Summer 2026 Issue

EMDR Online
By Sue Coyle, MSW
Social Work Today
Vol. 26 No. 3 P. 14

An increasing number of clinicians and clients are finding that virtual EMDR can be just as beneficial as in-person.

Like most outpatient mental health treatment prior to the COVID-19 pandemic, eye movement desensitization and reprocessing (EMDR) therapy was largely an in-person modality. “Some people were conducting EMDR therapy over telehealth, but not many” says Mark Nickerson, LICSW, an EMDR trainer for EMDR Institute of Dr Francine Shapiro, an EMDR International Association (EMDRIA)-approved consultant, and director of EMDR Advanced Training and Distance Learning. Nickerson is based in Massachusetts.

The then-growing conversation around telehealth and mental health did inspire the EMDRIA, of which Nickerson was on the board, to look into and issue recommendations in 2019. But even then, it wasn’t considered an imminent, high-priority concern. Most practitioners were meeting clients in person.

EMDRIA surveyed 1,600 clinicians connected to the association asking about their use of and concerns with virtual services. The survey responses, Nickerson describes, highlighted the importance of assuring privacy and safety for the client, maintaining relational attunement, finding ways to do bilateral stimulation (BLS), handling technology challenges and more.

The information and subsequent discussions “led to a report that was published just before COVID hit,” Nickerson remembers. The report was timely and provided guidance with the onset of COVID, when almost all EMDR therapy shifted to virtual.”

Today while in-person treatment has returned, many clinicians maintain virtual-only or hybrid practices, and many clients seek out virtual EMDR therapy services. In fact, a 2022 study found that 88% of clients would be extremely comfortable receiving EMDR therapy online. Nickerson adds that “the increase in online therapy revealed many hidden benefits such as making therapy more accessible for clients who live far from their provider, have transportation or mobility issues, are possibly contagious, feel stigmatized or exposed going to a [therapist in person] or are managing other schedule challenges.”

However, offering EMDR therapy via telehealth is not as simple as setting up a Zoom account. Social workers who wish to deliver effective and quality EMDR treatment must maintain a firm understanding of how they approach/manage not only the modality but the concerns that were identified in EMDRIA’s 2019 survey, which are still relevant today.

The What and the Who of EMDR
The first step in delivering EMDR therapy virtually is understanding what it is and who it is for, regardless of if the client is in person or online. The EMDR Institute, which was founded by Francine Shapiro, PhD, the originator of EMDR therapy, describes it as “a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences.”1 The therapy has eight different phases starting with history taking/treatment planning and ending with closure and reevaluation.

However, the part of EMDR therapy that most clinicians and laypeople are aware of is BLS. BLS, according to EMDRIA, is used in phases 4 through 6 of EMDR. These “three phases are known as the ‘reprocessing’ phases and all involve dual attention bilateral stimulation (BLS). Dual attention BLS activates the client’s information processing system while keeping the client anchored in the present moment. Dual attention BLS can be side to side eye movements, sounds, or taps.”2

EMDR was originally used to treat PTSD and remains a common approach for treating trauma today. “EMDR is especially effective for single incident traumatic memories—when there is a type of traumatic experience that is not connected to other experiences or adversity,” explains Scott Giacomucci, DSW, LCSW, BCD, CGP, FAAETS, TEP, director and founder of the Phoenix Center for Experiential Trauma Therapy in Media, Pennsylvania, and an EMDR consultant. “We assess that by comparing the negative belief, feelings, and sensations attached to memories. Most clients experience relief from disturbing memories after just a few EMDR processing sessions when working with a single incident trauma.

“EMDR is still effective for complex trauma but will simply require a longer treatment process because there will be significantly more memories in the traumatic memory network,” he adds.

However, it is not just for trauma. “I think it works for a lot of people,” says Christine Agic, LCSW, a private practitioner who offers therapy for individuals and couples in Connecticut, Florida, Iowa, and Utah. “I often work with a lot of high achievers, both women and men, who might describe themselves as Type A or overthinkers, people who tend to carry a lot of anxiety and a lot of responsibility and who are dealing with a lot of overwhelm and burnout. For those folks, the reason I like EMDR is that folks who live a lot in their heads and tend to overthink a lot are usually not short on insight. They usually have a lot of insight into why they behave the way they do or why they think the way they do or why they’re carrying the stress they’re carrying. That insight can end up being intellectualized. Having the insight alone doesn’t necessarily mean we’ll make the change. What EMDR really helps us do is work with our subconscious parts.”

“One of the things I love about [EMDR] is it is really versatile,” affirms Meghan Gilliland, LCSW, LICSW, EMDR-certified therapist, EMDRIA-approved consultant, and owner of Inner Wisdom Counseling, PLLC, offering therapy to individuals in Arizona, Massachusetts, Oregon, and Washington. “You can use it for a lot of different issues.” The way treatment progresses or is approached may differ depending on the reason someone is seeking therapy and the complexity of the trauma or issue.

Online Client Considerations
Determining if EMDR is appropriate for an individual seeking treatment is largely the same in-person and online, though there are some additional considerations a social worker should keep in mind for virtual clients. For example, Giacomucci says, “There are situations where we might advise against EMDR online, such as if the client’s home environment isn’t conducive to trauma therapy sessions in terms of privacy, safety, traumatic triggers, or internet stability. When a client presents with higher risks of dissociation, self-harm, suicidality, or psychiatric instability, we would be more likely to recommend starting with in-person EMDR sessions.”

It’s also about comfort, Gilliland says. Some clients may reach out for online therapy but as treatment progresses they or the therapist may realize that the virtual set up does not sit well with them. “Maybe because of their trauma, they feel really watched or uncomfortable being online. They almost feel like there’s something eerie or two-dimensional [about it]. If they can’t feel comfortable meeting online, that’s automatically going to be a good reason for them to do it in-person,” she describes. “I have to do a lot of work with somebody who has more complex trauma in the beginning to get a sense of whether or not I think it’s going to be good to do online for them.”

Other clients may simply recognize that online is not the platform for them. “For some folks, it is harder to focus. I started with somebody with ADHD who said ‘No, I’m going to have to it in an office. I can’t focus in my home. That was the only time I’ve had that happen, but that would be I think the one downside,” Agic says.

Clients also must have the ability to set up for EMDR therapy online. It is a little more involved than logging into a meeting. Nickerson, Gilliland, and Agic were all quick to point out that if a client can only find privacy in their car (a solution that became common during COVID), EMDR virtually might not be the best choice. It is possible but it’s not ideal.

“Here you have to balance mixed principals within ethical care,” Nickerson says. “On one hand, you want to hold a high standard of providing EMDR therapy in the optimal way. On the other hand, you want to serve populations that may not have resources that others do. I this case, if the only platform the person has is a phone, you would try to work out phone placement and other strategies to make EMDR possible.”

Preparing as a Clinician
But it’s not just the client who needs to be properly set up for telehealth EMDR. The clinician must also ensure they have the tools necessary to move this modality online. That starts with steady internet connection—something that is both obvious and incredibly necessary. “The biggest risks of online EMDR include the possibility of opening up a traumatic memory and having a technology problem that ends the session abruptly, which leaves the client unsupported and alone in the midst of overwhelming emotions and sensations,” Giacomucci emphasizes.

“I make sure that I’m really secure—all of my internet connections. I don’t do anything over WiFi. Everything is wired. If my main internet connection dies, I have a backup internet, to make sure I’m not cut out in the middle [of a session]. I even have an extra power supply in case there’s a power outage so that will give me a few minutes to contact people,” Gilliland says. If she does experience a power outage, she reaches out to the client, potentially continuing the session by phone or just taking a few minutes to connect and close out the session.

Then, there’s the BLS. The most common and the traditional form of stimulation engages the eyes, moving them rhythmically from side to side. Social workers can rely on apps for this when offering telehealth services (and in person), logging into a site, generating a link for the client to use and retaining control of the stimulation throughout the session with their log-in. Gilliland uses remotEMDR and Agic uses bilateralstimulation.io, for example.

During a session, Agic has the client open the screen with the BLS while also keeping a separate screen open where the client can see her. “In EMDR, the therapist’s presence is actually an important piece of it. It’s important for the client to see you as well. What I tell them to do if we’re watching the dot is open as big as they can the tab with the dot and then lower maybe in the righthand or lefthand corner, shrink Doxy—the platform we use for video calls—so you can see my face, but it’s not taking over your screen. So that for them, they’re doing the bilateral stimulation, they’re hearing my voice, and they can see if they choose to out of the corner of their eye—like they would in an office—the therapist’s presence. That’s important,” she says.

On her end, it’s the opposite. “It’s more important that I see them. I don’t need that bilateral stimulation screen to be big on mine. I just need to see how fast it is and how many passes happen with each set. I have their face big on my screen, and I have just a tiny thing where I can see how many passes are happening with each set.”

Social workers and clients can also turn to other forms of stimulation, using buzzers if the client is able to purchase them, tapping, and more. “We can also use these different types of tactile stimulation. For some people that’s tapping shoulder to shoulder if they cross their arms in what we call the butterfly hug. I’ve even had people tap their lap side to side and even look down from one hand to another as they tap, because then they get a little bit of the eye movement as well,” Gilliland says.

“I’ve gotten really creative about it with people if they have limits with their technology,” she adds. “The most creative intervention I had with somebody was that they only had a phone and they had a metronome. And they had sticky notes. So, we had them put sticky notes on the wall in front of them so their eyes could move back and forth from one to the other, and we set it to the metronome.”

Benefits and Efficacy
With the who and the how set up for both client and clinician, EMDR therapy can work well online. “The research overall says that it does work,” Nickerson says. “Not as consistently well as in person, but virtual EMDR therapy has been validated in peer reviewed articles as an evidence-based protocol.”

However, he points out that much of that research is from the COVID era. Since the end of the pandemic and the gradual return of in-person treatment, there have been fewer studies about EMDR via telehealth.

“It seems to have become accepted within the EMDR therapy clinician community that virtual EMDR can work. The discussion has shifted to what clinicians can do to ensure that they and the client take measures that create optimal effectiveness,” Nickerson says.

And he’s right. While there is not a significant number of studies available for reference, the ones that have been published show that online EMDR can be as effective as in-person EMDR therapy and other forms of treatment, provided the clinician is properly trained and prepared and the client is the right fit for the modality. In fact, a 2023 systematic review of online EMDR therapy studies that “encompass a wide array of populations, including adults, adolescents, and health care workers, [demonstrate] the applicability of EMDR across various age groups and professional backgrounds. Some studies specifically target health care workers, emphasizing the need to address the mental health challenges within this occupational group. The delivery formats also vary, with studies utilizing individual live sessions, group live sessions, and self-administered computerized sessions.”3 The review showed that EMDR therapy is a promising option for clients and clinicians.

All a social worker needs, then, to deliver EMDR therapy online confidently are the know-how, the tools, and the resources (and the certification) to do it.

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.

References
1. What is EMDR therapy? EMDR Institute, Inc website. https://www.emdr.com/what-is-emdr/

2. Kaufman S. The eight phases of EMDR therapy. EMDR International Association website. https://www.emdria.org/blog/the-eight-phases-of-emdr-therapy/. Updated August 13, 2021.

3. Kaptan SK, Kaya ZM, Akan A. Addressing mental health need after COVID-19: a systematic review of remote EMDR therapy studies as an emerging option. Front Psychiatry. 2024;14:1336569.