The EMDR Fidelity Rating Scale (EFRS) 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: 10/01/2018)  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. 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 Foundation website in August 2017 (Version 1), making it more precise and user-friendly.  The Manual has been expanded with more examples and details.  The EFRS Scoring Form has also been modified and now differs from the versions originally published on the EMDR Foundation Website (August 2017) and in the appendix of the third edition of Shapiro’s Eye Movement Desensitization and Reprocessing (EMDR) Therapy (2018).  Some previously existing items were reworded and some new items were added.  The Excel workbooks, with their embedded calculators have been updated to correspond with  the revised Scoring Form.  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.  The Manual is designed both to provide basic instructions for the use and scoring of the EFRS and to answer questions that clinicians, raters and researchers might have about incorporating the EFRS into consultative and research settings.

To obtain the EFRS, click on the file you wish to download in the table at the end of this document. Users should download all five parts of the EFRS, which are briefly described here:    

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 ERFS, 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, please complete the online user registration form so that we can send you updates, information, and opportunities.  Please first complete the EMDR Fidelity Rating Scale User Registration Form


Filename Date
Click here to download zip file 2023

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