Can EMDR Therapy Be Done Online?

As an accredited EMDR therapist who works internationally and mostly online, I often get asked this question. Understandably it’s an important question because if you’re going to commit to the process of therapy, that means you have things you want to shift. In particular if you are coming for EMDR, which is widely recognised and recommended for shifting trauma.

International clients reaching out to me for online EMDR are often in some type of crisis. It could be a relationship rupture or betrayal. A business ending. A depression that won’t go away. A nervous system that is so frazzled that they are no longer functioning fully. There might have been a final trigger that made you start the search for therapy after a long period of things building up. Other clients get in touch because of a one-off traumatic episode. So when you start the therapy search there is a lot at stake.

The stakes are often very high. If you don’t resolve this issue you fear you will lose your partner. Or never find a partner. You fear you will have a breakdown. Or lose your business. Or fall into addiction. Time is precious. You feel like you don’t have time to lose.

You want to make sure that the type of therapy and the therapist themselves will be able to help you. You don’t want to have to go through the whole process of opening up and explaining your life story again (as you’ve likely had some type of therapy before), only for the therapy not to work. Even worse you don’t want to raise your hopes and expectations. Especially since there are parts of you that might feel hopeless, helpless and resigned. These parts feel too fragile to hold any more disappointment. They might already believe (falsely) that they are broken or permanently damaged. They don’t want to have that reinforced.

Not to mention the financial investment — you want to make sure it is going to be worth it.

You need to know the therapy has a proven track record for your type of issue. You also want to know that the therapist has a proven track record of helping people like you with that modality.

So dear reader, let me tell you more about EMDR.

 Online EMDR Therapy Worldwide

Today many EMDR therapists work with clients internationally through secure online sessions. Online EMDR therapy allows people to access specialised trauma treatment regardless of where they live. I work with clients across the UK, Europe and internationally who are seeking online EMDR therapy, as well as seeing clients in person in Lisbon.

Can EMDR Be Done Online?

Yes of course. I have been working online since I got accredited with the UK EMDR Association and EMDR Europe in 2019 and before. When the pandemic hit a lot of therapists took their practices online including EMDR therapists. In my professional network of attachment-informed EMDR therapists, many of us are still working entirely online. Others have around half of their case load online.

How does it work online? There are various platforms. The one I use is called Bilateral Base. It is a platform created by EMDR therapists that allows us to conduct EMDR via video call. There is no subscription at your end and no software to download.

At my end I can set a light bar in motion across the screen. You follow the light bar with your eyes. As your eyes follow it they move horizontally from the right side of the eye socket to the left side. This is exactly the same as following a therapist’s fingers during EMDR in person.

The platform also allows the light bar to move diagonally or in other directions, which can be helpful if the processing becomes stuck.

If you prefer to process with your eyes closed, Bilateral Base also allows me to play binaural tones which alternate between the left and right ear. This can help you connect more deeply with body sensations, which can be particularly helpful when working with preverbal trauma.

Bilateral tapping is also an option. This is where you tap left-right-left-right on your body instead of following the light bar. Many EMDR therapists worked this way for years and it remains very effective.

Is Online EMDR Effective?

EMDR can be as effective online as it is in person. For some clients across the UK, Europe and internationally it is even more effective.

One reason is that being in your own familiar space can help you feel more relaxed and safe than travelling to a therapy office. For people with social anxiety or high stress levels the journey to therapy can itself be dysregulating.

Online therapy removes this barrier. It also removes practical obstacles such as travel time or scheduling difficulties, which means clients are more likely to attend consistently.

Research conducted during and after the Covid-19 pandemic has shown that EMDR delivered via secure video platforms can be effective. For example Lenferink et al. (2020) found that online EMDR significantly reduced symptoms of traumatic grief and PTSD. Research on telehealth trauma treatment more broadly, including Spence et al. (2021), has also found that trauma-focused therapies delivered online can produce clinically significant reductions in PTSD symptoms comparable to in-person treatment.

Professional bodies such as EMDR International Association (EMDRIA) and EMDR Europe also recognise that EMDR can be delivered effectively through telehealth when appropriate preparation and safety procedures are in place.

Who Online EMDR Works Best For

Online EMDR can work well for a wide range of clients.

In the past some clinicians believed that people who were very dysregulated should only do EMDR in person. However since the pandemic many therapists have successfully worked online with clients presenting with complex trauma.

In the initial assessment session I carry out a risk assessment and explore what will help you stay contained in the work.

If your Window of Tolerance is relatively narrow we simply spend more time on resourcing before beginning processing.

The term Window of Tolerance was introduced by psychiatrist Dan Siegel and refers to the range of emotional activation within which a person can function effectively. When we move outside this range the nervous system may move into anxiety and overwhelm or into shutdown.

Research on video-based psychotherapy suggests that therapeutic alliance and treatment outcomes are comparable to in-person therapy. For example Simpson & Reid (2014) found that strong therapeutic relationships can be developed through video sessions.

In practice the key factor is not whether therapy happens online or in person, but whether the therapist works carefully and attunes to the client’s nervous system throughout the session.

What an Online EMDR Session Looks Like

Each session lasts 50 minutes.

In the first session we begin with an assessment. I ask questions to understand what you are struggling with and to identify a clear therapy goal. Having a defined goal gives the work structure and allows us to track progress over time.

I also explore your current context including support systems, relationships and stressors. As an attachment-informed EMDR practitioner I also ask about childhood and teenage experiences.

In the second session we focus on resourcing. This includes exercises designed to help you feel grounded and supported in the work.

These may include the Safe or Special Place visualisation, imagining a team of protectors, or identifying a wise figure that represents guidance and compassion.

We install these resources using bilateral tapping, often tapping left-right on the thighs or using the “butterfly hug”.

When we move to trauma processing we typically use the light bar or auditory bilateral stimulation.

EMDR therapists vary in how quickly they begin processing. Earlier approaches were more cautious about starting processing with highly dysregulated clients. However research has increasingly shown EMDR can also be beneficial for more complex presentations including personality disorders. For example Miller et al. (2021) found that EMDR therapy significantly reduced symptoms in individuals with borderline personality disorder when traumatic memories were processed.

When we begin processing we identify a target memory or situation. EMDR works with visual channels so we establish a clear image linked to the issue you want to change. We identify the emotions, body sensations and beliefs connected to that memory.

Then bilateral stimulation begins while you allow your mind to follow whatever associations arise.

Working With an EMDR Therapist Online Worldwide

Many of the people who contact me for online EMDR therapy are living internationally.

Some are expatriates who have relocated for work. Others travel frequently or live in countries where it is difficult to find an EMDR therapist.

For many clients it is also important to work in English even if they live in a non-English-speaking country. Being able to express complex experiences in your first language can make therapy easier and more precise.

Online EMDR therapy makes it possible to work with the therapist who feels like the right fit for you rather than simply the therapist who happens to be geographically closest.

I work with clients across the UK, Europe and internationally through secure online sessions, and I also offer in-person therapy in Lisbon.

If you are considering EMDR therapy and wondering whether online sessions could work for you, the first step is usually an initial consultation.

In this conversation we explore what you are struggling with, what you would like to change, and whether EMDR therapy might be the right approach. It also gives you a chance to ask questions and see whether working together feels like a good fit.