EMDR Therapy & Autism: Accommodations That Benefit Everyone
As EMDR clinicians, we often seek tools, techniques, and frameworks to better meet our clients where they are. But what if the accommodations we make for a specific population, such as autistic individuals, can elevate the experience of EMDR therapy for all our clients?
This blog is written in that spirit. While the insights I’m sharing were inspired by the work of Sherry Paulson, LCSW, and focused on EMDR therapy with autistic individuals, I’ve found that these strategies ripple outward – creating more thoughtful, inclusive, and effective care for a wide range of clients.
Do You Need EMDR Accommodations for Autistic Clients?
As an EMDRIA consultant, therapy group practice owner, and full-time EMDR therapist in St. George, UT, I find myself learning and repeating to my EMDR consultees, “Our clients are endlessly diverse. And this is why we all need ongoing EMDR consultation.”
It’s true. We will never have EMDR “figured out.” Nor will we ever have the confidence to apply it perfectly. Because nearly every client will ask us to tweak, adjust, accommodate, and interweave with grace and flexibility. And we commit to them when we enter the mental health field.
Do you work with clients on the autism spectrum or who identify as neurodiverse? Then this blog is for you. Do you work with neurotypical clients? This blog is also for you. These accommodations will benefit all the folks who find their way to your EMDR practice. Let’s begin.
EMDR and Autism: Relationships First, Always
Francine Shapiro taught us that relationship comes first – yes, even with EMDR.
EMDR therapy never trumps therapeutic rapport. Sherry Paulson reinforces this, reminding us that a strong connection with clients and their caregivers (if applicable) is foundational – especially in work with autistic individuals.
One of the most immediate ways to foster this trust is through predictability. This might mean holding sessions on the same day and time each week, using a consistent format (such as the same check-in and checkout prompts), or maintaining a familiar rhythm to sessions.
In real life, I knew a therapist who only ever wore Hawaiian-print button-down shirts to work to create a sense of predictability (but I think he loved the shirts just as much as his clients)!
And I know another, a play therapist, who ends every single session with a trip to the snack cabinet where his young clients can choose from a range of consistent and predictable tasty options.
Structure can ease anticipatory anxiety and help clients settle into the process more comfortably. This kind of trust building cannot be rushed or overlooked. Some will build a trusting relationship with you fast… and some very slowly. There’s no right or wrong pace, but make it a priority.
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EMDR Therapy and Flexibility with Bilateral Stimulation (BLS)
For many autistic individuals, eye movements may not be accessible or comfortable. Paulson often uses tapping instead, and that flexibility is key.
Even outside of autism-specific accommodations, I’ve found that having multiple BLS modalities available is simply good clinical practice. Whether due to sensory sensitivity, physical limitations, or session context, it helps to have various tools (tappers, auditory tones, tactile BLS) ready and assess what feels best for the client.
Here in Southern Utah, we have an active community of mountain biking enthusiasts. And it’s no wonder; we’re just 30 minutes away from Zion National Park and a range of red rock trails. As a result, it’s not unheard of for clients to come in having suffered a concussion on the trail over the weekend, requiring us to switch from eye movements to tapping.
Or perhaps they sprained their wrist… or strained their shoulder… Looks like we’re switching from butterfly-hug BLS to tapping or eye movements.
Autism aside, options are good.
Making The Switch From Talk Therapy to EMDR Therapy
Shifting from talk therapy into EMDR can be jarring – and not just for neurodivergent clients. Autistic clients may struggle with transitions more significantly, but many clients experience difficulty adapting to EMDR’s structured approach.
Prepare them. Talk about it. Normalize the adjustment period. Let clients know that EMDR has a different rhythm, purpose, and focus – and that together, you’ll navigate this transition with care and clarity.
To assist with this process, it can be helpful to provide clients and caregivers with a range of options to learn about EMDR in a way that is accessible to their unique brain and learning style.
You might consider:
– Book recommendations
– Handouts with lists or bullet points
– Informational videos
– Videos that feature client testimonials
– Storytelling / Fictional children’s stories
– Role playing
Being A Leader In EMDR Therapy Sessions
Be prepared to take a more of a leadership role during EMDR. Many therapists, including me, have fallen into the pattern of letting our clients set the agenda for therapy week after week after week.
Maybe we did this out of respect for the client and because of a major transition they were experiencing. Life can certainly throw us curveballs. And with individuals with autism, we may need to pivot more often to accommodate their sensory needs that day or capacity for disregulation.
Or perhaps you just got lazy (it happens to all of us).
I encourage you to consider whether you need to be more mindful of supporting your clients’ attention to the EMDR process and the transition from talk therapy to the 8 Phases.
ASD & EMDR Therapy: Processing Delays Are Real
Clients on the spectrum may appear regulated during sessions but experience shutdowns, meltdowns, or emotional overload afterward. This delayed processing isn’t a failure—it’s a feature of how their nervous systems integrate experiences.
We can support them by ending sessions with grounding practices, building in time for co-regulation, and checking in about post-session experiences. Creating a reliable and gentle “wind-down” routine for EMDR can help prevent unintended dysregulation once they leave the room.
On that note, we often encourage clients to be gentle with themselves after EMDR therapy sessions. I know that I do this for my clients in Southern Utah. But I’m often surprised that many clients don’t actually know what this means – to be gentle with themselves.
It can be helpful to talk about options like ordering pizza for dinner… ignoring the pile of laundry… or going to bed early instead of watching Netflix. Don’t assume your clients know what self-care looks like or feels like.
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Support Learning Differences with Concrete EMDR Tools
Neurodiverse clients often benefit from visual, tactile, or concrete aids in therapy – and, honestly, so do many neurotypical clients.
One of my favorite tools is Ana Gomez’s Positive and Negative Cognition Notecards. These allow clients to identify their thought patterns more clearly, giving shape to the vague or confusing thoughts and feelings that often bring them to therapy.
Other tools, such as a laminated list of common NCs and PCs, feelings charts/feelings wheels, sand trays, paper and drawing supplies, dry-erase markers and boards, and all manner of coping or fidget toys, can be helpful.
When you adapt how you teach EMDR concepts, you’re not “watering down” the method – you’re strengthening it and making it work for your unique and endlessly diverse clients.
EMDR Target Generalization May Not Come Naturally
Finally, it’s important to remember that autistic individuals may struggle to generalize EMDR work across different contexts. They may do meaningful trauma processing in session but find it challenging to apply those insights in varied real-world settings.
This calls us to be intentional in how we bridge the gap between insight and application. Using real-life examples, role plays, or follow-up check-ins can help clients make that leap.
Additionally, we must support our clients in having realistic expectations of what EMDR does and does not do. For example, I recently did my own EMDR work (it was part of a live demonstration at an EMDR basic training) to clear the anxiety I felt about a complex caretaking role.
After just this single session, I felt a huge sense of relief and empowerment. But… nonetheless… this caretaking role is still challenging for me! Granted, I have less anxiety, and it’s easier for me to pace myself and choose gratitude more often. But it’s still hard, and it may always be hard.
EMDR can’t change what it is… but it can help me shift my thoughts, feelings, and heal my nervous system’s response.
EMDR Therapy, Diversity and Inclusion
As you integrate these practices, you’re not just making accommodations but creating a more inclusive, thoughtful, and practical approach to EMDR therapy. And you might find, as I have, that what you intended to be an adjustment for the few turns out to be a gift for the many. Because good therapy doesn’t just follow the research – it honors the human being in front of us.
EMDR consultation allows us to continue to conceptualize our clients’ stories and needs, neuro-spicy or not, and find ways to make EMDR for them.
Truly, just a few years ago, we did not have such well-thought-out practices for clients on the autism spectrum, and new information is coming out all the time.
We have a responsibility to our clients to stay up to date and to challenge ourselves to learn more and do differently so we can continue to serve our diverse clientele with EMDR therapy. Consultation can help you ground into the model’s fidelity, gain confidence, and get creative. Reach out today to explore working together. I’d be honored to support your growth (and clients’).