CIPOS—Constant Installation of Present Orientation and Safety—is a specialized technique within EMDR therapy designed to help clients maintain a strong sense of present-moment safety while briefly approaching traumatic material. It is especially useful for dissociative clients and those with complex trauma who become quickly overwhelmed. It was developed by Jim Knipe, described in EMDR Toolbox, Chapter 13: “The CIPOS Procedure”)
If you’re unfamiliar with EMDR therapy, EMDRIA provides an excellent, brief overview here:
https://www.emdria.org/about-emdr-therapy/
Why CIPOS Exists: The Specific Problem It Addresses
CIPOS: Helping Clients Stay Present During EMDR Trauma Processing
CIPOS—Constant Installation of Present Orientation and Safety—is a specialized technique within EMDR therapy designed to help clients remain grounded in the present while briefly approaching traumatic memories. It is particularly useful for individuals with complex trauma or dissociation who become overwhelmed when attempting to process painful experiences.
The technique was developed by Jim Knipe and is described in Chapter 13 of his book, EMDR Toolbox: Theory and Treatment of Complex PTSD and Dissociation.
The central idea behind CIPOS is relatively simple: Rather than asking a client to remain focused on a traumatic memory until it is processed, the therapist helps the client approach the memory for just a few seconds and then return to the safety of the present.
Through repetition, the client may gradually develop a greater capacity to experience disturbing memories without becoming overwhelmed.
For readers unfamiliar with EMDR therapy, the EMDR International Association provides an excellent introduction:
What Is EMDR Therapy? — EMDRIA
Why Is CIPOS Necessary?
One of the challenges of working with complex trauma is that clients may become overwhelmed when approaching traumatic memories.
In ordinary EMDR processing, a client is asked to focus on a disturbing memory while engaging in bilateral stimulation, typically guided eye movements. As processing unfolds, the client may experience emotions, bodily sensations, thoughts, and other memories associated with the original event.
However, some clients have difficulty maintaining sufficient awareness of the present while accessing traumatic material.
They may experience:
Emotional flooding: Intense emotions that become difficult to tolerate or regulate.
Dissociation: Feeling disconnected from themselves, their surroundings, or what is happening in the session.
Shutdown: Becoming emotionally numb, mentally blank, or unresponsive.
Loss of present orientation: Feeling as though the traumatic event is happening again rather than recognizing it as a memory of something that happened in the past.
For these clients, the problem is not necessarily that EMDR is inappropriate. Rather, they may need a different way of approaching the traumatic material.
In EMDR with Complex Trauma, Tyler Orr Zimmerman emphasizes that dissociation during processing can sometimes be a response to overwhelming activation. The therapeutic task, therefore, is not simply to eliminate dissociation but to help the client experience traumatic material at a level they can tolerate.
CIPOS addresses this problem by helping clients maintain present orientation while approaching traumatic memories in small, manageable portions.
Understanding Dual Attention
A central concept in EMDR therapy is dual attention.
Dual attention means that a person can think about a traumatic experience while simultaneously recognizing that they are safe in the present.
For example, a client might remember being frightened as a child while remaining aware that they are now an adult sitting in a therapist's office.
They recognize two realities simultaneously:
'Something frightening happened to me in the past.'
'I am here now, and that event is not happening to me anymore.'
This distinction is essential.
When a person loses dual attention, the traumatic experience may feel as though it is occurring again. Instead of remembering fear, the person experiences fear as a present reality.
CIPOS helps strengthen the ability to maintain both perspectives at the same time.
The Back-of-the-Head Scale (BHS)
One of the most important components of CIPOS is the Back-of-the-Head Scale, developed by Jim Knipe.
The BHS helps the therapist assess how strongly the client is oriented toward the present versus becoming absorbed in a traumatic memory.
Unlike the familiar 0–10 disturbance scale used in EMDR, the Back-of-the-Head Scale is not primarily concerned with how upset the client feels. It measures where the client's awareness is directed.
How the Scale Works
The therapist asks the client to imagine a line extending from a point approximately 14 inches in front of their face all the way to the back of their head.
The therapist may hold up two fingers in front of the client to represent the beginning of the line.
There are two endpoints:
1. In front of the face: Fully present
At this end of the scale, the client is completely aware of being in the therapist's office.
They can see the therapist, hear what is being said, recognize their surroundings, and understand that they are safe in the present moment.
Their attention is directed toward what is happening here and now.
2. At the back of the head: Fully immersed in the memory
At the opposite end, the client is mentally absorbed in the traumatic memory.
Even if their eyes are open, they may feel as though they are back in the original experience.
Their attention is no longer sufficiently connected to the present. They may have difficulty hearing the therapist, recognizing the safety of the room, or maintaining the awareness that the event is over.
The Dual-Attention Zone
Between these endpoints is an area where the client remains aware of the present while also having some access to the traumatic experience.
This is the dual-attention zone.
<escape> Fully Present ←——————→ Absorbed in the Past
| Present Orientation | Dual Attention | Traumatic Immersion |
</escape>
The purpose of the BHS is not to assign a numerical score. Instead, it gives the client and therapist a simple, visual way to assess how much the person's awareness has shifted away from the present.
For example, a client might point to a position relatively close to the therapist's fingers, indicating that they remain strongly connected to the room.
Later, after briefly approaching a traumatic memory, they might point farther back toward their head.
This suggests that the memory has become more absorbing and that the therapist may need to help them reconnect with the present.
How a Therapist Introduces the BHS
The therapist might explain:
'Imagine a line extending from my fingers here in front of your face all the way to the back of your head.
'This point in front of you represents being completely present here in the room with me. You can see me, hear me, and easily recognize where you are.
'The back of your head represents being so absorbed in a memory that, even though your eyes might be open, you feel as though you are back in that experience.
'Now, point to where you are on that line right now.'
The client indicates their present level of orientation by pointing somewhere along the imaginary line.
The therapist may then ask the client to look around the room, notice particular objects, listen to the therapist's voice, or become aware of the chair supporting their body.
Afterward, the therapist can ask the client to point again.
Ideally, the client will indicate a shift toward the present-oriented end of the scale.
Why the BHS Is So Helpful
One difficulty in trauma therapy is that clients may not always recognize when they are beginning to dissociate.
They may appear quiet or calm while becoming increasingly disconnected from their surroundings.
The BHS gives the therapist a practical way to check the client's level of present orientation without relying entirely on outward appearance.
It also helps the client become more aware of changes in their own consciousness.
Over time, the client may learn to recognize when they are becoming absorbed in traumatic material and how to return to present awareness.
The goal is not to eliminate awareness of the traumatic memory. It is to maintain sufficient awareness of the present while approaching the memory.
Why CIPOS Uses Very Brief Exposure to Traumatic Memories
Knipe's CIPOS procedure draws on the observation that when a client shifts attention from the present into a traumatic memory, awareness of the present may remain available for a brief period.
In his description, this short-term memory of present orientation may persist for approximately 2–20 seconds.
CIPOS makes therapeutic use of this principle.
Instead of asking a client to remain focused on the traumatic memory for an extended period, th
