Rethinking Readiness: EMDR for Complex Trauma in the Perinatal Period

EMDR therapy is a powerful modality for healing traumatic memory networks, but when we try to use it with perinatal clients holding deep, complex trauma, many clinicians find themselves stuck.

They may stall out in Phase Two, hesitate to enter Phase Four, or altogether shelve EMDR with clients they worry are "too complex" or "not ready." But -

What if the protocol isn’t the problem?

What if it’s how we’re understanding readiness?

The Problem with Starting Too Big

When clients arrive in acute distress, it can feel necessary to dive straight into their most overwhelming material. But instructor and author of EMDR with Complex Trauma, Thomas Zimmerman, Ms.Ed., LPCC, cautions us to slow down, "Therapy is going to be a while. We’re not in a sprint to be done in 8-12 sessions with clients with severe trauma.”

Thomas often uses a boat and fish metaphor to reframe how we assess capacity: the boat is the client’s store of adaptive information; the fish is the trauma target. "You can’t land a fish bigger than your boat.”

And for many perinatal clients with complex trauma, that boat is small. They simply don’t yet have enough adaptive information to support full reprocessing.

Watch Thomas Zimmerman explain the boat and the fish metaphor and its clinical relevance to EMDR with complex trauma.

Understanding Adaptive Information

Thomas reminds us that EMDR’s Adaptive Information Processing (AIP) model rests on one crucial mechanism:

"The difficult and stuck information starts to connect with existing adaptive information... and Shapiro was clear that you have to have enough of the needed adaptive information somewhere in you for EMDR therapy to work." - Thomas Zimmerman, Ms.Ed., LPCC

But people with complex trauma histories often didn’t have the chance to develop that adaptive information. Thomas calls it "learning that is different than the learning in the trauma.” Without it, the memory can't metabolize.

Research continues to affirm the importance of resourcing and stabilization in perinatal EMDR. A 2022 randomized controlled trial found that EMDR significantly reduced fear of childbirth and PTSD symptoms in pregnant individuals (Baas et al., 2022). Similarly, in 2015 van Deursen-Gelderloos and Bakker reported positive outcomes using EMDR for postpartum trauma, supporting the notion that carefully paced EMDR can be effective in these contexts.

Pacing as Ethical Practice

Thomas is clear: "I’ve never regretted starting with a small target with a client with complex trauma.” Starting smaller isn’t playing it safe - it’s trauma-informed care. It helps us test the boat and makes sure it floats before trying to land anything big.

Using metaphors like the Couch to 2K program, Thomas explains:

"We don’t start with the marathon. We can recognize it as our goal, but preparing for the 2K is what allowed us to start it... They [clients] are very likely to get hurt. And these are people we are trying to help.” - Thomas Zimmerman, Ms.Ed., LPCC

Watch Thomas Zimmerman expand on the importance of pacing through relatable metaphors.

These insights align with research on trauma-informed pacing. In a 2016 randomized trial, Meysner, Cotter, and Lee found that EMDR was effective for individuals experiencing complicated grief - but only when applied in a well-paced and attuned manner. Similarly, in 2001 Sprang found improved psychological outcomes for clients who received EMDR for traumatic stress and mourning, reinforcing the importance of thoughtful timing in treatment.

When clients ask to tackle their most painful memories right away, Zimmerman encourages us to say: not yet. Not because we won’t go there, but because we want them to survive the journey.

Starting Somewhere

For many clinicians, the hardest part isn’t resisting the impulse to rush; it’s knowing where and how to begin. Thomas warns that "one of the biggest risks is that we get so overwhelmed by everything that we aren’t going to start."

Join Thomas for a training that bridges the gap between the EMDR you were taught and the clients you actually work with. You’ll leave with practical tools, a clearer understanding of the AIP model’s implications for complex trauma, and renewed confidence in your ability to meet your clients where they are - without compromising the work.

EMDR and Complex Trauma with Perinatal Clients

🗓 August 19, 2025

Learn how to adapt EMDR for complex trauma in the perinatal period, with a focus on Phases Two and Four. Support clients in building tolerance, resourcing effectively, and moving toward deeper processing.

LEARN MORE AND REGISTER

Led by Thomas Zimmerman, Ms.Ed., LPCC, this training helps EMDR practitioners ethically and effectively adapt EMDR therapy for perinatal clients with complex trauma. You’ll gain tools to:

• Implement "dip-your-toe-in" resources and attachment-focused strategies

• Navigate the complexity of Phases Two and Four with greater confidence

• Build client capacity through tolerable, strategically paced interventions

These aren’t detours. They are the path. And they can make the difference between a client who disengages and a client with complex trauma who builds the internal capacity to heal.

This is especially vital given the high prevalence of posttraumatic stress in the perinatal period. Yildiz, Ayers, and Phillips (2017) found that PTSD affects a significant portion of individuals during and after pregnancy, making targeted and appropriately-paced interventions not just helpful, but essential.

If you’ve ever paused mid-session, wondering whether your client is truly ready for Phase Four, or felt unsure how to adapt EMDR for someone whose nervous system is already at capacity, you’re not alone.

This isn’t about abandoning the protocol. It’s about learning how to honor it more deeply.

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References

Baas, M. A. M., van Pampus, M. G., Stramrood, C. A. I., Dijksman, L. M., Vanhommerig, J. W., & de Jongh, A. (2022). Treatment of pregnant women with fear of childbirth using EMDR therapy: Results of a multi-center randomized controlled trial. Frontiers in Psychiatry, 12, Article 898215. https://doi.org/10.3389/fpsyt.2021.898215

Meysner, L., Cotter, P., & Lee, C. W. (2016). Evaluating the efficacy of EMDR with grieving individuals: A randomized control trial. Journal of EMDR Practice and Research, 10(1), 2–10. https://doi.org/10.1891/1933-3196.10.1.2

Sprang, G. (2001). The use of eye movement desensitization and reprocessing (EMDR) in the treatment of traumatic stress and complicated mourning: Psychological and behavioral outcomes. Research on Social Work Practice, 11(3), 300–320. https://doi.org/10.1177/104973150101100302

van Deursen-Gelderloos, M., & Bakker, E. (2015). Is EMDR effective for women with posttraumatic stress symptoms after childbirth? European Health Psychologist, 17(4), 873.

Yildiz, P. D., Ayers, S., & Phillips, L. (2017). The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. Journal of Affective Disorders, 208, 634–645. https://doi.org/10.1016/j.jad.2016.10.009