Does EMDR have to be done in person?

The short version people used to believe

EMDR, Eye Movement Desensitisation and Reprocessing, was built around something physical. You hold a distressing memory in mind while the therapist moves their hand back and forth in front of your face, and your eyes track it. That side-to-side movement is called bilateral stimulation, and it's the part everyone thinks of when they picture EMDR.

For a long time the assumption was obvious: if the therapy depends on the therapist's hand moving in the room, you have to be in the room. Francine Shapiro, the psychologist who developed EMDR in the late 1980s, worked in person, and so did nearly everyone who followed her.

Then, in 2020, the assumption broke.

What the pandemic settled

When COVID closed consulting rooms, therapists had a choice: stop treating trauma, or find a way to do it down a video call. EMDR's professional bodies were writing the first proper guidelines for online delivery as it was happening. The rules were being drawn up more or less in real time.

What came out of that period is now some of the most useful evidence we have. A systematic review published in 2024 pulled together sixteen studies covering 1,231 people, and found that remote EMDR produced real reductions in PTSD symptoms, anxiety and depression, with results that stood up against in-person treatment. Earlier trials pointed the same way. A study of survivors of sexual assault found no meaningful difference between the two formats. So did work comparing online and in-person EMDR for people with PTSD.

The picture is consistent enough to state plainly: for a lot of people, online EMDR works about as well as sitting in the room. The reviews come with the usual honest caveats: some of the studies were small, some had no control group, some leaned on people reporting their own symptoms rather than an independent measure. So this isn't the last word. But the direction of the evidence is clear, and both NICE and the World Health Organisation already recognise EMDR itself as an effective treatment for PTSD.

But how does the eye movement bit work through a screen?

This is the sensible question, and it has a sensible answer.

The eyes-following-a-hand version is only one way to deliver bilateral stimulation. It was never the only way, even in person. The alternating left-right rhythm can also be delivered through sound, tones that move between your ears through headphones, or through touch, usually tapping. Some clients tap their own knees or shoulders alternately, a technique sometimes called the butterfly hug.

Online, the therapist uses these. You might follow a dot or a bar moving across your screen, listen to alternating tones, or tap yourself while the therapist guides the pace. It isn't a watered-down substitute. It's the same mechanism, delivered a different way, and the outcomes above were produced by exactly these adaptations.

What a remote session actually asks of you

Online EMDR is not simply the in-person version piped through a webcam. A good therapist adjusts for the medium, and there are a few things that fall to you.

You need a private space. This matters more than people expect. EMDR asks you to go to painful material, and you cannot do that if you're braced for someone to walk in. A room with a door that shuts, where you won't be overheard, is not a nice-to-have. It's part of the treatment working.

You need a reliable connection and a device you can prop up steadily. A call that freezes in the middle of processing a difficult memory is more than an annoyance. It can leave you stranded in distress with the thread cut. Sort the technical side out beforehand.

And expect the shape of a session to differ. Screens are tiring in a way a face across a room isn't, so remote sessions are often a little shorter, with more breaks and more grounding built in. Your therapist should also spend time at the start making sure you have ways to steady yourself, because if something surfaces and the connection drops, you need to be able to bring yourself back down on your own.

When in person is still the better choice

Here's the part the "you can do it from your sofa" marketing tends to skip.

Remote EMDR suits a great many people. It does not suit everyone, and the honest answer to "does it have to be in person" includes knowing when it should be.

If you experience severe dissociation, losing time, feeling detached from your body or surroundings in a way that's hard to pull out of, being physically in the room with your therapist is safer. The same goes if you're in acute crisis, or if your trauma is complex and the work is likely to be intense and unpredictable. In those situations a therapist relies on reading your whole body, catching the small shifts a webcam flattens or crops out, and being able to help you re-ground with their actual presence. A screen makes all of that harder.

A responsible therapist will talk this through with you rather than defaulting to whatever's convenient. If someone offers you online EMDR without ever asking how you tend to respond under stress, that's worth noticing.

So, in person or not?

You have a real choice, and that's the point worth taking away.

For most people seeking help with trauma, online EMDR is a genuine option, backed by evidence, not a compromise you settle for. It removes some very real barriers: distance, a lack of local therapists, difficulty leaving the house, the sheer logistics of getting to an appointment week after week. For some people, being in their own home makes the hard work feel more manageable, not less.

For others, particularly where dissociation, crisis or complex trauma are in the picture, the room still matters, and there's no shame in needing it.

The best way to decide isn't to pick a format first and find a therapist to fit it. It's to talk to a qualified EMDR therapist about your situation and work it out together. The delivery method should follow the clinical need. Not the other way round.

If you are looking for EMDR therapy we have a list of practitioners, both in-person and online here.