I’ll never forget those few days in the middle of March 2020. Like most of my therapist colleagues, I was keeping my eye on the news about some virus that was sweeping around the world and watching as businesses, national sporting leagues, and indeed entire cities were shutting down in order to protect our public health. When it was clear that this virus was going to become very real for my work, I quickly did a google search to find out about online platforms so I could continue to see my clients with as little disruption as possible. Within a matter of days, my practice – which had up until that time been entirely conducted in person – was 100% telehealth. Prior to March 2020, it had never occurred to me to see clients online. I was worried about what this would mean for the quality of care I provided to my clients. I had no idea if doing telehealth would meet my standards, or if it would even work.
Fast forward to almost four years later, my practice is still 100% virtual. Over the past four years, I have done literally hundreds of hours of EMDR sessions online, including EMDR intensive sessions. In that time, my experience has been, and I think my clients would agree, that online EMDR therapy is just as effective as in person EMDR therapy.
When new clients reach out to me for EMDR therapy, there are a few common questions that they tend to have. In this blog, I am addressing what is by far one of the most common questions I hear: Can EMDR be done online?
Today we'll explore the possibilities, benefits, and considerations for online EMDR therapy so you will know whether or not it's right for you.
Online therapy has become increasingly normalized in recent years, and the benefits are clear. We have easy access to good technology, with a variety of secure telehealth platforms available that enable therapists and clients to meet at a time and place that is convenient and flexible. Online therapy has allowed us to increase access and overcome geographical, logistical, and scheduling constraints. For many, scheduling their therapy session into their day in between other meetings, during their lunchtime, or at the beginning or end of their day – without ever leaving their home – has become a normal part of life.
Most people would agree that all of this is true for talk therapy, but what about EMDR? Is there anything different about doing EMDR online?
The answer is yes and no.
First, let’s talk about what is the same whether it’s in person or online EMDR therapy.
Doing good online EMDR therapy is in some ways no different from doing good therapy, period.
Therapeutic Relationship
The research on what makes any form of therapy effective is clear. The primary contributing factor to good therapy outcomes is not in fact the therapeutic modality being used, although some modalities are certainly more effective than others. The primary factor associated with successful therapy is the quality of the therapeutic relationship between the therapist and client. We need to establish a therapeutic relationship in order to reach therapeutic goals, which means building trust and a good rapport with each other.
Clinical Competence of the EMDR Therapist
Whether you are seeing an EMDR therapist online or in person, it is important to know that the EMDR therapist is qualified and competent in their use of EMDR therapy in practice. While I will deal with this issue in more depth in a separate blog, suffice it to say that if your EMDR therapist has only received Basic Training without any further training or consultation in EMDR, and you are wanting to work on issues related to complex trauma, dissociation, or attachment issues, then you are not likely to achieve the results you are wanting, regardless of whether you are meeting in person or online. Basic Training in EMDR is just that – basic. No more, no less.
Ethical Integrity
In early 2022, the EMDR International Association (EMDRIA) published a series about online EMDR therapy, including their Guidelines for Virtual EMDR Therapy Report which had been released in 2020. In this report, EMDRIA emphasized the importance of maintaining all the typical and usual elements of good practice. These elements include practicing EMDR therapy in a way that keeps fidelity to the model, just as if sessions were in person. The phases of EMDR therapy, including but not limited to history-taking, preparation and resourcing, reprocessing, closure and re-evaluating remain the same. Being able to assess and know when you and your therapist are ready to move to the next phase in your work, knowing when you are struggling to maintain presence and stay grounded, and staying attuned are all part of good therapy no matter what.
Results
Assuming you and your EMDR therapist have established a good therapeutic rapport, your EMDR therapist is qualified to treat the concerns you want to work on, and your EMDR therapist is using solid clinical practices, then chances are you will see good results in your therapy, whether you are meeting in person or online. Going back to my story at the beginning of this blog, when I quickly switched from in person to telehealth in March 2020, I didn’t know what to expect in terms of the results for my clients. After a short time, I was pleasantly surprised – and relieved! I continued to see my clients make progress in their healing even though we were meeting online.
This is by no means an exhaustive list, but hopefully it gives you an idea of the ways online EMDR therapy is no different from in person EMDR therapy.
Now let’s talk about what might be different about online EMDR therapy.
Preference for In Person EMDR Therapy
First and foremost, there is a difference between effectiveness and preference. If you simply prefer to meet with your EMDR therapist in person, then that is your preference and that is what you should be able to have. Some people are sick of being on screens and prefer to be able to walk into a therapist’s office, have an oasis away from their routine environment, and be in the same room with their therapist. And that is OK! In this article, we are talking about the fact that online EMDR therapy is just as effective as in person EMDR therapy. But you might not want online therapy, so for you, in person EMDR therapy is going to be more effective because it’s what you prefer.
Practicing Presence
While the ability to attune and gauge where you are in the therapeutic process is a routine part of good therapy, there are some differences when you and your EMDR therapist are online as opposed to in the room together. As a therapist who practices a mind/body approach like EMDR, I have to say that being with clients online doesn’t always allow for the same level of ease with attunement and coregulation – that “togetherness” feeling – that I remember having with my clients when we were a few feet apart from one another. And quite honestly, I miss that feeling. It takes a lot more emotional and physical energy to feel connected on a screen. And we experience communication differently online, such as not being able to look directly at each other, or having unnatural pauses if the connection is delayed. There are, however, some best practices for telehealth we can follow to simulate being together as much as possible.
Adapting Bilateral Stimulation
Other than staying attuned with each other, this is probably the biggest adjustment EMDR therapists and clients had to make with telehealth. In EMDR therapy, we use bilateral stimulation (BLS) to either install a positive experience into your nervous system or reprocess a painful or distressing experience. BLS is stimulating alternate sides of the body and therefore stimulating alternate hemispheres of the brain. As the name EMDR – Eye Movement Desensitization and Reprocessing – suggests, the traditional method for doing BLS was to use eye movements. The EMDR therapist would typically sit close to the client in their office, facing each other but slightly to the side (think ships passing in the night), and the therapist would do BLS by holding their arm out to the side and moving their hand back and forth in front of the client’s field of vision so that their eyes would move back and forth across the midline. Some therapists accomplished this by using a light bar that the client could look at and follow with their eyes back and forth. Other therapists, like myself, used “tappers” that the client would hold in each of their hands and feel the vibration alternating back and forth. Still others would at times, for certain clinical reasons and with client agreement, sit in front of their clients and alternate tapping on the client’s knees or on the back of their hands on top of a pillow. Some therapists and clients use auditory sounds, alternating back and forth from ear to ear. Finally, many EMDR therapists teach their clients how to do a “butterfly hug” and/or self-tapping on their arms or knees, depending on the need. All of these methods of doing BLS accomplish the same thing: to bilaterally stimulate the body and therefore the brain.
Obviously, there are many ways to do BLS, and, even before telehealth became a routine way to practice, most EMDR therapists needed a variety of ways to do BLS to meet the needs of their clients. Whether it was for a clinical reason or client comfort and preference, having a range of options for BLS was always important. However, with online EMDR, doing BLS has taken on a more technical flavor, and EMDR therapists have had to get comfortable with using technology in new ways.
Obviously, if you are meeting online, EMDR therapists can no longer physically tap their clients. And the days of someone coming into my office and using my tappers have come to an end. However, some exciting new options have become available, such as online platforms that do BLS on the screen so clients can follow the visual cue across their computer screen or listen to the auditory BLS in their headphones. There is even now a service that allows you to have a “library” of tappers that you have purchased and then “lend” them out to clients who then return them for use with the next person. Necessity is truly the mother of invention, and the creativity of these inventors over the past few years has been incredible to see!
Some EMDR therapists still prefer to hold an object up to the screen and have their clients follow visually. True confessions, I did that for a while. It worked, but it felt a little sloppy to me. I prefer the online platforms much better, and I think my clients do as well. Of course, clients can still do the butterfly hug and other self-tapping. I usually recommend to my clients that they try a couple of different methods of BLS to see which one they prefer, and sometimes I recommend one or the other depending on the clinical issues we are working on. So there are still plenty of options for BLS, including some new ones we didn't have before.
Privacy & Safety
No discussion about online therapy in general, or online EMDR therapy in particular, would be complete without mention of the additional considerations around privacy and safety that are involved in telehealth. It goes without saying that therapists must take reasonable steps to ensure a confidential online environment through using secure telehealth platforms. By the same token, clients are responsible for ensuring they have privacy during their sessions. When meeting online, therapists can’t control the therapy environment and physical space the same way they can in person, so they are more reliant on clients to manage some of that themselves.
In the event of a crisis, therapists practicing online are well advised to have extra ways to communicate with their clients and/or emergency contact(s). Ideally the therapist would have relevant policies and procedures clearly outlined for clients in their informed consent or intake paperwork that go above and beyond what would be required for in person therapy.
Hopefully this blog has given you clarity on some of the similarities and differences between doing EMDR therapy in person and online, and helped you understand that - yes - online EMDR can be just as effective as in person. Ultimately, the decision to pursue online EMDR therapy is a personal one for both EMDR therapists and clients, and takes into account individual strengths, needs and preferences. As with any form of therapy, the key lies in the skillful use of EMDR therapy, the establishment of a strong therapeutic alliance, and a commitment to the healing journey, whether it unfolds in an office or through a screen.