Virtual EMDR: How to Do it and How Effective is it?

Francine Shapiro, Ph.D., a clinical psychologist from California, began foundational work on EMDR and led research demonstrating its effectiveness. The EMDR therapy process covers delving into traumatic memories as a therapist guides the client’s eye movement rapidly back and forth between two points. Hand tapping and audio stimulation are also standard techniques for therapists to redirect eye movement. This type of left-right stimulation is also known as bilateral stimulation (BLS). 

EMDR therapy focuses on the following three objectives:

1. Process past events and the groundwork of dysfunction
2. Target the current circumstances that elicit distress
3. Assist in the adaptive functioning of future events

EMDR is a standard treatment option for individuals diagnosed with PTSD, such as veterans or refugees. Any individual who experiences trauma in a way that negatively distresses their life may benefit from EMDR sessions.

According to Dr. Shapiro, successful EMDR therapy:

• Relieves affective distress
• Reformulates negative beliefs
• Reduces physiological arousal

To practice virtual EMDR, a degree in counseling and additional specialization in mental telehealth are necessary. There are 8 phases to the EMDR treatment, all of which can be performed remotely. 

Phase 1: Client History and Treatment Planning

The initial phase consists of client intake, the treatment plan, and identifying traumatic events or triggers. Client history generally takes place in the first session. Ensure client notes, treatment plans, and communications are secure while intaking client history virtually through encrypted services.

The EMDR institute identifies a range of treatment lengths but suggests up to a 5-hour session for a singular traumatic event in adulthood. Clients with complex childhood traumas or multiple traumatic events require additional modifications to their treatment plans.

Phase 2: Client Preparation

After establishing the client's history, the therapist guides the client in brainstorming coping mechanisms for emotionally distressing times. To promote trust between an online therapy provider and client, explore ways for clients to maintain their emotional health between and immediately after sessions that divulge into trauma because EMDR therapists ask their clients to recall emotionally triggering memories during their sessions. Safety plans and external support systems, like friends or crisis hotlines, are essential to identify during the client’s preparation phase before their EMDR sessions.

Phase 3: Target Memory Assessment

During assessment, the therapist and client identify a specific traumatic event or trigger from the client’s history to discuss throughout the treatment session. The therapist completes two assessments during this time: the validity of cognition scale (VOC) and subjective units of disturbance scale (SUD). The following scales are available to access through the American Psychological Association Eye Movement Desensitization and Reprocessing Therapy treatments page for PTSD guidelines.

Validity of Cognition Scale (VOC)

Subjective Units of Disturbance Scale (SUD)

Phase 4: Desensitization

This phase asks the client to recall a traumatic memory with the associated imagery with the objective of desensitization. When leading a virtual EMDR visit, the therapist must decide which virtual EMDR tool to use. 

For example, a common tool to do EMDR remotely includes an EMDR light bar which combines audio and visual stimulation when attached to the therapy provider’s web camera. Look for a HIPAA-compliant platform, such as the subsequent software:

• remotEMDR
• VirtualEMDR
• ActiveEMDR
• Bilateralstimulation.io
• BilateralBase

Phase 5: Installation

The installation phase attempts to improve scores of positive cognition on the VOC and SUD scales. If a client scores a four on the VOC scale regarding a trigger, the therapist hopes to see improvements in positive cognition, possibly in the 5 to 7 range, after completing the virtual EMDR sessions. The SUD scale correlates with no disturbance at the lower end of the scale (0), so the therapist aims to reduce the SUD rating throughout therapy. 

This part of the virtual EMDR therapy process takes a similar approach to cognitive behavioral therapy (CBT), which is adaptable for online counseling.

Phase 6: Body Scan

The body scan phase incorporates a somatic approach to therapy. Virtual therapists are easily able to guide their clients through a body scan which encompasses identifying how emotions feel and where in the body they are felt.

Phase 7: Closure

Closure requires tactfully ending sessions when clients are in the act of reprocessing. In virtual EMDR therapy sessions, the therapist provides guidelines for self-control techniques and promotes coping mechanisms from previous phases until all treatments of EMDR are complete.

Phase 8: Re-Evaluation 

Re-evaluation occurs at the end of the EMDR process. The therapist examines the client’s progress in how they process past events and prepare for emotional resilience of future triggers. Virtual EMDR providers approach their sessions to quantitatively lower SUD scores and increase VOC scores. Clients with multiple traumatic events are more likely to need additional EMDR treatments as they manage several triggers.

1. Decide which type of bilateral stimulation (BLS) to use for virtual EMDR.
   • Will you use audio, visual, tactile, or a combination?
   • Ex. EMDR light bar, vibration motors on bracelets, moving sound sources
2. Find an encrypted, HIPAA-compliant virtual EMDR program.
   • How do you plan on record-keeping client files and communications? Ex. VirtualEMDR, ActiveEMDR, Bilateralstimulation.io
3. Consider additional certifications in the foundations of digital mental health or virtual EMDR.

Virtual therapy requires additional specialization in telehealth counseling to ensure the treatment remains effective in an online environment. To learn more about how to become an online counselor, consider this article which distinguishes in-person and online counseling.