How to do EMDR remotely: a practical guide

Does online EMDR work?

There is less research on remote EMDR than on in-person EMDR, but it is growing. A systematic review in Frontiers in Psychiatry looked at 16 studies with 1,231 participants. The studies covered remote individual and group EMDR and self-administered computerised protocols, and together they showed promising reductions in PTSD symptoms, anxiety and depression. The authors also point out the limits: small samples, few control groups and a reliance on self-report measures. In practice, many EMDR therapists now offer online sessions routinely, with a few adaptations described below.

What you need

• A video call platform you already use for the conversational parts: history taking, preparation, SUD/VoC and closure. Pick one that meets your privacy obligations (GDPR in the EU).
• A separate bilateral stimulation tool that the client opens in their browser. Screen-sharing a moving dot over a video call works poorly: compression and dropped frames make the movement stutter, and the client sees your whole desktop.
• On the client's side: a laptop or larger screen (a phone is small for eye movements), a stable connection, headphones if you use auditory stimulation, and a private room where they won't be interrupted.

Step by step with Remote EMDR

1. Start your video call as usual and check in with the client.
2. Open Remote EMDR and click Start a Session. A private session is created for you automatically.
3. Copy the Patient Link from the Share section and send it in the chat of your video call.
4. The client opens it in a new browser tab or on a second screen. They see only the full-screen stimulus, with no menus or controls.
5. Adjust speed, pattern (left-right, up-down, figure 8 or random), ball size, colour and optional bilateral sound. Changes appear on the client's screen immediately.
6. Keep the video call running so you can hear the client and see them between sets.

Tip: ask the client to put the stimulus full-screen on their laptop and join the video call from a second device, such as a phone propped up next to it. You can then see their face during sets too.

Remote EMDR doesn't need your client's name, email or an account. The patient link contains only a random session ID.

Adapting the protocol for remote work

• Put more time into preparation. Build resources such as a calm place and containment, and make sure the client can regulate themselves before you start reprocessing.
• Agree on a stop signal that works on video, such as raising a hand. Quiet speech is easy to miss.
• Use shorter sets and check in more often at first, until you know how the client responds online.
• Have a safety plan: the address where the client is during the session, the local emergency number, and someone they can contact afterwards.
• Plan for a dropped connection. Agree in advance that if the call drops, you will phone the client. Meanwhile they stop the stimulus and do a grounding exercise until you're back.
• Leave time for closure (phase 7). The client can't sit in your waiting room for ten minutes after the session, so build that time into the session itself.

Visual or auditory stimulation online?

Eye movements are the usual default, but some clients do better with sound: for example when the screen is small or their eyes get tired. With headphones, alternating left-right tones work very well remotely. Our guide to visual vs auditory bilateral stimulation compares the options.

When to consider in-person sessions

Consider in-person work if the client dissociates strongly or has frequent intense abreactions, if there is acute suicide risk, if there is no safe private space at home, or if the connection is too unreliable. These are clinical judgement calls. Many therapists start online and switch to in-person sessions when needed.