How Does EMDR Therapy Work Online?
EMDR Therapy has been gaining popularity in the past few years (and rightfully so!) But can EMDR Therapy be blended with the now commonplace practice of online therapy? Short answer: Yes. EMDR Therapy can be done effectively via telehealth therapy and here’s some info on how EMDR is conducted online.
How Online Therapy (with or without EMDR) Starts
If you’ve been to therapy before, you’re likely familiar with that first initial session where the therapist asks you some (or many) questions about yourself and your background. This is typical in any therapy modality whether it be psychodynamic, cognitive behavioral or EMDR therapy. Typically, your therapist will conduct a biopsychosocial assessment where they gather some basics from you that include the following:
Presenting Problem (why are you seeking therapy now? How long has this been brewing for you, is it brand new or has the issue been building over time?)
Family History (what your childhood was like, who makes up your family, what’s your relationship like with family members and any knowledge of mental health struggles within your family)
Educational and Employment History (tell your therapist any highlights and lowlights from educational institutions throughout your life as well as any employment information)
Alcohol and Drug Use (this is NOT to be judgmental if you’re with the right therapist. It is my belief that substance use is a symptom of deeper pain to be addressed, it’s not the main issue.)
Future Goals (what do you want to see when you finish therapy? Less anxiety? More meaningful social relationships? How do you want to feel when therapy is completed? Lighter, at peace? )
All of these questions are typical for a first session regardless of the therapy type you are seeking. This is because even as an EMDR therapist, I still benefit from getting to know you as a full person. Ideally, and most likely, the information gathered in this initial session will begin to inform future sessions and our work together. For example, I’ve met with folks in the first session who present with anxiety related to a recent work incident that is affecting them greatly. Upon further exploration during this first session, I learn that they in fact have a long history of being taken advantage of in work settings as well as in friendships which has continued to fuel their low self image and self worth. This is valuable information, especially in EMDR Therapy, as we work together to identify some of the primary negative cognitions you have (more on that later).
All of this is completed, typically, during that first session and you can get a feel for if this therapist is right for you. For more information on picking the right therapist for you, click here.
What Happens After The First Session?
After that first session, you and your therapist will probably spend some time getting to know each other and building rapport. This length of time depends on your comfort level as well as the therapist’s. For me, I notice that after 1-3 sessions the majority of clients are ready to dive deeper into EMDR Phase 1 work. Phase 1 of EMDR includes the assessment and gaining of information and rapport building so no time lost- you’re already doing EMDR Therapy!
Your therapist will now begin to officially have you identify a theme (or themes) of the work you’d like to focus on for EMDR. This will likely be a larger umbrella that will hold some specific negative cognitions and memories. With your therapist, you’ll identify some floatback memories related to whatever negative cognition is most relevant to your theme/presenting issue. The best part of EMDR is that even during this phase, where we’re specifically asking you for the distressing, perhaps disturbing memories, you do not need to go into detail. I’ve had clients present as baffled by this idea of not describing, in detail, the worst parts of their lives; the sense of relief and comfort cannot be underestimated.
Once memories (target memories in EMDR) have been identified related to the negative cognition, you’ll begin Phase 2 known as Preparation or commonly referred to as Resourcing.
What’s Resourcing?
Phase 2 is where your therapist will begin using bilateral stimulation or dual attention stimulus to strengthen internal coping. Bilateral stimulation or BLS is, primarily, what makes EMDR Therapy unique. This is the mechanism of action used to create change (as opposed to talking for instance). BLS can be in the form of eye movement, tactile stimulation (holding buzzers in your hands or self administered tapping) and through auditory tones by wearing headphones. In each of these forms, bilateral stimulation is the action of crossing the midline, engaging both hemispheres of your brain.
Allie shows you what it looks like to engage in slow, short sets of eye movement when doing EMDR Therapy online.
Your therapist will explain each type of BLS and you get to choose which feels like a fit for you. I can’t explain how you’ll “know” which one is right other than saying you’ll know when you’ve found it. Doing EMDR online with your therapist does not limit you to only one of these types of stimulation. You have the option to use eye movements which can be done through various websites which your therapist controls the speed of as well as the option for audio tones and client administered tapping.
Eye movements will be slower during this phase, and will be paired with typically some sort of visualization, meditation, breathwork or other internal resource you’ve already described using. These are either initially developed during this phase of EMDR Therapy or strengthened, depending on what your baseline may look like entering therapy.
Some clients spend one session in “official” resourcing, some spend longer and there’s truly no right or wrong way. It all depends on you as a client. For some folks, they’ve never learned deep breathing, engaging their 5 senses, visualization or other similar techniques. That’s their baseline. Some folks do yoga weekly, have been practicing meditation for years or really like that box breathing technique their former therapist taught them. The primary thing your therapist is looking for in this phase is whether you have some form of regulating/managing your emotional state within a window that’s safe for you and safe to proceed to reprocessing.
Right Before Reprocessing
Once you and your therapist have reviewed and seen some success in using resources effectively (to manage distress), you will pick which target memory to begin with for reprocessing. Now, technically Phase 3 is not referred to as reprocessing but for brevity, this next part is setting the scene.
Let’s say you had identified earlier (Phase 1) a theme of “powerlessness” and a negative cognition of “I cannot handle it”. With this theme you will have shared 3 specific memories and now that we’re near reprocessing, you as the client get to pick which one you’d like to start with. Some clients start with the first memory related to their theme, some go with the worst, some go with the most recent (those are your 3 choices). My choice as a therapist would lean toward the first memory but my choice really isn’t what’s important here. Whichever memory feels ok enough for you to start is where you should start, the brain will do its work regardless.
Once you identify the target memory (first, worst or most recent or even a present trigger), your therapist will begin Phase 3 of EMDR Therapy which involves engaging your senses and all the channels in which memories are stored (the image itself, senses involved with it such as smells, touch, sound, etc, emotions, thoughts, and body sensations). This is how we store memories so it makes complete sense that to begin reprocessing, we’re essentially activating these channels up (bringing the memory into the working memory so you can reprocess it). At this point, your therapist will be asking you specific questions related to the above channels, bringing the memory up, asking you to give some ratings of distress and then you’re right into reprocessing.
Phase 4-6 Specifically (Reprocessing)
Now that you’re in reprocessing, the therapist will be leading you through sets of bilateral stimulation (again, whatever version of this you align with most). These sets are faster and longer than in Phase 2. The key in reprocessing as a therapist is to stay out of the way and let the brain and the client do the work. For the most part, after each set, you’ll be invited to take a breath and then asked to share whatever you notice right then and there. This could be an image, a sound, a thought, emotion, body sensation, a scene from years ago, anything. Your brain is now doing the work and though it may at first glance be taking you on a wild goose chase, I assure you it’s not. Our brains make connections in ways we aren’t consciously aware of and during reprocessing, whatever you notice is just that, it’s not permanent, it’s what you notice right now.
Once your disturbance related to the target memory has gone (on a scale of 0-10 with 0 being none), you’ll move to installing a positive belief and a body scan (Phases 5 and 6 of EMDR). If you’re interested to see an entire telehealth session using self administered tapping, click here.
Debriefing
A session of EMDR Therapy may not end with you having zero disturbance related to your target memory and that’s ok. Some folks go one session and complete a target memory (meaning the memory doesn’t bother them or evoke strong reactions, positive belief installed and a clear body scan) and some people don’t. There’s no timeline for this, we’re humans.
You’ll likely end your session with either using a resource identified and strengthened in Phase 2 or simply verbal debriefing of the session, the choice is yours. Although the standard protocol of EMDR doesn’t change and is generally what I’ve outlined in this post, it can be experienced differently by everyone because therapy is not one size fits all. Just know that your therapist is keeping track of the time and your distress and will not close down an entire session without ensuring you have some closure and relief regardless of whether the target was cleared.
I hope this shed some light and reduced anxiety related to what EMDR Therapy may look like when done virtually with a trained therapist. EMDR Therapy can be done effectively online, in the comfort of your own home or safe environment. If this is something you’re interested in trying and you reside in Ohio or New York, contact me.
