Please carefully read the information outlined below and initial each point to indicate that you understand and agree to what is outlined in this document. Please contact the LK Institute regarding any questions or matters that require clarification. Further, you acknowledge that you have had significant time to review this document before signing it.

(a) Eligibility Criteria

Licensed Mental Health Professionals

• Qualifying Medical Doctors must be licensed to practice in their state or province.
• Qualifying Advanced Practice Registered Nurses must have a Master of Science in Nursing (or higher) with a specialization in psychiatric mental health nursing and must be licensed to practice through their state board or province.
• Qualifying Mental Health Clinicians must have a Master’s Degree in the mental health field (Counseling, Marriage Family Therapy, Psychology, Psychiatry, Social Work) or related mental health discipline and be licensed to practice through their state board or province.

Pre-Licensed Mental Health Professionals

• These are clinicians who are actively pursuing a mental health license through their state board (or province) while working under a licensed supervisor. Some of these license types may include: associate, intern, limited, provisional, temporary and pre-license.
• Qualifying Pre-Licensed Mental Health Clinicians must have a Master’s Degree in the mental health field (Counseling, Marriage Family Therapy, Psychology, Psychotherapy, Psychiatry, Social Work) or related mental health discipline and must be actively pursuing a full license through their state board (or province) while working under a licensed supervisor.

Graduate Students

• Qualifying graduate students must be enrolled in a Master’s or Doctoral program in the mental health field (Counseling, Marriage Family Therapy, Psychology, Psychotherapy, Psychiatry, Psychiatric Nursing, Social Work) or related mental health discipline. Students must have completed their core graduate academic coursework and must be in the practicum/ internship portion of their graduate program. First year graduate students are not eligible. Graduate students must be on a licensing track and working under the supervision of a fully licensed mental health clinician.
• Graduate students who would like to take an EMDR Training will need to submit certain documentation (graduate transcript, practicum or internship details, and a letter of recommendation from their supervisor which includes the supervisor’s license information and number) in order to verify their eligibility. Any documentation that needs to be submitted would go directly to the training provider either prior to or during the training registration process.

- I understand and acknowledge that I have read and understood the Eligibility Criteria for the EMDR Basic Training, and that I meet the eligibility requirements. 

- I attest that I am permitted to practice counseling/ psychotherapy according to the state regulatory bodies where I intend to practice EMDR Therapy.

-I understand that I am responsible for knowing the practice requirements as dictated by the state in which I intent to practice counseling/psychotherapy, and that I have fulfilled all of those requirements (e.g. graduate student under supervision, non-licensed professional under supervision, independently licensed mental health professional).

-I understand that I cannot practice EMDR Therapy, and thus cannot participate in this EMDR Basic Training, if I am not currently eligible to practice counseling/ psychotherapy.

-I understand that failure to provide written documentation to the LK Institute indicating that I am under any required supervision will forfeit my opportunity to participate in EMDR Basic Training and I will not receive a refund.

-I understand that all fees are non-refundable, though in the event that I must cancel my scheduled registration participation, I will have one calendar year from the date of payment to participate in a different EMDR Basic Training offered by the LK Institute.

-I understand that, per EMDRIA requirements, I must complete the EMDR Basic Training, including all consultations, evaluations and post-test within 12 months of the initial start date to receive my certificate of completion. 

-I understand that I must provide written intention to participate in alternative training dates with at least 30 days’ notice of the scheduled training. I further understand that my ability to participate in the alternative training dates will be subject to availability.

-Due to limited participant availability, I understand that Training Dates cannot be separated in the event that I request to schedule a different training than originally registered for.

(b) Participation in Training

A significant component of the training involves clinicians practicing EMDR and related procedures in small groups under the consultation of the instructor or a qualified staff member. These practice experiences are for training purposes only and not for personal therapy. All participants should be prepared to address disturbing real- life experiences as part of this training program in order to appreciate the subjective experience of EMDR Therapy as a client would, and to provide valid training experiences for other participants. It is not unusual for a target memory to be linked to other, unexpected, disturbing memories or material, which might surface during or after the practice session. Trauma- related case material presented didactically, in consultation sessions, or on video may be disturbing to those with unresolved personal issues. In submitting their application for training, participants affirm that they have developed appropriate self- soothing and affect/arousal management skills to cope with exposure to this type of material and will be able to employ these skills as necessary during and following EMDR training, practice and consultation sessions. The trainer reserves the right to withhold or dismiss from training any participant that they deem unable to successfully complete the training for any reason. 

-I acknowledge that I have read the above statement regarding participation in training, and that I have understood the above statement regarding participation in training.

-I understand that I may have the opportunity to volunteer as a participant in a demonstration through the course of this training. This might include different components of EMDR Psychotherapy including, but not limited to: History Taking, Treatment Planning & Case Conceptualization, Safe/Calm Place, Resources Development & Installation, Future Template, Affect tolerance exercises and trauma reprocessing (and/or Phase 4-7), Phase 8 Re-evaluation, and other therapeutic components relevant to the training process. I recognize that I may or may not be selected to be a volunteer based on time restraints, and/or what is best for the training and learning process. If I am selected, I understand that I am volunteering completely at my own will and that it is not a requirement for me to successfully complete training. I recognize that there are potential benefits and limitations to participating in a demonstration. Some of the benefits may include: a deeper understanding of the teaching material, an emotionally healing experience as a result of the work, and the opportunity to help other therapists learn the material so they can better serve clients. Some of the limitations may include: vulnerability among peers, experiencing intense emotions (sometimes distressing) before, during or after the demonstration, and potential psychological stress. In the event that you are not currently receiving psychotherapy, we are happy to provide you with referrals to psychotherapists in the event participation in the demonstration yields negative effects for you. By signing this document, I understand that if I do choose to volunteer as a demonstration, I am not initiating a therapeutic relationship with Lauren Kiser or any of LK Institute affiliates. I understand that this is only for training purposes, and I am not beginning psychotherapy services, nor can psychotherapy services begin with Lauren Kiser after the training experience. I understand that participants in the room and participants online (who may be national or internationally located) are viewing the demonstration as a part of the training experiences. While LK Institute prohibits unauthorized recording from any training participants, LK Institute cannot guarantee participants compliance. Further, while LK Institute uses a HIPAA compliant virtual platform to stream the training. I understand that trainings (including demonstrations) are recorded, yet audio/video/transcript of my demonstration will not be reproduced or distributed without my prior written consent. I hereby do not hold LK Institute liable for any occurrences, incidents, consequences, or actions resulting from my voluntary participation in a demonstration in this training. 

-I understand and acknowledge that clinicians presently engaged in personal therapy and/or psychiatric treatment should inform their therapists and/or psychiatrist about all aspects of this training including the experiential component and secure their therapist’s and/or psychiatrist’s support to participate before beginning this training.

-I understand and acknowledge that those with limiting or special medical conditions (pregnancy, heart condition, ocular difficulties, head injuries etc.) should consult their medical professionals before participating in this training and should discuss their condition(s) with the training director in advance of submitting their application to participate in the training.

-I understand and acknowledge that participants are expected to maintain a spirit of cooperation and mutual support for all in the training. Attention seeking and/or conflict-generating behavior is not conducive to group learning. The training director has the right to dismiss anyone who is disruptive from the training at any time.

-I understand and acknowledge that the reprocessing of targeted incidents during practicum sessions may lead to the emergence of other disturbing memories during and after the practicum. It is the responsibility of the participant to seek, obtain and pay for appropriate professional assistance if needed. Providing such assistance is not part of the training and will not be provided by the EMDR Basic Training facilitator. Clinicians who elect to do personal EMDR work can find lists of EMDR trained clinicians through www.EMDRIA.org.

-I understand and acknowledge that in order to assure confidentiality of personal and clinical information, audio/video recording by participants is not allowed. It is expected that all participants shall maintain the highest ethical standards of confidentiality regarding all personal and clinical information shared by others in this training. Failure to maintain confidentiality shall be treated as a professional ethics issue and may result in immediate dismissal from the training program. Confidentiality shall apply to all training, practicum experiences and consultation sessions; specifics may be discussed only with members of the immediate consultation or practice group, the participant’s group consultant, practicum facilitator and trainer(s). In addition, a participant may share his or her own emerging material with a private therapist.

-I understand and acknowledge that should I attend the entirety, or a portion, of this training virtually, I am required to keep my camera on at all times, unless indicated otherwise by the trainer. Per EMDRIA requirements, virtual trainees must have their cameras turned on so that training faculty can monitor attendance, visual cues, facial expressions, etc. I understand and acknowledge that should I keep my camera off when indicated to keep my camera on, I may not qualify for continuing education credit and may not receive my Certificate of Completion.

(c) Participation in Consultation

-I understand and acknowledge that EMDRIA requires that I complete 10 hours of consultation to obtain a certificate of completion for the EMDR Basic Training. The EMDR Basic Training hosted by Lauren Kiser includes these consultation hours as a part of the training course.

-I understand and acknowledge that this professional consultation provides the opportunity for continued learning about EMDR theory and practice. During consultation I understand that I will receive individualized instruction and feedback in the application of the EMDR procedural steps, use of EMDR within a structured treatment plan, case conceptualization, client readiness, target selection, specific application of skills, and the integration of EMDR into clinical practice. Consultation provides the opportunity to improve the overall understanding and knowledge of EMDR, the practice of EMDR skills, and integration of EMDR into my practice.

-I understand and acknowledge that EMDR training consultation usually begins two to four weeks after the completion of the training portion of the course. The consultation groups usually meet via teleconferencing or videoconferencing and will be scheduled ahead of time. Participants are responsible for ensuring confidentiality and attend consultations when offered. During virtual consultations, trainees must have their cameras turned on so that training faculty can monitor attendance, visual cues, facial expressions, etc. I understand and acknowledge that should I keep my camera off when indicated to keep my camera on, I may not qualify for continuing education credit and may not receive my Certificate of Completion.

-I understand and acknowledge that If I am unable to attend the consultations at the available times offered and a different time cannot be negotiated, I will then be responsible for seeking out my own EMDR Basic Training consultation to complete the training at my own expense.

-I understand and acknowledge neither my consultant, nor other therapists/participants shall be construed as providing supervision to a participant on any specific case. While clinical possibilities will be discussed and ideas shared in relation to the clinical situations presented, I am solely responsible for the clinical management of the client/patient and I am expected to exercise my best judgment in all relevant clinical matters. I understand and acknowledge that whatever information is presented in these sessions is to be kept confidential among the participants both during and after my participation in the group. I agree to avoid disclosure of client’s names or other identifying information in making verbal presentations and in sharing written documentation of client sessions.

-I understand and acknowledge that the ability to practice EMDR Therapy with clients or other appropriate individuals is required in order to participate in this consultation. Consultation participants who are under supervision must receive written permission from their licensed supervisor to utilize EMDR Therapy during the consultation period. Students and interns must have approval to practice EMDR therapy through their university or agency and under the authority of their appointed supervision. This training program is not intended for managers and researchers who do not carry an active psychotherapy caseload.

-I understand and acknowledge that as part of training and consultation, I will have access to many documents that are the intellectual property of The Advanced Education Institute. These documents are meant for my personal and professional use. They may not be copied or disseminated to others without written permission by The Advanced Education Institute. All documents are meant as examples only. The appropriate creation, maintenance and storage of all client information remain the individual therapist’s responsibility in accordance with their state requirements, HIPAA regulations, and all other relevant governing agencies.

-I understand and acknowledge that the 10 hours of group consultation must be completed within 6 months of the training. Upon registration, I acknowledge that I am responsible for attending. This is a professional responsibility. Additionally, I acknowledge that if this is a 2 Part Basic Training, I am not able to attend the second part of training until I have completed at least 2 hours of consultation. Inability to attend Part 2 of the registered EMDR Training due to failure to complete the required 2 hours of consultation forfeits my opportunity to complete the training and all fees remain non-refundable.

Additional Information

Please carefully read the information outlined below and initial each point to indicate that you understand and agree to what is outlined in this document. Please contact the LK Institute regarding any questions or matters that require clarification. Further, you acknowledge that you have had significant time to review this document before signing it.

-I understand that a Certificate of Completion will be issued to all participants who satisfactorily complete the entire training and required consultation. Lauren Kiser is a Licensed Professional Counselor, Certified Eating Disorder Specialist Supervisor, EMDRIA Approved Consultant, Certified EMDR Therapist, PhD.

-I understand that this experiential training is intended to prepare clinicians to apply EMDR for clinical purposes only and will not qualify the participant to train others in EMDR. I understand that attempts to use any of the copyrighted training material to train others in EMDR without meeting the standards as defined by the EMDR International Association would present a violation of professional ethics and standards.

-Beginning December 22, 2022, EMDRIA requires that participants who begin the EMDR training must complete the entire training (including the 10 hours of follow- up consultation) within 12 months from their initial start date unless there are extraordinary circumstances. I understand and acknowledge that I must complete the entire EMDR Basic Training (including the 10 hours of follow- up consultation) within 12 months from the initial start date unless there are extraordinary circumstances communicated with and approved by the LK Institute training team, in coordination with EMDRIA.

-I understand and acknowledge that any EMDR-related products that might be available for purchase at the training (e.g. Theratappers, essential oils) are non- refundable given that there is no clear defect with the product. No returns or exchanges are permitted.

-I understand and acknowledge that, should I attend in- person, there may be complimentary snacks and refreshments provided at the training each day. These items might contain allergens such as eggs, dairy, wheat, and may not be made in a nut-free kitchen. Though the majority of refreshments are produced in commercial kitchens, some food products might be prepared in a home kitchen that is not inspected by the Department of Health Services or a local health department. I understand and acknowledge that consumption of any complimentary snacks, food, refreshments or beverages will be at my own discretion and I hereby waive any liability or responsibility to the EMDR Training Staff and Facilitator if I am to experience an adverse reaction related to product consumption.

-I understand that this advanced training qualifies for 40 NBCC hours. I acknowledge that participants interested in receiving the CE credit hours  may purchase those at an additional cost of $250. Participants may request further information regarding CE credit hours purchase at [email protected]. LK Institute has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7464. Programs that do not qualify for NBCC credit are clearly identified. LK Institute is solely responsible for all aspects of the programs.

-I understand participants must attend the training in full to receive the continuing education credits. Participants will not receive partial credit for partial attendance.

-I understand that the EMDR Training Fee is non-refundable. The fee for this training is $1475. 

-I also understand that I am responsible to read, understand, and agree to the EMDR Basic Training Participation Agreement before submitting this registration form. I hereby state that I have read, understand and agree to the guidelines outlined in this document.