What an EMDR note is
EMDR (eye movement desensitization and reprocessing) is a trauma‑focused psychotherapy with eight phases, from history taking to reevaluation. A general progress note format such as SOAP or DAP can hold an EMDR session, but it doesn't have obvious places for the target memory, the negative and positive beliefs, the 0 to 10 SUD rating, the 1 to 7 VoC rating or the number of sets. An EMDR note adds those fields so you can follow each target across sessions.
The VA's National Center for PTSD describes EMDR for PTSD as typically delivered weekly over about three months, in individual sessions of up to 90 minutes, with the length varying by the patient's needs and response (VA National Center for PTSD). That means a typical course produces a dozen or so notes for the same few targets, which is why consistent fields matter.
| | |
|---|
| | Fields for each phase, target, SUD, VoC and sets |
| Medical and integrated settings | Works if you put SUD and VoC under Objective |
| | Works for history and preparation sessions with little reprocessing |
| | Use for non-EMDR sessions with the same client |
| | Feeds the target list in phase 1 |
What to record in each phase
| |
|---|
- History and treatment planning
| Targets identified: past events, present triggers, future situations. Readiness and any reasons to delay reprocessing. |
| Explanation given, consent, resources taught (calm place, container) and how well the client used them |
| Target, image, negative belief, positive belief, starting VoC, emotions, starting SUD, body location |
| Type of bilateral stimulation, number of sets, what emerged, abreactions and how they were managed, SUD at the end |
| Positive belief installed and final VoC |
| Residual sensation and whether it cleared |
| How the session was closed, state at the end, between-session instructions |
| At the start of the next session: SUD for the previous target, changes reported, what to work on next |
EMDR note example
Tomas (fictional), 44, was in a highway collision ten months ago. His therapist diagnosed chronic PTSD and they are using EMDR. Sessions 1 to 3 covered history and preparation. Session 4 started reprocessing the moment of impact. This is the note for session 5.
| Tomas, session 5, October 22, 2026, 60 minutes |
|---|
| F43.12, post-traumatic stress disorder, chronic |
| Reports two nightmares this week, down from most nights. Driving to work still with dread. SUD for the impact target is 5, from 3 at the end of session 4. Used the container exercise twice. |
| Moment of impact on the highway, continued from session 4 |
| Headlights filling the windshield |
| |
| "It's over. I survived." VoC 3. |
| Fear. Tightness in chest and hands. |
| Eye movements, 24 sets. Memory of the paramedic's voice emerged, then guilt that his passenger was hurt. Brief crying in sets 9 to 11, settled with grounding. SUD 2 at the end. |
Installation and body scan | Not started. Target incomplete. |
| Container exercise and calm place. Client calm and oriented at the end. Reminded to log disturbing images or dreams and use the container. |
| No suicidal thoughts. No safety concerns. |
| Session 6: reevaluate, continue desensitization on the impact target, then check the guilt about the passenger as a possible separate target. |
Two details make this note useful to the next session. It says plainly that the target is incomplete and why installation wasn't started, and it names the new material, guilt about the passenger, as a possible separate target. A note that only lists "EMDR, eye movements, client tolerated well" can't be picked up by you or anyone else.
Blank EMDR note template
- Client, date, session number, start and stop time:
- Diagnosis and ICD-10-CM code:
- Phase(s) covered this session:
- Reevaluation: changes since last session, SUD for the previous target:
- Target (past, present trigger or future template):
- Image:
- Negative belief:
- Positive belief and starting VoC (1 to 7):
- Emotions, starting SUD (0 to 10) and body location:
- Bilateral stimulation type and number of sets:
- What emerged, abreactions and how they were managed:
- Ending SUD:
- Installation: positive belief and ending VoC:
- Body scan result:
- Target status: complete or incomplete:
- Closure: method used and client's state at the end:
- Between-session instructions:
- Risk check:
- Plan for next session:
Common mistakes
- Recording SUD and VoC only at the start. The ending numbers are what show change, and the next session's reevaluation compares against them.
- Not marking incomplete targets. If the note doesn't say the target is open, the next session may start a new one by mistake.
- Writing the full trauma narrative in the progress note. Record the target and the client's responses. The detail of what they described can stay in your separate notes, if you keep any.
- Leaving out closure. If a client leaves distressed, the note should show what you did about it and how they were when they left.
- No start and stop times. Psychotherapy codes are billed by time, so record it every session.
Billing EMDR sessions
There is no CPT code specific to EMDR. You bill the psychotherapy code that matches the session, most often 90837 for a session of about an hour or 90834 for about 45 minutes, after an initial 90791 diagnostic evaluation. Some EMDR sessions run 75 or 90 minutes, so check your payer's policy before scheduling longer sessions. The diagnosis on the claim is usually a trauma code such as F43.12.
CPT is a registered trademark of the American Medical Association. CPT codes copyright 2026 American Medical Association. All rights reserved.
EMDR notes and psychotherapy notes
HIPAA's definition of psychotherapy notes in 45 CFR 164.501 excludes session start and stop times, the modalities and frequencies of treatment, results of clinical tests, and any summary of symptoms or progress to date. So the fields in this template, including the SUD and VoC ratings, belong in the regular record. What a client said about the trauma during reprocessing can be kept as separate psychotherapy notes if you choose. Our article on psychotherapy notes covers the difference.
Writing EMDR notes with Twofold
During reprocessing, most of the session is the client reporting what came up between sets, which makes it hard to take notes and stay present. Twofold drafts the note from the session, and with a custom template you can set up the fields above. Check the SUD and VoC numbers and the target status before signing, since those drive the next session.
For phase 1, use the trauma timeline and therapy intake assessment. For non‑EMDR sessions, the psychotherapy progress note or therapy note template. If risk comes up, use the mental health risk assessment and safety plan. Related codes: F43.12 and F43.10.
Reviewed and updated October 2026.
