Online EMDR Therapy: How It Works Over Telehealth

Many people picture EMDR as a therapist moving a finger back and forth a few feet from a client’s face. So when therapy moved onto video calls, a fair question followed: can EMDR be done through a screen?

It can, and many clinicians now offer it that way. My practice is telehealth only, so every EMDR session I provide happens over secure video with adults in Nevada and Utah. This guide explains what EMDR is, how the back-and-forth part works on a screen, what the research supports and where it is still thin, and how to prepare your space at home.

What is EMDR therapy?

EMDR stands for Eye Movement Desensitization and Reprocessing. The U.S. Department of Veterans Affairs’ National Center for PTSD describes it as an individual therapy for PTSD in which a person focuses on a trauma memory while following a back-and-forth movement or sound, such as the provider’s moving finger, a flashing light, or a tone that beeps in one ear at a time. Clinicians call that back-and-forth input bilateral stimulation.

Two details surprise people. The first is how little you have to say out loud. The National Center for PTSD notes that in most cases you will not be asked to talk about the details of your trauma, although you will be asked to think about it in session. The second is the absence of homework: according to the same source, EMDR does not require practice assignments between sessions.

EMDR has strong institutional backing for PTSD. The 2023 VA/DoD Clinical Practice Guideline for PTSD recommends three individual trauma-focused psychotherapies, and EMDR is one of them, alongside Cognitive Processing Therapy and Prolonged Exposure. The World Health Organization’s 2013 guidance on care after trauma also names EMDR, with cognitive behavioral therapy, as a treatment to consider for people with PTSD. Response varies from person to person, and no guideline promises a particular result.

How does EMDR work over video?

The structure of the therapy stays the same online. What changes is how the bilateral stimulation reaches you. The EMDR International Association (EMDRIA) lists the options as back-and-forth eye movements, tactile tappers or buzzers, alternating tones, or physical movement. On a video call, that usually means one of three things:

• Eye movements on screen. You follow a moving shape or light across your screen while your therapist controls its speed and timing.
• Alternating tones. You wear headphones and hear a sound move from one ear to the other.
• Tapping. Your therapist guides you to tap on your own body, alternating left and right.

The stimulation comes in short sets. The National Center for PTSD describes each one as lasting about 30 seconds, after which you and your therapist talk about what you noticed. Your therapist watches and checks in between sets, the same as in an office.

One boundary matters here. Online EMDR means EMDR delivered live by a trained, licensed clinician. EMDRIA states plainly that it does not condone or support do-it-yourself virtual EMDR. An app or video that plays moving lights with no clinician present is a different thing, and the VA/DoD guideline found insufficient evidence to recommend for or against mobile apps and other self-help interventions for PTSD.

What happens in an EMDR session, phase by phase?

EMDR follows eight phases, and they do not all happen in one appointment. EMDRIA describes them this way:

1. History and treatment planning. Your therapist learns your history and the two of you decide what to work on.
2. Preparation. You learn ways to steady yourself when emotions rise. EMDRIA notes this phase typically takes one to four sessions.
3. Assessment. You identify the specific memory to target and the beliefs and body sensations attached to it.
4. Desensitization. You hold the memory in mind during sets of bilateral stimulation.
5. Installation. You strengthen a more helpful belief about yourself in relation to the memory.
6. Body scan. You check for tension that remains in the body.
7. Closure. Each session ends with steadying, whether or not the memory feels finished.
8. Reevaluation. The next session opens by reviewing what has shifted and what still needs attention.

Notice how much happens before any memory work begins. The first two phases are about trust, pacing, and building skills, and they can take several sessions. The grounding techniques described elsewhere on this blog are the kind of skill practiced in the preparation phase.

You stay in charge of the pace. You can ask to slow down, pause, or stop at any point, on a screen as much as in an office.

On length: the National Center for PTSD describes a typical course as about three months of weekly sessions lasting 50 to 90 minutes. That is a general description. How long it takes depends on your history, your goals, and what an assessment shows.

Does online EMDR work as well as in person?

The research is encouraging, and it is younger and smaller than the research on in-person EMDR. Both parts of that sentence deserve a closer look.

On the encouraging side, the 2023 VA/DoD guideline recommends secure video teleconferencing to deliver its recommended PTSD psychotherapies when a therapy has been validated for video use or when other options are unavailable. A 2024 systematic review in Frontiers in Psychiatry pulled together 16 studies of remote EMDR with 1,231 participants. Its authors concluded that online EMDR “shows promise as a valuable tool in alleviating PTSD symptoms.”

On the cautious side, the same authors list the weaknesses of the studies they reviewed: small sample sizes, missing control groups, and a reliance on self-reported measures. Only three of the 16 studies checked whether therapists followed the EMDR protocol faithfully. With gaps like those, the question of whether online and in-person EMDR are equivalent is still open.

So a fair summary is this: online EMDR is a recognized way to deliver a well-supported therapy, early results are positive, and nobody can promise it will work the same for every person. Any clinician who tells you otherwise is overselling.

How do you set up for an online EMDR session?

A few practical choices make a difference. These come from EMDRIA’s guidance for clients:

• Use a computer or a larger tablet instead of a phone. A wider screen gives your eyes more distance to travel. EMDRIA suggests 12 to 16 inches.
• Test your connection first. A wired connection is the most reliable. If that is not possible, ask others in the house to stay off video streaming during your appointment.
• Wear headphones. They improve the sound and keep the conversation private.
• Choose a quiet, private space. Turn off notifications and let the people you live with know you are unavailable.
• Keep comfort within reach. A blanket, water, or a pet nearby can help.
• Leave room afterward. EMDRIA notes that many people feel tired after a session, so avoid scheduling something demanding right after.

Privacy can be the hardest item on that list. In a full house, the options include a parked car, a bedroom with a fan running outside the door, or an appointment during the hours when the house is empty. If you live with someone who makes it unsafe to speak freely, tell your therapist at the start so the two of you can plan around it.

It is also reasonable to ask a therapist what happens if the call drops in the middle of a session. Ask before memory work begins, so the plan already exists when you need it.

Is online EMDR available in Spanish?

Yes. I offer EMDR sessions in English, in Spanish, or moving between the two. Many Latinx and first-generation adults grew up in one language at home and another everywhere else, and you are welcome to use whichever words come to you in the moment. In EMDR you also choose how much to say out loud.

Consultations and intake paperwork are available in Spanish too. If family or cultural expectations around therapy are part of what you are weighing, the article on therapy as a first-generation American speaks to that directly.

Is EMDR the right fit?

An article cannot answer that, and neither can a quiz. EMDR is one of several approaches a clinician might consider, and the choice depends on an assessment of your history, your current stability, and what you want from therapy. Some people start with skills and stabilization and move to memory work later. Others find a different approach, such as Cognitive Processing Therapy, suits them better.

If you recognize yourself in descriptions of trauma responses, such as the ones in signs of unresolved trauma in adults, a conversation with a licensed trauma therapist in your state is the place to sort out what fits. Questions worth asking any clinician who offers EMDR:

• What EMDR training have you completed?
• How do you deliver bilateral stimulation over video?
• How many sessions do you usually spend on preparation before memory work?
• What is the plan if I become overwhelmed or the connection drops?

My fees, insurance details, and the full list of approaches I use are on the services page. If you are new to therapy altogether, how to start therapy walks through the first steps.