TL;DR: This page explains why EMDR is often most effective when integrated with other therapeutic models, why some clients plateau in therapy, and how working with an EMDR specialist can support better treatment outcomes.
Therapists often ask why clients might do more than one type of therapy or an integrated therapy (integrated not eclectic). This article is meant to answer that question. The short answer is that some clients get stuck while using only one model. The long answer will follow in the rest of the article. While I am using EMDR therapy integration as an example here, this works in the reverse as well, and for several other models of therapy.
Specialists in Medicine vs. Specialists in Therapy
When a patient goes in for heart surgery, they do not see one provider. This is because one provider cannot cover all the bases for what is needed to help the patient. They see a surgeon, an anesthesiologist, a cardiac nurse, an imaging technician, a phlebotomist, etc.. Each one has a defined job. Nobody steps on anyone else’s role. Nobody redoes the other’s work. They communicate when it matters and stay in their lane the rest of the time.
At times, especially with complex cases, therapy may need to work the same way. The client may need to see a talk therapist, a prescriber, someone who can assess for neurodivergence or personality disorders, a trauma specialist and so on. Why doesn’t it work this way? Most referral relationships in mental health are built as hand-offs instead of partnerships. A client gets passed from one therapist to another, and the first therapist loses the thread entirely. That model made sense when specialties did not really overlap . It makes less sense now. For instance so many therapist are doing solid work in one model such as CBT or DBT and still hitting a wall that talk therapy alone cannot move.
Another reason for this is some schools of therapy teach that we need to be everything to a client, and if we cant, then we have failed as a therapist. Or if we cannot work with everything the client has going on, then we should not see them. This leaves the client looking for a unicorn therapist who can do everything. And in today’s era of ‘niching down’ this is becoming harder and harder to find. And finally, some therapists are afraid that if they ‘share’ a client with another therapist, that the other therapist will steal their client.
Why Some Clients Plateau in CBT and DBT
You know this client. The one you’ve done your best CBT or DBT with. The one who is engaged, doing the homework, using the skills, and still stuck on the same pattern six months later. The insight is there. The behavior change is not, or it is inconsistent in a way that does not match how much work the client is putting in.
This is often not a motivation problem or a skills gap. It is a sign that something underneath the presenting issue has not been processed. CBT and DBT are built to change thought patterns and build regulation skills. Neither one is designed to metabolize the traumatic memory driving the pattern in the first place. When the memory stays unprocessed, the nervous system keeps generating the same response no matter how many new coping tools the client has.
That is not a failure of your treatment. It is a different kind of clinical work, and it usually needs a different specialist.
Why Some Clients Plateau in EMDR
The client that plateaus in EMDR has the reverse problem. The trauma is being processed. The right memories have been worked through. The therapist is skilled, and the client is motivated, but they are still not getting the amount of change you would expect for the effort they are putting in. EMDR is great for removing the heat around the traumatic memory. However, trauma teaches us thought patterns and ways of coping that do not work in day-to-day life. Shutting down during a traumatic event may be the only way to survive it. Shutting down when your boss is calmly going over your quarterly assessment at work is not helpful.
While EMDR is an excellent tool, clients also need to develop new coping skills and thought patterns. Those can best be taught in talk therapy. While some EMDR therapists are skilled at both, those that are not, can look into partnering with another therapist who does a model such as DBT to help the clients fill the gap.
What the Specialist Model Actually Looks Like
In practice, what the specialist model looks like is excellent teamwork. Finding therapists and prescribers who fill the gaps in your skillset to make sure the client gets everything they need. I do this myself in my own practice routinely. For instance, I have clients who I can assume are neurodivergent based on their presentation. I don’t have the appropriate skillset at this time (it’s July 2026 and those courses are planned for later this year). Since I can’t do the appropriate assessments for this, I have therapists that I partner with who are incredibly skilled in Autism and ADHD assessment.
The client can sign a release for us to talk to each other, or they can bring their testing back themselves so that I have their results. The client can choose to see the specialist during the same week if they like, or we can go to every-other-week for the trauma treatment, or even pause if I think that is needed while they see the specialist. My goal is to do what’s best for the client’s health and mental health.
I also am on the other end of this with several clients. I am an EMDRIA Certified Therapist and Approved Consultant, based in Columbus, Ohio. I often work with talk therapists, CBT therapists, DBT therapists, and other talk therapists as the EMDR specialist on a shared case. They keep doing what is already working. I address the trauma block. Same client, same week, no overlap in approach. This is even the case when I know and use the same models. For instance, I have one therapist I partner with who is an excellent DBT therapist. I also do DBT. With our shared clients, I do not do DBT, only EMDR. We identify the memories and process them. Then I ask the client to report back to their DBT therapist what we worked on this week so that the DBT therapist can integrate that information into their work with the client.
This only works with a few ground rules in place.
How I Make The Specialist Model Work
In order for the specialist model to work, I have to set some ground rules that I always follow. This is to keep the focus on the client’s welfare, keep both therapists from working on the same issue while telling the client to do different things, and it keeps therapists from being concerned that I’m going to steal their client.
I Do Not Take Clients Who Already Have a Therapist Without That Therapist’s Knowledge
This is not a courtesy. It is a requirement before any referral moves forward. Sometimes a client comes to me and mentions an existing therapist and that therapist has not referred them to me for the additional work. When this happens I stop and make sure the client discusses the situation with their current therapist. I want to get everyone on the same page and connected before we start EMDR. Co-treatment only works when both providers know the full picture.
I Stay in My Lane Clinically
If the other therapist is doing DBT with a client, I am not teaching DBT skills in my sessions. If I am doing EMDR, I ask the client to use the skills their individual therapist has already built with them when they need to regulate during processing. I am not duplicating the other therapist’s work or second-guessing their treatment plan. I am integrating with it.
Clients Are Trained to Flag Conflicting Instructions
The biggest concern with having more than one therapist working a case is conflicting instructions. For example, if I ask a client to container a memory we have not finished processing and their CBT therapist assigns journaling on that same material that week, that is a problem. I handle this by telling the client how to handle this in the very first session, before anything can become an issue. I tell every client directly: if my instructions and your other therapist’s instructions seem to conflict, say something to both of us immediately. This means the therapists need to communicate and coordinate treatment. This one habit prevents most of the friction that co-treatment relationships worry about.
Insight Gets Routed Back to the Original Therapist
When something surfaces in an EMDR session that belongs in the cognitive work the talk therapist is doing, I send it back. I am feeding and integrating into their treatment, not competing with it. The goal is to clear what is blocking your client’s progress with them, not to become their new primary therapist. That being said, I have therapists who send their client over for a few weeks of EMDR to clear the block on one memory that is getting in the way of progress in talk therapy. I have other therapists I work with who we do co-therapy for months to help a client with severe dissociation or PTSD process the blocking memories while talk therapy continues apace.
Why EMDRIA Certification Matters When You Refer
When you send a client for EMDR, you are trusting that the processing gets done correctly. EMDRIA certification requires advanced training beyond a basic EMDR course, supervised practice hours, and ongoing continuing education. The preparation phases before actual processing begins are the difference between a client who leaves session more activated than when they walked in and one who leaves feeling resolved. Those phases are not optional extras. They are taught and practiced under supervision, and skipping them is where a lot of undertrained EMDR goes wrong.
As an EMDRIA Approved Consultant, I also supervise other therapists building their EMDR practice, and my current PhD research examines EMDR’s impact on family relationships. This is not a sideline service for me. It is the specialty. Over the course of my certification and consultation career I have learned multiple types of EMDR and which types work best for which clients. I also understand that EMDR may not always be the best option for a specific client, and am more than willing to discuss this with the client and talk therapist if I feel that the client is not currently a fit for EMDR and suggest other modalities that may work better.
What This Looks Like for Your Practice
You do not lose the client. You do not lose the relationship. You get a partner who clears the trauma block so your work can move again, then steps back once that piece is done. No overlap, no competition, no disruption to the treatment plan you have already built.
If you have a client where the therapeutic relationship is solid and the skills work is solid, but a pattern keeps resetting no matter what you try, that is worth a conversation before anything else.
I am happy to get on the phone before any referral moves forward, whether it is about a specific client or just how this kind of co-treatment might work in general. No commitment required on either end.
