EMDR Basic Training Participant Agreement Form  

The participant acknowledges that (s)he has been advised and understands:

This training is designed to be offered in both in-person and online formats. The participant can choose either option. In-person training is contingent upon a minimum enrollment of three (3) participants. If the minimum enrollment is not met, the training will be delivered fully online, and participants will be notified in advance. Potential Realized utilizes secure, encrypted HIPAA compliant audio/video transmission software to provide this distance learning. All professional and ethical considerations regarding confidentiality should be maintained for any clinical material that is obtained during the course of the training. The audio and/or video recording of the training or any portion thereof is not permitted. Potential Realized will record the training, but the participant is not permitted to record or distribute the content of this training. Course material, manual and worksheets will be provided and only available to the participant, but may not distribute or reproduce for personal/professional use (can be used with clients ONLY).

In-Person and Virtual Training

1. EMDR Basic Training is available to clinicians who work for non-profit or public sector organizations in a clinical mental health capacity. Clinicians working with underserved communities are also eligible to complete their training through Potential Realized. You will be asked to submit your employer's name, organization name, address, city, state, phone number and email address.
2. By entering this training, you are acknowledging that you will comply with a reasonable interpretation of the following statement and conditions: The content and application of this training material is for licensed clinicians only, and for their personal (non-commercial) use only. Viewing of this training is for registered participants only. No video, audio or image recordings of the presentation are permitted. No distribution of the program material to others including presenter PowerPoint slides is permitted without the presenter and sponsor’s permission. Any information pertaining to clinical examples must remain confidential. Participants will be assigned to groups of three (with one or two or four, if necessary, based on numbers) in order for there to be an observer. Observers will have explicit instructions to alert the facilitator under certain circumstances to ensure participant safety.
3. EMDR therapy is considered an "A" level treatment for trauma, recommended by the World Health Organization for children, adolescents, and adults. "World Health Organization. Guidelines for the management of conditions specifically related to stress. (2013)" Current research for additional applications will be presented and discussed in the training.
4. It is not unusual for a target memory to be linked to other, unexpected, disturbing material or memories.
5. A prerequisite for receiving a Record of Attendance is full attendance during the morning lectures and the completion of all practicum hours, where clinicians will give and receive EMDR under small group supervision. The practice experience is for educational purposes only and not for personal therapy.
6. Case material presented didactically, on video, or experienced during the practice session may be disturbing.
1. Clinicians presently engaged in personal therapy must consult with their therapist before participating in the Training; and
2. Those who presently have a dissociative disorder should not register before contacting the Potential Realized office; and
3. Those with limiting or special medical conditions (such as but not limited to pregnancy, seizures, heart condition, ocular difficulties, etc.) must get medical clearance from their medical professionals prior to participating in this Training.
7. Throughout the training you will need to be in a quiet learning environment. During the practice sessions, it is essential that the learning space be private and without any interruptions. You will be fulfilling the roles of therapist and client during the practice session. You should be in a location where you can talk freely, and others will not overhear you. If, at any time during the training, there is concern about your personal safety, you should inform the Potential Realized Faculty. All measures will be taken to ensure your safety and stability. 
8. Since the processing of targeted incidents may continue after training, other dreams, memories, etc. may surface. In such cases, it is the responsibility of the participant to seek and obtain appropriate assistance. Providing such assistance is neither a part of nor an extension of the Training. Clinicians who wish to continue with personal EMDR work can find a therapist on www.EMDRIA.org.
9. These experiential workshops are for clinical and research purposes only and will not qualify the participant to train others in EMDR.
10. Audio and/or video recording of the Training or any portion thereof is not permitted.
11. Attendance will be monitored by Potential Realized and the Zoom platform. Records of Attendance will only be issued to those who attend the full 42-hour training and participate in the practica on all five days. A Record of Completion will only be issued to those who complete the entire training and participate in all practica and complete all 10 hours of consultation. 
12. To successfully complete the training and receive the Record of Completion, you will be required to take a learning assessment based on the text and lecture with a score of 80% or better. You will have unlimited attempts to retake the assessment if needed.
13. EMDRIA will receive the roster of those who completed the virtual training within one week of their completion date, so that they have the option to survey them regarding their training experience. They will be referred to EMDRIA to encourage membership and for ongoing information and resources regarding EMDR Therapy.
14. 10 hours of consultation within 12 months of the training start date are required by EMDRIA to become a certified EMDR therapist. These 10 hours of consultation are included if scheduled within the first 3 months after training completion. During consultations, it is required for you to present cases in which you are using EMDR. After the 3 months, the participant is responsible for the full cost of consultations. This can range from $25 per session to $150 per hour and you may use any EMDRIA certified therapist who is either a consultant in training or consultant, who is also currently a member of EMDRIA. You may find them here: https://www.emdria.org/find-an-emdr-therapist/

If not licensed, I agree to practice EMDR only under the supervision of a licensed mental health clinician. I certify that the registration information that I have submitted online and on this form is accurate. 

Prior to your training, it is required that you read:

• Shapiro, F. (2001, 2018). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (3rd ed.). New York: Guilford Press.
• Shapiro, F. (2012). Getting past your past: Take control of our life with self-help techniques from EMDR therapy. New York: Rodale Press.
• EMDRIA (Ed.). (Fall 2020). EMDR and Racial Trauma. Go with that Magazine, 25(3).https://www.emdria.org/wp-content/uploads/2021/05/GWT.2020.Vol_.25.Issue_.3.RacialTrauma.ALL_.pdf 
• EMDRIA Virtual Training and Therapy Task Group. (Spring 2020). Guidelines for Virtual EMDR Therapy. https://www.emdria.org/wp-content/uploads/2020/04/Virtual_TG_Report_for_Member.pdf

Prior to the training, it is required that you view all 7 training videos and watch the pre-training learning video:

• Video links will be provided after registration in an EMDR training with Potential Realized.
• The books are available at any major online bookstore. All other Potential Realized resources are available through the Potential Realized site: https://www.emdrhap.org/content/training/trainee-resources/ 

Virtual Training Only

1. You will receive email instructions about how to connect to the training program. Please make sure that you have an adequate internet connection and power source for the entire training. It is also advised that you have a back-up plan in case there is loss of internet or a power outage during the training.
2. The training will be delivered via Zoom and the course materials will be available on Kajabi. You must familiarize yourself with these platforms in advance of the training.
3. Participants registered for the virtual format are required to complete a separate Zoom registration prior to the training date. This additional registration step is required to protect the integrity, privacy, and security of the training space. You may only be logged in to the platform on one device at a time.
4. Each participant will receive an individual Zoom access link via email after our admins approve your registration. Access links are unique and may not be shared. Sharing a Zoom link or allowing unregistered individuals to attend is strictly prohibited. Potential Realized reserves the right to remove any participant from the training if unauthorized access, link sharing, or security concerns arise.
5. It is important to note, per EMDRIA requirements, that during Virtual EMDR basic training, trainees must have their cameras turned on so that training faculty can monitor attendance, visual cues, facial expressions, etc.
6. Attend sessions from a quiet, private, and professional environment when possible. Avoid attending from public spaces or while engaging in other activities (e.g., driving).
7. You must sign-in to the training with the same name you registered with and be an authenticated Zoom user. You may Google this to find out how to ensure you are an authenticated user.

In-Person Training Only 

1. The in-person training is held at: Plaza Level Conference Room, Building 15, 3575 Piedmont Road NE, Atlanta, GA 30305 (In Piedmont Center)
2. Participants are responsible for purchasing parking. Information on the location will be sent via email to trainees who register to attend the training in-person.
3. While prior attendees have generally not experienced ticketing during daytime professional events, parking policies are managed by the property and may change at any time. Potential Realized does not control parking enforcement and is not responsible for parking citations, fees, towing, or policy changes.
4. Participants are responsible for reviewing posted signage and paying for their parking. Parking costs $5 per day for up to 10 hours and $10 per day determining whether to purchase parking in advance.

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I certify that I have read the entire Participant Agreement Form and that I understand and agree to accept all its terms.