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Ask a room full of EMDR therapists whether they use EMDR with complex PTSD and you will get a telling mix of answers. Some do, carefully. Some tried once, had a session go sideways, and retreated. And many keep those clients in preparation indefinitely, not because the client needs it, but because nobody ever taught the therapist how to reprocess safely with this population.
The hesitation is understandable. It is also worth examining, because the research picture is more encouraging than the field's anxiety suggests.
The Short Answer
Yes, EMDR can be used safely and effectively with complex PTSD when treatment is planned around the client's capacity. Research supports trauma-focused treatment for CPTSD, including EMDR, and does not support indefinite stabilization as a prerequisite. Safety comes from assessment, treatment planning, and reprocessing adaptations, not from avoiding reprocessing altogether.
What Makes Complex PTSD Different
ICD-11 defines Complex PTSD as the core PTSD symptom clusters (re-experiencing, avoidance, and a persistent sense of current threat) plus disturbances in self-organization: affect dysregulation, a persistently negative self-concept, and difficulties in relationships (Heim et al., 2022). Those disturbances are what make these clients feel so different in the room. The trauma is rarely a single event, the symptom list is long, and the memory networks are dense and interconnected.
Dissociation adds another layer. A scoping review by Fung and colleagues (2023) found dissociation is strongly associated with CPTSD, which matters clinically because dissociation is precisely what can make open-ended reprocessing risky: a client who leaves the room, psychologically speaking, cannot integrate what is being processed.
So the caution is not irrational. The question is what the caution should produce: avoidance, or adaptation.
Where the Fear Comes From
For decades, the dominant guidance held that clients with complex trauma need an extended stabilization phase before any trauma-focused work. That phase-oriented model was built from sound clinical instincts, and for some clients a stabilization period is genuinely necessary.
But the model also produced an unintended consequence: therapists who never leave phase one. Preparation becomes the whole treatment. Months or years pass, the client acquires an impressive collection of grounding skills, and the trauma driving the symptoms remains untouched. Researchers began questioning whether lengthy stabilization was empirically required at all, arguing that the evidence for it as a universal prerequisite was thin (de Jongh et al., 2016).
What the Research Actually Shows
A randomized controlled trial by Sele and colleagues (2023) compared phase-based treatment, prolonged exposure alone, and skills training alone for Complex PTSD. The findings did not show that skipping straight to trauma-focused work harms clients, and they did not show that skills training alone resolves trauma symptoms. Trauma-focused treatment earned its place in the plan.
Case-level research points the same direction for EMDR specifically. De Jongh, Hafkemeijer, and colleagues (2023) documented trauma-focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy, illustrating that even clinically complicated presentations can respond to well-planned reprocessing.
None of this means every CPTSD client should start reprocessing in session three. It means the blanket assumption that these clients cannot tolerate trauma-focused work is not supported, and that keeping a client in indefinite preparation carries its own cost. Complex PTSD is metabolically and functionally expensive to live with. Every month spent circling the work is a month the client keeps paying for symptoms that treatment could be reducing.
Safety Is a Planning Question
The honest reframe is this: with complex PTSD, safety does not live in the choice between reprocessing and not reprocessing. It lives in how the work is planned and adapted. Clinicians working safely with this population tend to do a few things consistently:
- They assess readiness deliberately, including screening for dissociation, rather than relying on a feeling that the client is or is not ready
- They plan treatment around symptoms, choosing the symptom costing the client the most and mapping its triggers as targets, instead of trying to address an entire trauma history at once
- They sequence targets collaboratively, using SUDS ratings so both people know where the work is starting and why
- They adapt reprocessing itself, using constricted processing strategies like EMD and EMDr to contain activation when full associative processing would be too much
- They reevaluate, treating Phase 8 as a genuine decision point that shapes what happens next rather than a formality
Each of those is a learnable skill. Together they turn "is EMDR safe for this client" from a source of dread into a clinical question with a workable answer.
When Slowing Down Is the Right Call
Adaptation is not the same as urgency. There are presentations where more preparation genuinely is the work for now: severe unmanaged dissociation, active crisis, no capacity to self-regulate between sessions. The point of readiness assessment is that it can say "not yet" as clearly as it says "go." What it should never say is "not yet, forever, because I am not sure what I would do next."
Frequently Asked Questions
Is EMDR safe for clients with Complex PTSD?
Yes, when treatment is planned around the client's capacity. Research supports trauma-focused treatment for CPTSD and does not support indefinite stabilization as a universal prerequisite. Safety comes from readiness assessment, symptom-focused planning, and reprocessing adaptations that contain activation, such as constricted processing.
Do complex PTSD clients need stabilization before EMDR?
Some do, for a defined purpose and period. What research does not support is lengthy stabilization as a blanket requirement for everyone with complex trauma. Readiness should be assessed deliberately, and preparation should build toward reprocessing rather than becoming the entire treatment.
Can EMDR make dissociation worse?
Unassessed dissociation can complicate reprocessing, which is why screening matters before trauma-focused work begins. With appropriate assessment and adaptations that limit how much material is activated at once, clinicians can work with dissociative clients while reducing the risk of overwhelm.
How is EMDR adapted for Complex PTSD?
Common adaptations include symptom-focused treatment planning, collaborative target sequencing using SUDS, constricted processing strategies (EMD and EMDr) that narrow the focus of reprocessing, and structured Phase 8 reevaluation to guide ongoing decisions. The goal is reprocessing the client can integrate, at a pace their system can hold.
References
de Jongh, A., Resick, P. A., Zoellner, L. A., van Minnen, A., Lee, C. W., Monson, C. M., Foa, E. B., Wheeler, K., ten Broeke, E., Feeny, N., Rauch, S. A. M., Chard, K. M., Mueser, K. T., Sloan, D. M., van der Gaag, M., Rothbaum, B. O., Neuner, F., de Roos, C., Hehenkamp, L. M., ... Bicanic, I. A. E. (2016). Critical analysis of the current treatment guidelines for complex PTSD in adults. Depression and Anxiety, 33(5), 359-369. [VERIFY FULL AUTHOR LIST + ADD DOI LINK]
De Jongh, A., Hafkemeijer, L., et al. (2023). Trauma-focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy. Journal of Clinical Psychology. [VERIFY FULL AUTHOR LIST, VOLUME, PAGES + ADD DOI LINK]
Fung, H. W., Chien, W. T., Lam, S. K. K., & Ross, C. A. (2023). The relationship between dissociation and complex post-traumatic stress disorder: A scoping review. Trauma, Violence, & Abuse, 24(5), 2966-2982. [ADD DOI LINK]
Heim, E., Karatzias, T., & Maercker, A. (2022). Cultural concepts of distress and complex PTSD: Future directions for research and treatment. Clinical Psychology Review, 93, 102143. https://doi.org/10.1016/j.cpr.2022.102143
Sele, P., Hoffart, A., Cloitre, M., Hembree, E., & Oktedalen, T. (2023). Comparing phase-based treatment, prolonged exposure, and skills-training for Complex Posttraumatic Stress Disorder: A randomized controlled trial. Journal of Anxiety Disorders, 100, 102786. https://doi.org/10.1016/j.janxdis.2023.102786
World Health Organization. (2022). ICD-11: International classification of diseases (11th revision). https://icd.who.int/
