The EMDR Fidelity Rating Scale (EFRS) evaluates adherence to EMDR therapy’s standard eight-phase treatment approach and three-pronged protocol (Shapiro, 2001, 2017). 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 in addressing memories of adverse life experiences or current triggers eliciting distress.

The EFRS is a comprehensive rating instrument designed to assess treatment integrity in a single EMDR session and over the course of EMDR treatment. Also, to use in research, the EFRS can be used by an individual clinician to monitor fidelity in his/her own treatment sessions and by EMDR consultants when assisting therapists in the development of their EMDR therapy skills. It includes the EFRS Scoring Workbook which contains an embedded calculator which automatically calculates scores for each session, a therapist’s overall fidelity, and the overall fidelity in a research study. 

The current version (version 2: 10/01/2018)  was completed by Deborah L. Korn, Psy.D., Louise Maxfield, Ph.D., Nancy J. Smyth, Ph.D., and Robert Stickgold, Ph.D., and integrates feedback from clinicians, raters, and researchers. For questions or feedback, please email the authors at

Important Information about Version 2

The EMDR Fidelity Rating Scale (EFRS) has been significantly revised since it was originally published on the EMDR Research Foundation website in August 2017 (Version 1).  Based on feedback from clinicians, consultants, and researchers, changes were incorporated to make the EFRS more precise and user-friendly.  The Manual has been expanded with more examples and detail to help consultants, researchers, clinicians, and raters in using the EFRS to evaluate fidelity.  The EFRS Scoring Form was modified and Version 2 now differs from the versions published both on the EMDR Research Foundation Website and in the appendix of the third edition of Dr. Francine Shapiro’s textbook (2018).  Some previously existing items were reworded and some new items were added.  The Excel workbooks, with their embedded calculators used for calculating fidelity scores, have been updated to correspond with Scoring Form Version 2.  If you were previously using Version 1 of the EFRS, we strongly urge you to shift to using the updated and improved Version 2.  Also, we offer you a reminder 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.

To access the EFRS scroll to the table at the bottom of this page and click on the file name you wish to download. Users should download all five parts of the EFRS, which are briefly described here:    

Part One The EFRS Scoring Form (with five subscales)

  1. Introductory Subscale 
    (history-taking and treatment planning, preparation, safe/calm place exercise)
  2. Resource Development and Installation (RDI) Subscale
    (optional part of the Preparation Phase)
  3. Adverse Life Experiences (ALE) Processing Subscale for Past Events and Present Triggers/Symptoms
    (reevaluation, assessment, desensitization, installation, body scan, closure)
  4. Future Template (FT) Subscale
  5. Three-Pronged Protocol (TPP) Subscale 
    (Ratings based on the review of data from Treatment Plan Tracking (TFT) form available in the online manual. Evaluates whether clinician did or did not appropriately identify and process relevant past adverse life experiences, present triggers/symptoms, and future templates associated with a given presenting issue. Completed by rater at the end of treatment/research study.)

Part Two: The EFRS Manual
The 35-page manual includes an overview of the ERFS, description of the scale and subscales, scores and fidelity criteria, instructions for researchers, instructions for clinicians, instructions for raters, and references.

Part Three the EFRS Clinician Forms (includes two forms that are completed by the clinician)

  1. Single Session Summary (SSS) Form 
  2. Treatment Plan Tracking (TPT) Form 

Part Four the Blank EFRS Workbook
An excel spreadsheet that includes an embedded calculator which automatically calculates scores for each session, a therapist’s overall fidelity, and the overall fidelity in a research study.

Part Five the Sample EFRS Workbook
An excel spreadsheet that provides a sample of how the EFRS Scoring Workbook is used.

For questions or feedback, please contact the authors at:


Filename Date
An Adobe Acrobat file 1. EFRS Scoring Form v2 2018-10-03
An Adobe Acrobat file 2. EFRS Manual v2 2018-10-03
An Adobe Acrobat file 3. EFRS Clinician Forms v2 2018-10-03
A Microsoft Excel file 4. EFRS Blank Workbook v2 2018-10-03
A Microsoft Excel file 5. EFRS Sample Workbook v2 2018-10-03