I bet most people would have never thought that they would only have online therapy as an option. I never thought that there would be a time the only way I could continue to see clients would be online, but here we are in a global pandemic learning to adapt with what we have.
Whether you are a client that was already familiar with the EMDR process and now had to adapt to EMDR online therapy, or you are a new client interested in what EMDR has to offer or online therapy in general, we are all figuring this out together.
Can EMDR Therapy Be Done Online?
Let’s get straight to it, yes EMDR online therapy is possible. While EMDR is not a new therapy, EMDR online is a relatively new way to do EMDR therapy and it is important to note that the research is on-going. The research of online therapy in general has been studied and found to be highly effective (Barack et. al, 2007).
Why Might It Be An Important Time to Continue or Start EMDR Online Therapy?
People who are seeking out therapy are usually experiencing stress.
Some clients are experiencing intense chronic stress due to long standing childhood traumas that have impacted negative feelings of being abandoned, loneliness and trouble with trusting others. It can be really important to address these stressors and use EMDR as a way to manage triggers and daily life.
Now imagine having these long standing challenges with chronic stress, abandonment, trust and loneliness and finding yourself in a pandemic where your chronic issues are being triggered consistently.
These issues can stem from not trusting people, concern over whether or not others are properly washing their hands or keeping an appropriate distance. We can really feel the long term impact of social distancing traumatizing, which may arise from a long standing issue of abandonment, loneliness, or a sense of loss in safety.
It can put people who aren’t currently seeing a therapist in the position of needing to address not only the current stress but the deeper preexisting trauma that is coming to the surface, all the while adapting to the idea of doing EMDR online.
The challenge is that, while working through trauma online can be odd or difficult, the reality is not addressing your traumas can mean unaddressed stress, anxiety, loneliness, triggered traumatic memories and possibly even more dissociation at home, all while doing this alone.
It might be a difficult transition but your therapist is there for you.
How Is EMDR Online Therapy Different From In-Person EMDR Therapy?
The feedback that I have received from clients that transitioned from EMDR in office to EMDR online has been mainly positive. Generally, most clients felt there was a transition period but overall they felt comfortable with processing online and it was not as challenging of an adjustment to make as they anticipated.
If you are already doing EMDR therapy or are shifting to EMDR online there are some things you might want to consider.
Do you have a support system you can reach out to if you can’t be in office with your therapist?
Do you need to revisit or restore the contract of your work together? Do you need to reassess the goals of your trauma treatment?
Clients that are transitioning to EMDR online therapy might need a session or two to reassess goals and to build their comfort with meeting online.
Once they become familiar with online therapy, are familiar with the process of EMDR, have safety procedures in place, new contract and goals reestablished there is nothing standing in the way of moving back into work.
The standard 8 phase EMDR protocol can be used in a fairly traditional manner.
For new clients, just as you would have in office, you would have an assessment, history taking and resource building phase before moving into the reprocessing or desensitizing phase of EMDR. You would establish safety steps and support systems and practice using them before shifting into EMDR. Eventually you very much feel like there is a routine and structured approach to your online sessions.
Some Considerations For Online Therapy
A therapist office environment is set up in a way that creates a sense of safety, comfort, calmness and confidentiality. When you are adjusting to therapy at home there are some things you want to consider in terms of your environment.
Can you find a space where you can speak uninterrupted by kids?
Are you restricted to common areas that have a lot of noise?
Do you feel like you can speak safely without worrying about someone overhearing what you are saying or working on, in your session?
Do you have headphones and a webcam on your device?
Will you at some point have access to a computer instead of just a phone or ipad?
Some clients don’t want to process trauma in a space that they usually use to calm down from their triggers because it can contaminate or taint the feeling of the space.
How Does Bilateral Movement/Taxation Work if I’m Not In The Office?
Typically, in an in-office session, a therapist will get you to follow their fingers or a light bar to create taxation through eye movement.
Pulsers or tapping is used to create physical taxation and headphones are used to create taxation through auditory sensory. There are a variety of different methods that can be used to create physical, eye or auditory taxation online.
When it comes to eye movement you can decide with your therapist if you want to follow their fingers through the screen (assuming there is enough screen space to create eye movement). A creative way to create eye movements is to place post-it notes either on the corner of the computer or on the wall in front of you, far enough apart to create eye movement and when it comes time to process moving your eyes back and forward between the established points.
There are many different YouTube videos made specifically to create eye movement and also provide audio movement (with headphones). There are apps that can be bought that allow for the therapist to control the taxation methods, speeds, direction from their computer. Clients also have the option of tapping on themselves to create a physical taxation, which can also be done at a very slow and calming state at the end of the session when containment and calm place are done.
With more therapists becoming familiar with the work of EMDR 2.0 you can determine with your therapist additional non-bilateral stimulation methods of taxing the brain, such as counting or multiplying or creating more challenging ways of tapping.
With EMDR 2.0 you can get creative or have fun with your clients by creating different ways of taxing the working memory, such as getting clients to list different breeds of dogs, silly but effective.
What Happens When There Is Internet Interruption During EMDR?
This is a conversation you should have with your therapist.
What if the doorbell rings, your phone rings, or one of the kids enters the room unexpectedly?
The circumstances of your living situation would determine what needs to be explored as possible interruptions, each plan would be based on the person’s feelings, needs or comfort level.
You and your therapist will have a plan in place for the situation where the internet connection cuts out.
Typically the exercises are established before EMDR processing, such as containment, resource development, calming techniques or even physical activities to complete at the end of session to help clients refocus. It might be that if connection cuts out you immediately move to your established exercises (e.g. containment and calm place) until your therapist reconnects with you either by video chat or a follow up phone conversation.
This would also be a time when your support person would help you follow through with the strategies that were set in place.
How To Prepare Before an Online Session of EMDR Therapy?
Have your supports be aware that you have your session.
Explain to them what their role might be, if that is to ask you to do a grounding technique, bring out a grounding scent, play a predetermined song or head you through a grounding exercise.
Their role might come after the session or if there was an interruption with the internet connection during the session and how to help you until connection is reestablished.
Before your EMDR session you are going to want to make your space comfortable and make it so that you don’t have to get up from the computer often. For example, make sure you have tissues close by, water, you have gone to the washroom beforehand, maybe your beloved pet comes into the session with you or you remove them before the session depending on your preference.
How Does An EMDR Session End in an Online Setting?
In the same way that it would in an office session, EMDR ends based on your own personal needs of what helps calm your body and mind.
For some clients, they do a containment exercise where you visualize putting away the content of the session for the time being. You can also create a calm space, use the smell of a calming scent (eg. candle, spice, clothes of a loved one), listen to music or do a few yoga postures to bring the mind to focus on the body.
Whatever the exercise is, after an EMDR session your therapist guides you through the exercises that have been established to work for you.
Giving yourself some extra time to transition out of your session is a great idea as well. The benefit of being at home is that you can go for a walk, take a bath, talk to your support person or do some home exercises immediately following the session.
The Good News Is You Don’t Need To Postpone Addressing Your Triggers!
It can feel like an odd transition for both new and experienced EMDR clients to adjust to the concept of online therapy and EMDR therapy online.
While there is still on-going research about the use of EMDR online, for those who feel like they are in a place where they cannot wait for the pandemic to be over, take comfort in knowing that EMDR online is an option to explore with your therapist and that there are strategies in place so that you can benefit from what EMDR has to offer in the comfort and safety of your own home.
Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services, 26(2-4), 109-160.