Can you do EMDR by video call?

Yes. And the evidence says it works about as well as being in the room.

That question is settled enough that I have written about it separately. What I want to do here is the practical version. Not "does it work" but "what actually happens, and what do I need to make it work".

Because online EMDR therapy is not the in-person version piped through a webcam. It is a genuinely different set of conditions, and the things that make it go wrong are mostly logistical rather than clinical.

What the bilateral stimulation looks like on a screen

The obvious problem is the eye movements. If the therapist's hand is in another county, what are you following?

There are three answers, and none of them is a compromise.

Screen-based visual tracking. You follow a dot or a bar moving side to side across your screen. Your therapist controls the speed and the number of passes. There are dedicated tools for this, and most therapists doing remote work will share a window or send you to a page they control.

Alternating audio tones. Sound moving between your left and right ear through headphones. This is arguably better online than in person, because the delivery is identical either way. Headphones are not optional for this one.

Self-tapping. You tap alternately on your own knees or shoulders while your therapist sets the pace. The crossed-arms version, tapping your own upper arms, is sometimes called the butterfly hug.

None of these were invented for lockdown. Alternating tones and tactile stimulation were part of EMDR long before anyone had heard of Zoom, and were being used in consulting rooms by therapists whose clients could not tolerate the eye movements. Remote delivery just made them the default rather than the fallback.

Your therapist should be asking you which you prefer, and you should feel free to say the dot on the screen is making you nauseous and you would rather have the tones. It is not a test.

What your therapist can and cannot see

This is the part that actually matters, and it is not talked about enough.

In the room, an EMDR therapist is reading you constantly. Not just your face. Your breathing. Your hands. Whether your feet have gone still. Whether your colour has changed. Whether you have gone somewhere else behind your eyes. They are watching for signs that you are drifting out of the window where processing can happen and into the zone where you are simply being flooded.

On a video call, they get a head and shoulders in a small rectangle, possibly lagging, possibly badly lit.

That is a real loss, and the honest literature says so. The most commonly named limitation of virtual EMDR is precisely this: the loss of non-verbal cues. Subtle changes in facial expression and body language that would tell a clinician something is going wrong are harder to read through a screen.

There are things that mitigate it. Sit far enough back that your therapist can see your torso and your hands, not just your face. Get your face lit from the front, not from a window behind you. If your therapist asks you to move the camera, that is not fussiness, it is them trying to see you.

But it does not go away entirely, and it is one of the reasons the honest position on remote EMDR is "yes, and with caveats".

The room you are in

You need a private space with a door that shuts.

I want to be exact about why. EMDR asks you to go deliberately to painful material and stay with it. You cannot do that with half an ear on the hallway. A part of you stays braced, and the part that stays braced is the part that would otherwise be doing the work.

This is not a nice-to-have. If you cannot secure a private room for the duration of a session, remote EMDR is going to underperform, and it is better to say so than to book the session and hope.

Some practicalities that follow from this.

The car park is not a therapy room. People do it. Do not do it.

Headphones matter for privacy as well as for the tones.

Tell whoever else is in the house that you cannot be interrupted, and mean it. If you cannot say why, say you are on a work call. Nobody interrupts a work call.

And check what is behind you, because you will be looking at yourself for an hour and a half and a pile of laundry is a surprisingly effective way of pulling someone out of a memory.

The technical stuff, briefly

A stable connection, because a session that keeps freezing mid-set is not just annoying, it interrupts processing at exactly the moment you need continuity.

A device that stands up on its own. Holding a phone for ninety minutes while you process a trauma is not tenable. Prop it up.

A platform your therapist has chosen for its security, not the one you find convenient. This is their obligation, not yours, but you are entitled to ask what they use and whether it is encrypted.

Charge everything beforehand.

Screen fatigue and pacing

A ninety-minute EMDR session is exhausting in person. A ninety-minute EMDR session staring at a screen is more so, and the clinical guidance on virtual delivery specifically flags screen fatigue as something therapists should be adjusting for.

Shorter sessions and more breaks are a reasonable adaptation. If your therapist offers a fifty-minute remote session rather than the ninety they would run in person, that is not them short-changing you. Shapiro's own research found comparable treatment effects whether sessions ran ninety minutes or fifty.

If you are flagging, say so. The pacing is negotiable.

The bit that worries me most

Closure.

In the room, the end of an EMDR session has a physical shape. You do the grounding, you come back, you have a moment, you gather your things, you walk out, you have a corridor and a street and a walk to the car. There is a transition built into the architecture.

Online, you press a button and you are in your kitchen.

Shapiro's guidance on closure includes a step people forget: after guided imagery, the clinician assesses whether the client is dissociated in a way that would make it unsafe for them to walk down the street or drive a car, and sometimes a client should sit in the waiting room until the therapist is satisfied.

There is no waiting room on Zoom.

So the closure phase has to be done more deliberately, not less. Your therapist should be leaving real time at the end. And you should have a plan for the twenty minutes after the call ends, which is the window in which people who are still dysregulated do the things they later regret.

Do not schedule anything immediately afterwards. Do not book the session in a gap between meetings. Have somewhere to go and something to do that will bring you the rest of the way down: a walk, a shower, the kettle.

Rotem Brayer's rule holds regardless of the medium. You do not end an EMDR session with someone at a level of disturbance they cannot bring down. The consequences of getting that wrong are serious, and the medium makes it harder to spot, not easier.

And before you start, agree what happens if the connection drops mid-processing. Who calls whom. What number. That conversation takes ninety seconds and it is the difference between an inconvenience and being left alone, activated, staring at a frozen screen.

Who should probably not be doing this remotely

The honest caveat, and it is the same one that appears in every serious discussion of virtual EMDR.

If you dissociate, if you have complex or developmental trauma, if your emotional regulation is fragile, if you have no genuinely safe space at home, then the case for being in the room is strong. Those are precisely the situations where a therapist most needs to read the small signals, and where the loss of non-verbal information matters most.

That is not a rule. Plenty of people with complex histories are treated remotely by therapists who know what they are doing. But it is the conversation to have honestly at the start rather than discover the hard way in session four.

The short version

It works. The bilateral stimulation adapts without loss. What you have to supply is a private room, a stable connection, a device that stands up, headphones, and an hour afterwards that belongs to nobody else.

What your therapist has to supply is closer attention than they would need in person, a real closure phase, and a plan for when the wifi goes.

Get those right and the video call is not a lesser version of EMDR. It is EMDR, in your own house, without the drive.

This is general information, not clinical advice. If you are considering remote EMDR, discuss with an accredited therapist whether it suits your situation. If you are in crisis, contact your GP, NHS 111, or Samaritans on 116 123.

References

Brayer, R. (2023). The Art and Science of EMDR: Helping Clinicians Bridge the Gap. PESI Publishing.

Shapiro, F. (2017). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.