EMDR Over Telehealth: Does It Actually Work?

By Christina Mathieson, LMFT #115093, founder of My Mental Climb.

TL;DR. EMDR works over telehealth. Bilateral stimulation is delivered through screen-based visual tools, client self-tapping, or alternating audio tones through headphones, and outcome research is broadly consistent with in-person results for most presentations. The eight-phase protocol is unchanged. In-person work is sometimes preferable for complex trauma with significant dissociation, and any experienced EMDR clinician assesses that fit early in the preparation phase.

The most common question we get about telehealth EMDR is whether it works. The short answer is yes, and the research on remote EMDR expanded substantially during and after the pandemic. What follows walks through how EMDR is adapted for video sessions, what the research shows, and when in-person work is still the better fit.

How Bilateral Stimulation Works Online

The mechanism EMDR relies on is bilateral input: alternating left-right stimulation while the client holds the target memory in mind. In-person EMDR most commonly uses eye movements, tracking a therapist's finger or a light bar across the visual field. Over telehealth, three methods deliver the same functional input:

Screen-based visual bilateral stimulation. The client watches a dot move back and forth across their screen while the therapist controls the pacing through a shared application or web-based tool. The eye movements are the same as in-person work; the stimulus is on the client's screen rather than in the therapist's office.

Client self-tapping. The therapist guides the client to tap alternately on their own knees, or to use the "butterfly hug" (arms crossed over the chest, tapping alternately on the shoulders). This delivers alternating tactile input under the client's own control, and many clients find the tactile modality less activating than visual for early reprocessing sessions.

Alternating audio tones. The therapist runs a web application that plays alternating tones through the client's headphones, left ear then right ear then left. Some clients find audio-only stimulation more grounding than visual, particularly if screens are dysregulating.

Different clients prefer different methods. The best telehealth EMDR practice teaches the client all three options during the preparation phase and lets them pick what works best for their nervous system. Nothing about the underlying protocol changes.

What the Research Shows

Formal research on telehealth-delivered EMDR was limited before 2020. The pandemic pushed a large volume of clinicians into remote practice, and the research literature has grown substantially since. What outcome studies have generally found:

• For single-event PTSD, telehealth EMDR produces outcomes broadly consistent with in-person EMDR.
• For most anxiety-related presentations where EMDR is used (specific phobias, panic connected to identifiable past events), telehealth appears comparable in effectiveness.
• For complex trauma, the picture is more mixed, and outcomes depend heavily on preparation-phase work and the specific client presentation.
• Client dropout rates are broadly similar between telehealth and in-person, and in some studies telehealth has lower dropout because access is easier.

The EMDR International Association (EMDRIA) has published guidance on remote EMDR delivery, and the standard eight-phase protocol has been formally adapted for online contexts. The clinical field has moved toward treating telehealth EMDR as a mainstream delivery mode rather than a pandemic-era workaround.

What a Telehealth EMDR Session Looks Like

Sessions typically run 60 to 90 minutes rather than the standard 50-minute hour, because both preparation and closure need time. A reprocessing session over telehealth looks like this in practice:

1. Grounding at the start. You check in about the week, the therapist confirms you are regulated and ready, and you review any material that surfaced between sessions.
2. Setting up the target. You bring up the memory identified in the earlier assessment phase: the worst image, the negative belief, the body sensation, and the current disturbance rating.
3. Bilateral stimulation. The therapist starts a set of bilateral stimulation (screen-based visual, guided self-tapping, or audio tones through your headphones) while you hold the target in mind. Sets typically last 20 to 30 seconds.
4. Brief report. The therapist pauses and asks something short: "What are you noticing?" You report briefly: an image shifted, a feeling moved, the body released some tension, a new memory associated. The therapist follows what surfaces rather than directing.
5. Repeat. You do sets of bilateral stimulation with brief reports between them, following the spontaneous chain of associations, until the target has been reprocessed to lower distress or until it is time for closure.
6. Closure. The therapist guides you back to the present, checks that you are regulated, and reviews the plan for the next 30 to 60 minutes. If material surfaced that did not complete, containment exercises help hold it until the next session.

The client experience over telehealth is remarkably similar to in-person work once the setup is worked out. Most clients report the difference matters less than they expected.

What You Need at Home

For telehealth EMDR to go well:

• A private, quiet space where you will not be interrupted for the duration of the session
• A device with a screen large enough to follow visual bilateral stimulation, or headphones for audio-based work
• A comfortable seat or position that allows tapping if you use tactile stimulation
• A tissue box, water, and something grounding (a blanket, a weighted object, a favorite object) within reach
• A trusted contact you can reach after the session if you need one
• A plan for the 30 to 60 minutes after the session that involves rest rather than immediately switching into work or high-stimulation activity

Most of these are less about EMDR specifically and more about creating the conditions that make any deep therapeutic work possible from home.

When In-Person Is Still the Better Fit

Telehealth EMDR is not appropriate for every client. Situations where in-person work may fit better:

• Significant dissociation. Clients who dissociate strongly and have difficulty returning to the present may need the physical containment of an in-person office and the therapist's direct proximity for grounding.
• Unstable living situation. Clients without a reliably private space, or in living situations where being emotionally activated could produce interpersonal risk, may need the neutral space of an in-person office.
• Severe reactions during preparation. If preparation exercises produce reactions the client cannot regulate at home, in-person pacing is safer.
• Client preference. Some clients simply prefer the felt sense of being in the same room as their therapist, and preference matters clinically.
• Complex dissociative disorders. Formal dissociative disorders often benefit from specialized in-person work with clinicians trained in dissociation-informed EMDR.

Any experienced EMDR clinician assesses fit for telehealth during the preparation phase, before reprocessing begins. Deciding to switch to in-person work if telehealth is not the right fit is a normal part of good clinical practice.

Why This Matters for California Clients

For California residents outside major metros, or for clients who want a specifically-trained EMDR clinician rather than the closest one, telehealth EMDR expands access substantially. A client in a smaller California city can work with an EMDRIA-trained clinician from anywhere in the state without the logistics of weekly travel, and the outcomes for most presentations look comparable to in-person work.

At My Mental Climb, our EMDR work is led by Jalyse Stewart, AMFT #153712 (supervised by Christina Mathieson, LMFT #115093), delivered via telehealth across California using the standard eight-phase protocol. If you have been considering EMDR but held back because you thought it required in-person, a free 15-minute consult with our intake coordinator is the low-pressure way to talk through fit.

Related Reading

For a broader picture of EMDR generally, our EMDR therapy specialty page walks through the eight-phase protocol in detail. For comparison with other trauma modalities, see EMDR vs CBT for Trauma and EMDR vs Brainspotting. For who tends to benefit from EMDR, Who Can Benefit From EMDR Therapy.

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Related from My Mental Climb: EMDR Therapy · EMDR vs Brainspotting · EMDR vs CBT for Trauma · EMDR for Breakup Recovery · Who Can Benefit From EMDR Therapy · Free 15-minute consult

Common questions

Does EMDR work over telehealth?

Yes. EMDR via telehealth uses the same eight-phase protocol as in-person work, and outcome research is broadly consistent with in-person outcomes for most presentations. The bilateral stimulation is delivered through screen-based visual tools (a moving dot on the video call), client self-tapping (butterfly hug or shoulder tapping), or alternating audio tones through the client's headphones. For complex trauma with significant dissociation, in-person work is sometimes preferable, and any experienced EMDR clinician should be able to assess fit early in the preparation phase.

How does bilateral stimulation work over video?

Three common methods: screen-based visual (a dot moves back and forth across the client's screen while the therapist controls pacing), client self-tapping (the therapist guides the client to tap alternately on their own knees or use the 'butterfly hug' with hands crossed on the chest), or alternating audio tones through headphones (a therapist-controlled app or web tool plays tones in the client's left and right ears). All three deliver the same functional bilateral input that in-person EMDR delivers, and different clients prefer different methods.

Is telehealth EMDR as effective as in-person?

For most presentations, yes. Research on telehealth EMDR expanded substantially during and after the pandemic, and outcome studies have generally found comparable results to in-person work for single-event trauma and most PTSD presentations. For complex trauma with significant dissociation, ongoing safety concerns, or clients who have significant difficulty regulating between sessions, in-person work is sometimes the better fit. This gets assessed during the preparation phase before reprocessing begins.

What do I need at home for telehealth EMDR?

A private, quiet space where you will not be interrupted. A device with a screen large enough to follow visual bilateral stimulation, or headphones for audio-based stimulation, or a comfortable position for self-tapping. A tissue box, water, and something soft nearby (a blanket, a stuffed animal) for grounding. A trusted contact you can reach after the session if you need one. And a plan for the 30 to 60 minutes after each session that involves rest rather than immediately jumping into work or high-stimulation activity.

Can EMDR be done via telehealth for complex trauma?

Sometimes, with careful preparation and pacing. Complex or developmental trauma typically requires longer stabilization work before reprocessing begins, and the preparation phase is where the therapist assesses whether telehealth is appropriate for a specific client. Factors that may point toward in-person work include significant dissociation, unstable living situations, or a history of severe reactions during preparation exercises. Many complex trauma clients are successfully treated via telehealth EMDR; the decision is made case by case.

Last clinically reviewed: July 8, 2026 by Christina Mathieson, LMFT #115093.