The evidence-base for EMDR in the treatment of numerous mental health concerns is compelling. In March 2020, the literature regarding the effectiveness of delivering EMDR online was promising and it was armed with this smattering of evidence, a clinical hunch and a leap of faith that I began offering EMDR remotely. Since then, much more research, our own external audit, client feedback and clinical intuition all point to the success of using this wonderful treatment modality online. In this blog I’ll share some tips based upon what I’ve learned while offering EMDR online routinely in my practice.
1. Socialize your client to the model and its use online
Sharing the rationale for EMDR will always be one of the first parts of embarking on EMDR with your client. When I’m sharing with a client what a session will look like, I’m careful to show them how the bilateral stimulation looks during an online EMDR session. I reassure them of the growing evidence base and let them know that I have personally used this model successfully with numerous clients online.
2. Be prepared to use an array of methods of bilateral stimulation
My go-to method is to use software that has a dot moving across the screen. I can adjust the speed of the dot and can stop it when needed. It’s helpful that it also counts the number of sets. I bring it up on my PC and share my screen through the HIPAA compliant video platform.
If this doesn’t work for some reason (e.g. technical hitch, slow wifi) I’ll go to hand movements. I’ll make sure I’m sitting with my face and body out of view of the screen and move my hand in the way I would in a face-to-face session.
If eye movements aren’t suitable I’ll move to the butterfly hug. I always do this in time with my client so they know what pace to go at and it helps me keep track of the number of sets.
You can also use audio stimulation by inviting your client to download an appropriate remote EMDR app, which you can control your end. Tactile pulses are available which you can control remotely too. However, I’ve steered away from these as I haven’t needed to use anything other than eye movements or the butterfly hug and it’s a bit of a hassle to arrange them.
3. Ensure a suitable space and device
Remind your client to access the session on a laptop or tablet. Phones are smaller and don’t allow for the full breadth of a sweep in the same way.
And of course, as with all online sessions, you need to ensure that you and your client are in a suitable and confidential space.
4. Be engaged
It isn’t a case of switching on the dot and simply letting EMDR do it’s thing. The therapeutic relationship remains key and the person you’re seeing needs to feel your presence through the screen. In online sessions in key moments you’ll find me very close to the screen at times, vocalizing my presence in a bid to contain, soothe and hold what comes up.
5. Know when not to offer EMDR online
There are some cases where I haven’t offered EMDR online. I don’t offer online EMDR to people who dissociate frequently and who have few coping mechanisms or support.
I do use EMDR online with some people who dissociate, but only if they have good grounding strategies and accessible support systems in place. As would be the case in face-to-face sessions, we spend a lot of time resourcing and I need to know that the client can use these resources effectively online before continuing. I go much slower with these clients, checking in often, pausing frequently.
I hope these tips help. Good luck!