IEMT Treatment Plans

A useful IEMT plan connects the client's chosen outcome with an explanation of the difficulty, a reason for the proposed intervention and a way to review its effects in everyday life. A brief piece of work may need only a short record. More complex needs call for more detailed planning, coordination and review.

This page translates the proposed Roy-informed governing principles into a practical workflow. It is an application developed for this wiki, not a validated assessment instrument, an established IEMT standard or a protocol authored by Callista Roy. It does not expand a practitioner's qualifications or scope of practice.

Start with what the person wants to become possible. Assess the response and its circumstances, agree an appropriate action, and review both the experience and the practical outcome.

Use the Adaptive Formulation and Outcome Review Sheet to make a concise record. The examples below illustrate how the same framework can support a decision to use IEMT or to prioritise other assistance.

The plan is an agreement developed with the client. Include only information relevant to understanding the work, making decisions and providing appropriate continuity of care.

• Purpose: the client's presenting concern, chosen life outcome and reasons it matters.
• Starting point: what the client reports, what the practitioner observes, existing strengths and relevant circumstances.
• Formulation: a provisional explanation, its supporting observations and what remains uncertain.
• Action: an IEMT target if appropriate, other options, practical support, responsibilities and consent.
• Review: indicators of progress, possible unwanted effects, the review date and the decision about further work.
• Coordination: relevant existing care, agreed communication and any needs that require another professional or service.

Record diagnoses already made by an appropriately qualified professional with their source where relevant. An IEMT formulation describes the proposed relationship between a difficulty and its circumstances; it is not a medical or psychiatric diagnosis.

For brief work, these elements may fit on one page. Where several services are involved, clarify who is responsible for each action and how the plan connects with existing care. Age, disability, culture, language and communication preferences may affect how planning is conducted. Sexual orientation and gender identity are not themselves problems to be treated; attend to the person's actual concerns and any discrimination or lack of support they face.

Ask what the client would like to do, experience or sustain differently. Translate a broad request such as “I want to stop feeling anxious” into a personally meaningful outcome, while retaining the client's own language.

For example: “I want to contribute an idea during our weekly team meeting, even if I still feel some nervousness.” Record what currently happens: the client has stayed silent at the last three meetings and reports anticipatory distress of about 7 out of 10. The distress rating and participation record describe different aspects of the starting point.

Agree the reference situation, scale anchors if using a rating, and a review point. A range, a verbal description or “I cannot tell yet” may be more accurate than a precise number. Do not make a zero distress rating a universal requirement for success.

Explore what occurs, when it occurs, what follows, when it is absent and what already helps. Distinguish the client's account from direct observation and from either person's interpretation.

“The client reports a racing heart before speaking” is a report. “The client paused for several seconds” is an observation. “The pause protects against criticism” is a hypothesis requiring exploration. An early memory offered during IEMT work does not, by appearing, establish the cause of the current problem.

Consider whether a response provides useful protection as well as creating difficulty. Do not assume every response has a discoverable protective purpose. The plan should preserve useful options and make room for alternatives.

Roy distinguishes three stimulus categories: focal, the internal or external stimulus most immediately confronting the person; contextual, other factors contributing to its effect; and residual, factors whose influence in the current situation remains unclear. Roy Adaptation Association: model terminology.

Use the categories as a working description, revisable as understanding changes. A remembered event or an imagined future conversation can be the focal stimulus now. “Residual” does not mean “past trauma”. The wiki's term “prospective” describes anticipated content rather than a fourth category attributed to Roy.

Ask about practical constraints and resources: workload, rest, access to help, illness, finances, housing, relationships, relevant skills and existing care. Record what the person can influence, what depends on others and what is currently outside their control. Adaptation may require changing or leaving a situation, challenging an expectation or obtaining support.

For individuals, Roy's four modes are physiological, self-concept, role function and interdependence. The questions below are proposed IEMT planning prompts; they are not a diagnostic checklist. Roy Adaptation Association: adaptive modes.

Record strengths as well as difficulties. Every mode need not become a treatment target. Bodily symptoms requiring assessment belong with an appropriately qualified professional, rather than being presumed to be emotional imprints.

Summarise the proposed relationship among the response, circumstances and desired outcome. Include uncertainty and at least one plausible alternative explanation. For example:

When anticipating speaking in a meeting, the client recalls a humiliating presentation and expects renewed criticism. This may contribute to avoidance. Limited preparation time and the meeting format also matter. We have not established that the remembered event caused the difficulty.

Then explain why the proposed action fits. An IEMT target might be a particular reported emotional response or identity statement, where work on that target is within the practitioner's competence and the client chooses it. Other actions might include practising a skill, arranging assistance, changing a demand or obtaining assessment from another professional.

Discuss the intended benefit, uncertainty, relevant risks and alternatives, including deferring or declining the intervention. Agree how to pause or stop. Shared decision making includes the person's priorities and their ability to change a decision; these principles are also described in NICE's healthcare guidance. That guidance does not constitute an endorsement of IEMT. NICE NG197: shared decision making.

Where needs exceed the practitioner's competence, seek suitable supervision, referral or coordinated care. Urgent medical, mental-health or safeguarding concerns require the appropriate local response. Neither the Roy framework nor this worksheet supplies validated IEMT triage thresholds.

Record the agreed target, what was actually undertaken, any modification or stopping of the work, and the client's account afterwards. Immediate relief is one observation. Review whether it persists and whether the intended life change becomes possible.

Use the same reference situation and measurement method where possible. Ask about unchanged difficulties, unwanted effects and relevant changes elsewhere, including support, workload or other treatment. Record missed follow-up as an unknown outcome. Avoid attributing all change to IEMT simply because it followed a session.

Reporting no improvement, a remaining difficulty or a wish to stop is legitimate feedback. It does not by itself establish a Pattern of Chronicity.

Document relevant observations in descriptive language. “The client asked to pause and looked away” preserves what happened. Calling the same behaviour “manipulative” or “resistant” adds an interpretation that may be wrong.

Check the meaning with the client and consider communication style, culture, disability, fatigue and the interaction itself. Eye contact, emotional expression or uncertain language alone does not establish motivation, mental capacity or a diagnosis. A formal mental status examination or diagnostic assessment requires the relevant competence; IEMT training alone should not be treated as conferring it.

Choose a measure because it answers a relevant question and suits the person's circumstances. A short record of a chosen activity, the client's description of a response and an agreed rating may be sufficient for a narrowly defined goal. These do not replace clinical assessment where that is needed.

Where using a standardised instrument, follow its current instructions, permissions, population, time frame and interpretation requirements. Record the version used. Do not turn a change in a screening score into a diagnosis or proof of an intervention's mechanism.

For example, the PTSD Checklist for DSM-5 (PCL-5) can support symptom monitoring and screening, but its publisher specifies clinician interpretation and distinguishes it from a structured diagnostic interview. It is not a universal IEMT outcome measure. US National Center for PTSD: PCL-5 guidance.

Keep three records distinct:

• Target: the specific experience or pattern being addressed in the session.
• Life outcome: what the client wants to become possible beyond the session.
• Evidence at review: what the client reports, what was observed and what remains unknown.

A lower distress rating with continued inability to perform a valued activity is a partial result. Participation despite some continuing distress may be meaningful progress. The interpretation depends on the client's agreed purpose, not on a universal threshold imposed by the practitioner.

SMART can be used as a writing aid: make a goal specific, measurable, achievable, relevant and time-bound. It is optional, and writing a SMART goal does not establish that the treatment will work. Use a practical indicator or a clear description where a number would be misleading. A review date is a point for learning and revising, not a promised recovery deadline.

For example: “Over the next two team meetings, I would like to contribute one prepared idea at each. At our review we will discuss what happened, how it felt and whether the meeting conditions supported this.”

Include dependencies: participation also requires an opportunity to speak and a workable setting. Goals concerning another person's cooperation should identify the client's own possible action and separately record the response from others.

Both examples are fictional planning illustrations. Their review scenarios are hypothetical, not treatment results or evidence of effectiveness.

Situation and outcome. Alex avoids contributing at otherwise supportive team meetings and wants to offer one prepared idea at each of the next two meetings. Alex recalls an embarrassing presentation and reports distress of approximately 7 out of 10 when anticipating speaking.

Formulation. The immediate focal stimulus is the anticipated meeting. Limited preparation time and a rapidly moving discussion are contextual factors. The recalled embarrassment is relevant material to explore, but its causal role has not been established. If its current influence remains unclear, record that uncertainty. Do not classify it as residual merely because it happened in the past.

Four-mode review. Alex reports restless sleep before meetings, a self-description of being incompetent, difficulty fulfilling a valued work role and reluctance to ask a supportive colleague for help. Existing strengths include subject knowledge and successful conversations in smaller groups.

Agreed action. If assessment supports its suitability and Alex chooses it, the practitioner proposes IEMT work on the agreed emotional response within their training. Alex also prepares a short contribution and considers asking the chair for an opportunity to speak. The practitioner explains uncertainty about benefit and agrees a stopping signal and review after the two meetings.

Review scenarios. Reduced distress together with useful participation would support discussing whether the agreed work is complete. Reduced distress without participation would prompt review of preparation, meeting conditions and remaining difficulty. No improvement would prompt reconsideration of the plan; it would not prove that Alex was resisting change.

Situation and outcome. Morgan is caring for a relative while working changing shifts. Morgan asks to remove the guilt associated with saying no, but also reports persistent exhaustion and insufficient help. The chosen outcome is a sustainable arrangement for care and rest.

Formulation. An immediate request to cover another night of care is the focal stimulus. Existing workload, interrupted rest and limited available help are contextual factors. A family expectation about always being available is a possible influence to explore, not an assumed cause.

Four-mode review. The discussion identifies lack of rest, a belief that asking for assistance means failure, competing work and caring roles, and a support network with real limits. Morgan already has a clear understanding of the care required.

Agreed action. The first plan is to explore available care support and renegotiate responsibilities, with relevant health assessment for the exhaustion. Morgan chooses whom to approach; the practitioner helps clarify the request and works within their role. Emotional or identity work may be considered later if wanted and appropriate. Reducing guilt alone would not supply missing care or rest.

Review scenarios. Review whether help was accessible, whether the workload became manageable and how Morgan experienced the changes. If support is unavailable, revise the practical plan. Continuing difficulty in those circumstances does not demonstrate a failed attitude, a defective identity or a Pattern of Chronicity.

Use the formulation and review sheet alongside any records required in the practitioner's setting. Store completed records in an appropriate secure practice system; do not enter identifiable client material on this public wiki.

The framework's usefulness should also be examined: does it help identify unmet needs, explain choices, notice lack of benefit and guide better next decisions? A coherent formulation is not proof of IEMT efficacy. Keep evidence for the procedure, evidence for the proposed explanation and evidence for the planning framework distinct. See the governing principles' discussion of evidence.

• Roy's Adaptation Model as Governing Principles for IEMT Practice
• Adaptive Formulation and Outcome Review Sheet
• Integral Eye Movement Therapy (IEMT): An Adaptive Model
• The IEMT Model