Can EMDR Be Done Online? Telehealth, Safety, and Bilateral Stimulation

At a glance

EMDR can be delivered remotely by a qualified clinician when the arrangement is appropriate. A 2024 systematic review identified sixteen remote-EMDR studies involving varied populations and formats. The findings were encouraging, but study designs and delivery arrangements differed substantially. That evidence does not establish that every online format is equivalent to in-person treatment. ^[1]

The essential distinction is between a complete therapy service and a tool that supports one part of it. A moving dot on a screen is not, by itself, EMDR treatment.

What the research says about remote care

A 2021 service evaluation collected reports from thirty-three therapists covering ninety-three clients. Symptom measures improved, supporting the feasibility of remote practice. However, the clinicians were self-selected, and the study was not a randomized comparison with in-person treatment. Its design cannot establish that a particular platform caused the improvement. ^[2]

The later review included a range of arrangements, rather than one uniform video-based clinical service. Combining those studies offers useful information about an emerging field, but it requires caution when translating findings into claims about an individual application. ^[1]

For a prospective client, the right question is not just “Can this happen online?” It is “Can this clinician provide appropriate care through this arrangement for my needs?”

Three claims that should not be confused

A treatment can have evidence for PTSD. A remote delivery format can have a developing evidence base. A particular software product can provide a useful feature. These are three different statements, and evidence for the first does not automatically prove the second or third.

This distinction is especially important on a product website. EMDRdot can be discussed as a support tool within a clinician-led workflow. The studies cited in this issue should not be presented as clinical trials of EMDRdot or proof of its privacy compliance, reliability, or treatment outcomes.

Our editorial recommendation is to describe the tool's role plainly and reserve clinical claims for the population, treatment, and delivery format actually studied.

Plan the setting, not just the connection

HHS guidance for telebehavioral health emphasizes preparation, consent, privacy, and emergency planning. Its emergency guidance includes confirming the person's location, identifying appropriate local contacts and resources, and agreeing what happens if the connection is lost during a crisis. ^{[3] [4]}

A stable internet connection is helpful, but it is not the whole plan. Our practical recommendation is to discuss whether the person can speak privately, whether interruptions are likely, and what arrangements are needed to maintain communication. A technically functioning call can still be unsuitable if someone cannot participate safely or privately.

These matters should be settled with the clinician rather than left for the client to solve during an emotionally demanding appointment.

Make the backup plan understandable

A hypothetical client might assume that a frozen screen means the therapist can still hear them. The therapist might assume the client knows to call back. A brief conversation beforehand can expose that mismatch.

We recommend agreeing on the backup contact method and what the client should expect if video, audio, or the stimulation display stops working. This is a communication recommendation, not a prescription to continue processing through a technical failure. The treating clinician should decide how the session changes when reliable contact is interrupted.

The plan should be specific enough to use without requiring the client to improvise under stress. It also should not rely on a website being available as the sole route to help.

Screens and preferences are not clinical validation

A person may find one display more comfortable or easier to follow than another. That feedback matters for usability. It does not establish that a phone, computer, visual pattern, or sound setting produces better clinical outcomes.

The remote studies reviewed here do not provide a direct validation of every device comparison or every feature offered by a BLS application. ^[1] Product claims should therefore separate comfort and convenience from effectiveness.

Our recommendation is to discuss visual, hearing, movement, or other access needs with the clinician. The choice of delivery method should follow clinical judgment and the person's needs, not an assumption that faster movement or more stimulation must be better.

What clients can ask before the first online appointment

“Where will the therapy conversation happen, what does the separate tool do, and how will we stay in contact if something stops working?”

That question clarifies the service. It also creates room to ask about privacy, recording, data handling, and who can access information. This newsletter does not certify any platform's compliance or substitute for the clinician's review of the actual technology and applicable requirements.

For clinicians, we recommend reviewing the real workflow rather than a product description alone. Clear responsibilities and a usable fallback plan are more meaningful than a general promise of seamless operation.

Bottom line

Online EMDR is a plausible and increasingly studied way to deliver clinician-led treatment, but the evidence requires careful interpretation. Good telehealth planning includes clinical fit, privacy, communication, and a backup plan. A BLS tool may support that work; it does not replace the therapist, the assessment, or the wider system of care.