deciding on target sequencing

It also works for varying case complexities.

Santos (the psychologist who created this framework) gave examples ranging from straightforward single-event traumas to complex PTSD with dissociative features. Either way, the structure adapts to whatever you’re working with.

The tool even includes a narrative formulation component, where you translate the visual diagram into a coherent story that you can share with the client. In other words, you’re helping them make sense of their experience in a way they can actually understand.

(The narrative follows a basic template but gets personalized for each case. It might sound something like this: “One way of understanding your difficulties is that as a result of these traumas, when you’re exposed to these triggers, you experience these intrusions which activate these negative beliefs. And this causes these current symptoms and difficulties. Despite all this, you have these strengths and resilience factors.”)

This combination of visual mapping and narrative explanation makes the formulation accessible to clients in a way that pure conversation sometimes isn’t.

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Now, if you work with clients exploring psychedelics or integration therapy, here’s where this gets particularly interesting:

Raine-Smith and Rose, in their 2025 book on psychedelic-assisted EMDR therapy, adapted Santos’s formulation tool specifically for use in psychedelic harm reduction and integration work. They call it the PsyA-EMDR Case Formulation Tool, and it builds on the original structure while adding elements that are especially relevant for working with psychedelic experiences (which in my opinion is worth understanding because they highlight some important dynamics in how memory networks interact with non-ordinary states of consciousness).

First, they separated childhood traumas and adverse childhood experiences from adulthood traumas and adverse life events.

This distinction matters in psychedelic work because childhood material often forms the foundation of the memory networks that get activated during a journey. When someone has a difficult psychedelic experience, it’s frequently because unprocessed childhood material is surfacing in ways that feel overwhelming or confusing.

By mapping out childhood versus adult experiences separately, you can see how early vulnerability shapes the way later traumas get encoded and processed.

Second, they added a specific box for emotions and body sensations as a distinct element that connects triggers to negative beliefs.

In psychedelic experiences, people often report strong somatic activation and emotional states that don’t immediately connect to specific memories or narratives. Having a dedicated space in the formulation for tracking these embodied experiences helps you understand what’s happening when someone reports:

“I felt this crushing pressure in my chest and overwhelming shame, but I couldn’t identify what it was about.” That emotional and somatic material is part of the unprocessed network, and it gives you clues about where to look for target memories.

Third, they included an “Intention(s)” box at the bottom of the diagram that informs treatment planning and target selection.

In psychedelic-assisted work, clarifying intention before a session is important for harm reduction.

• What does this person hope to address?
• What are they trying to heal or understand?
• What unprocessed material might surface?

The formulation tool helps you map whether their stated intention aligns with the memory networks you’ve identified, or whether there might be unprocessed material that could surface unexpectedly during the journey.

Fourth, they explicitly labeled “Current Symptoms/Behaviours (+ function)” to emphasize understanding what purpose each symptom serves.

This is important in integration work because psychedelic experiences sometimes temporarily reduce symptoms, and you need to understand what function those symptoms were serving so you can help the person develop new adaptive strategies.

If someone’s dissociation was serving to protect them from overwhelming emotion, and a psychedelic experience reduces that dissociation temporarily, you need to work on affect regulation skills before the old pattern re-establishes itself.

Once you take a look at the tool, you’ll notice throughout the PsyA-EMDR diagram labels for “Potential PsyA-EMDR Targets.”

These mark places where you might identify specific memories, triggers, beliefs, or symptoms to work on with EMDR processing either before a psychedelic session (to reduce the risk of overwhelming material emerging) or during integration afterward (to consolidate insights and process material that surfaced).

We could go a lot deeper, but I’ll stop there before this gets too long.

I’ll leave you with this:

Whether you use Santos’s original Case Formulation Tool or the PsyA-EMDR adaptation, having a visual way to map out the relationships between unprocessed memories, triggers, beliefs, and current symptoms makes your work more coherent and effective.

It helps you think more clearly about complex cases, communicate more effectively with clients about what’s happening, and make better decisions about where to focus your efforts.

If you want to check out either tool further, Santos’s original article is freely available and includes detailed case examples. The PsyA-EMDR adaptation is in Raine-Smith and Rose’s book on psychedelic-assisted EMDR therapy if you’re working in that space. Both are worth having in your clinical toolkit.

Have you used either of these formulation tools?

I’d be curious to hear what’s worked (or hasn’t worked) in your experience.

Hit reply and let me know!

Until next time,

Chris

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Disclaimer: The information contained in this article is for informational purposes only. This is not legal or clinical advice and we make no guarantees about the outcomes or results from information shared in this document. Proceed at your own risk and discretion.​
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