Your first online EMDR session: what to expect and how to prepare

What happens in an online EMDR session

Online EMDR follows the same steps as EMDR in a therapist's office. In the first sessions you talk about your history and what you would like to change, and your therapist teaches you exercises to calm yourself down. Only after that do you start working on a memory. Read about the eight phases of EMDR if you'd like the details.

During the memory work, you briefly bring a memory to mind while you follow a moving ball on your screen with your eyes, or listen to sounds that alternate between your left and right ear. After each round your therapist asks what you notice. You don't need to explain or analyse anything; you simply say what comes up, and the next round begins. Your therapist sees and hears you on the video call the whole time.

What you need

• A laptop, desktop computer or tablet. A phone screen is small for following a moving ball. You can use your phone for the video call and the bigger screen for the ball.
• A modern browser such as Chrome, Edge, Firefox or Safari. You don't need to install anything or create an account: your therapist sends you a link.
• Headphones, if your therapist uses sound. Without them you won't hear the left–right effect.
• A stable internet connection. If your Wi-Fi is unreliable, sit close to the router.
• A private room where you won't be interrupted or overheard for the whole session, including the end.

Preparing your room

• Sit on a stable chair at a table, with the screen at arm's length and at eye level.
• Close other programs and turn off notifications, so nothing pops up over the ball.
• Keep a glass of water, tissues and something comforting nearby, such as a blanket or a familiar object.
• Let the people you live with know that you mustn't be disturbed, and keep pets in another room if they distract you.
• Make sure your therapist knows the address where you are during the session, in case of an emergency.

How the screen with the ball works

1. Your therapist sends you a link, usually in the chat of your video call.
2. Open it in your browser, ideally on your bigger screen. Click anywhere on the screen to start; this also allows the sound to play.
3. Make the browser window full-screen: press F11 on Windows, or Control-Command-F on a Mac.
4. You see only the ball and the background. Your therapist controls the speed, the direction and the sound. Keep the video call open so they can see and hear you.

During the session

• Agree on a stop signal, such as raising your hand. You can stop at any moment.
• Let whatever comes up, come up. Images, feelings, body sensations or seemingly unrelated thoughts are all normal. There is no right or wrong.
• It can feel more intense before it gets better. Your therapist is watching and will help you through it or slow things down.
• If the connection drops, stop looking at the screen, put your feet on the floor and look around the room, naming things you see. Agree beforehand how your therapist will reach you, for example by phone.

After the session

At home there's no waiting room and no journey back to help you switch gears, so plan a buffer:

• Don't schedule a demanding meeting or task straight after the session.
• Do something calming: a short walk, a shower, a cup of tea.
• Processing can continue for a few days. You may notice new memories, dreams, emotions or insights. Write them down briefly and bring them to your next session.
• Use the calming exercises you have learned, such as your calm place or the container.
• If you feel very unsettled, contact your therapist.

Does online EMDR work as well as in person?

Research on online EMDR is younger than research on EMDR in the therapy room, but the results so far are encouraging. A systematic review in Frontiers in Psychiatry of 16 studies found promising reductions in PTSD symptoms, anxiety and depression with remote EMDR, while noting that more controlled studies are needed. Some people also find it easier to talk about difficult experiences from their own home. Sometimes sessions in person are a better fit, for example if you tend to dissociate strongly. Your therapist will discuss this with you.