The protocol is the protocol. Phases don't change, targets don't change, the assessment and the body scan don't change. What changes is logistics: how the bilateral stimulation reaches a person who isn't in the room, how you keep their face where you can read it, and what the two of you have agreed to do when the picture freezes in the middle of a set.

Most practitioners who move EMDR online find the clinical work translates and the failure modes are all mechanical. A tone that arrives a beat behind the dot. A client watching the stimulus on a phone propped against a mug. A set that runs to its timer while you're staring at a frozen frame and can't tell what your client is doing.

So the preparation is different, not the therapy. Three things carry most of the weight: the client's setup, an agreement about interruptions, and your own screen arrangement so you can still see them while the stimulus is running.

EMDRIA has published guidance on virtual delivery, and it is worth reading in full rather than in summary — it covers emergency protocols, location verification and the consent items that get skipped when the work moves online.

What actually changes when EMDR moves to video?

You lose peripheral information. In the room you read shoulders, hands, breathing, a foot that stops moving. On video you get a head and shoulders in a rectangle, and only if their camera is placed well. Ask for a slightly wider frame than a normal session — far enough back that you can see their hands.

You lose control of the environment. Their room, their door, their housemate, their notifications. The containment you'd normally provide with a physical space has to be built by agreement instead.

You lose the ability to hand them something. No tissues, no grounding object, no glass of water. These get moved into the pre-session note as things they bring to the chair before you start.

You gain a few things too. Clients who reprocess in their own home sometimes settle faster than they do in an office. And the drive home — often the least contained part of an EMDR day — disappears.

How does the bilateral stimulation get to the client?

Two broad approaches, and it is worth knowing which one you are using.

A separate tool alongside the call. You open a stimulation tool, send the client a link, and it runs beside the video window. Simple, usually free, and the one most practitioners started with. The costs are real: two windows on both sides, a client who has to manage a second thing, and no guarantee that what they see and what they hear are actually in step with each other.

Stimulation delivered inside the session itself. The stimulus reaches the client through the same connection carrying the call, so there is one window to manage and one thing to explain. This is the more recent shape, and the thing to check before you trust it is whether your face is still visible while the stimulus is running.

Whichever you use, three parameters matter clinically: the rate, the modalities you're running, and whether the sound and the picture actually agree with each other. Check all three before you trust a set.

What do you need to set up before the first set?

Send this before the first virtual EMDR session, not before the first set.

• A private room with a door. Non-negotiable. Reprocessing in a room someone might walk into is not reprocessing.

• A stable seat. A desk chair or an armchair, not a bed or a couch they sink into.

• The device charged and plugged in. A phone dying at the end of set three is a real and preventable failure.

• Stereo headphones or wired earbuds, if you're running audio. Phone speakers are usually mono, and mono audio is not bilateral stimulation.

• The biggest screen they have, in landscape. A phone in portrait gives a moving stimulus almost no horizontal range to travel.

• Tissues, water, and anything they use for grounding, within reach before you start.

Then agree what happens if the call drops: they stay put, you call them back on the phone, and neither of you carries on alone. Say it out loud in the first session so it isn't being invented mid-abreaction.

What about screening and safety?

Everything you'd screen for in the room, plus one item that is specific to a screen. A moving visual stimulus is visual flicker, and the categories worth asking about before the first visual set are photosensitive epilepsy, recent concussion, migraine with aura, vestibular disorders, and recent eye surgery.

If any of those are live, run the set without the visual. Sound and touch carry no photosensitive risk, and a set on audio alone against a still background is a complete set.

The other safety item is location. You need to know where your client actually is during the session and who to call if something goes wrong there. This is easy to skip when they're a familiar face in a familiar rectangle and they've moved to a different city.

What goes wrong, and what do I do about it?

The connection degrades mid-set. Stop the set yourself. A stimulus that keeps running while you can't see your client's face isn't stimulation you're delivering — it's stimulation that's happening to them. Don't wait for the timer.

The client's audio is mono. They hear a tone that doesn't move. Check headphones before the first set rather than diagnosing it in set four.

You lose them mid-abreaction. This is what the agreement is for. Call them, on the phone, immediately. Do not spend three minutes trying to rejoin.

They start reprocessing before you're ready. More common online, because the pre-session buffer that used to be a waiting room and a walk down a corridor is now a click. Build the buffer back in verbally.

What does closure look like when they're at home?

The same as always, with more time allowed. Leave more room than you would in person — you cannot see whether they're steady on their feet as they leave, so you have to ask, and then ask what they're doing next.

The short version

Run the protocol you already run. Move the effort into preparation: their room, their headphones, their screen, and one agreement about what happens when the picture freezes. Then keep your eyes on their face, and stop the set yourself the moment you can't.

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