The EMDR Fidelity Rating Scale (EFRS) is a 5-part application that evaluates adherence to EMDR therapy’s standard eight-phase treatment approach and three-pronged protocol (Shapiro, 2001, 2018). Originally developed for use in a study by van der Kolk et al. (2007), the Scale has been revised and expanded over the years after receiving feedback from researchers and raters who had used the scale. The EFRS can be used in the evaluation of EMDR treatment sessions for any disorder or presenting problem in which standard EMDR procedural steps and the three-pronged protocol are used to address either memories of adverse life experiences or current triggers eliciting distress.

The EFRS is a comprehensive rating instrument used to assess treatment integrity in a single EMDR session and over the course of EMDR treatment. While the EFRS was developed for use in research studies, it can also be used by individual clinicians to monitor fidelity in their own treatment sessions, or by EMDR consultants when assisting clinicians in the development of their EMDR therapy skills. It includes the EFRS Scoring Workbook, which contains an embedded calculator that automatically calculates (1) scores for each session, (2) a therapist’s overall fidelity, and (3) the overall fidelity for a research study.

The current version (Version 2.1: 2023/01/12) was completed by Deborah L. Korn, Psy.D., Louise Maxfield, Ph.D., Robert Stickgold, Ph.D., and Nancy J. Smyth, Ph.D., and integrates continued feedback from clinicians, raters, and researchers.

Introduction to Version 2.1

The EMDR Fidelity Rating Scale (EFRS) was originally published on the EMDR Research Foundation website in August 2017 (Version 1). It was significantly revised in October 2018 (Version 2).

Based on feedback from clinicians, consultants, and researchers, changes were incorporated in Version 2 to make the EFRS more precise and user-friendly. The Manual was expanded with more examples and detail to help consultants, researchers, clinicians, and raters in using the EFRS to evaluate fidelity. Some previously existing items in the Scoring Form were reworded and some new items were added. The Excel workbooks, with their embedded calculators used for calculating fidelity scores, were updated to correspond with Scoring Form Version 2. This version of the EFRS differed from what was originally published both on the EMDR Research Foundation website and in the appendix of the third edition of Dr. Francine Shapiro’s 2018 textbook.

In January 2023, several minor typographical errors in the Manual were corrected (Version 2.1). If you were previously using Version 1 or Version 2 of the EFRS, we strongly urge you to shift to using the updated and improved Version 2.1.

We remind you that the EFRS consists of 5 parts and the Scoring Form, Clinician Forms, and Workbooks should not be used without reading the Manual or, at least, the relevant sections of the Manual. The Manual is designed both to provide basic instructions for the use and scoring of the EFRS and to answer most questions that clinicians, raters and researchers might have about incorporating the EFRS into consultative and research settings.

The five parts are described briefly, below. To obtain the EFRS, click on the zip file at the end of this page. Please be aware that the Workbooks use Microsoft Excel, and you must have that app to be able to them.

Part One: EFRS Scoring Form (with five subscales)

This form is used to score the (1) Introductory, (2) Resource Development and Installation (RDI), (3) Adverse Life Experiences (ALE), (4) Future Template (FT), and (5) Three-Pronged Protocol (TPP) subscales.

Part Two: EFRS Manual

This 53-page manual includes an overview of the EFRS, with descriptions of the subscales, relevant scoring and fidelity criteria, as well as instructions for researchers, clinicians, and raters. Citations to related literature are also included. Version 2.1 (January 2023) includes several corrections of typographical errors.

Part Three: EFRS Clinician Forms

This includes two forms completed by the clinician: (1) the Single Session Summary (SSS) Form and (2) the Treatment Plan Tracking (TPT) Form.

Part Four: EFRS Blank Workbook

This is an Excel workbook that contains worksheets for up to ten sessions and an embedded calculator that automatically calculates (1) scores for each session, (2) a therapist’s overall fidelity, and (3) the overall fidelity of a research study.

Part Five: EFRS Sample Workbook

This is a copy of the Blank EFRS Workbook with several sample spreadsheets showing how the EFRS Scoring Workbook is used.

For questions or feedback, please contact the authors at:

If you download (or plan to download) the EMDR Fidelity Rating Scale v2.1, please complete the EMDR Fidelity Rating Scale User Registration Form so that we can send you updates, information, and opportunities.

File Name Date
Please click here to download zip file containing all 5 parts of EFRS v2.1 2023

Korn, D. L., Maxfield, L., Stickgold, R., & Smyth, N. J. (2018). EMDR Fidelity Rating Scale (EFRS), Version 2. Retrieved from