How to Set Up an Online EMDR Session: Step-by-Step Clinical Workflow

An online EMDR session has two layers that are easy to confuse: the clinical work, which follows the standard eight-phase EMDR protocol and your own training and judgment, and the technical workflow, which makes sure video, audio and bilateral stimulation (BLS) reach the client reliably. This article covers the technical workflow only. It does not tell you when to begin reprocessing, which target to choose or how to respond clinically; those remain decisions for the trained clinician.

The short version: confirm the client is suitable and prepared for remote work, run your video call as usual, send the client a separate BLS link, check that the stimulation is visible and audible on their device, then run and close the session while keeping verbal contact on video.

What is established: EMDR is a recommended treatment for PTSD in guidelines from the World Health Organization (2013) and NICE (NG116, 2018).

What is supported by some research: a systematic review by Lenferink, Meyerbröker and Boelen (2020) found that the available studies of online EMDR reported reductions in PTSD symptoms, but the number and quality of studies were limited. Online delivery should therefore be described as feasible and promising, not as proven equivalent to in-room EMDR.

What is a clinical decision: whether a particular client should receive EMDR remotely. General telepsychology guidance (APA, 2013) asks clinicians to assess the appropriateness of remote services for each client, address privacy and security, and plan for emergencies in the client's location.

The steps below describe the technical side of a session using any browser-based BLS tool; where BilateralSync is mentioned, it is as an example of how that tool works, not as a clinical standard.

• Use a computer rather than a phone for the therapist side, so the video call and the BLS controls can be visible at the same time.
• Use a wired or stable connection and close bandwidth-heavy applications.
• Open your video platform and your BLS control view before the client joins.
• Have the client's local emergency information and your agreed plan for a lost connection to hand. See preparing clients for online EMDR.

Ideally this happens in an earlier session, not minutes before reprocessing:

• A private room where they will not be interrupted.
• A laptop, desktop or tablet; a large enough screen to follow visual BLS comfortably.
• Headphones if auditory BLS will be used, because left–right tones depend on separate left and right channels.
• A short trial of the BLS link so that nothing is new on the day of reprocessing.

Keep your normal video platform for the therapeutic conversation. A BLS tool that runs in a separate browser tab does not need to replace or integrate with it. Agree how the client will tell you to stop (a word, a hand signal) and confirm that you can see and hear each other clearly. Background on platform choice is in EMDR telehealth.

Create the session on your side and send the client the session link through a channel you already use securely, such as the chat of your video platform. In BilateralSync the client opens the link in a browser with no download and no client account; the steps are shown on how it works, and you can try the tool yourself first with the free EMDR tool.

Ask the client to enter fullscreen and confirm they can see the moving stimulus across the full width of the screen without straining. Ask whether speed, size and colour feel comfortable. There is no universally correct setting; adjust to what the client can follow, as discussed in BLS speed and set length.

With headphones on, play a few tones and ask the client to confirm they hear them alternate left and right, not both sides at once. Many browsers block sound until the user has tapped or clicked the page, so if nothing is heard, ask the client to tap the page once. Set a comfortable volume before starting a set.

During sets the therapist starts, stops and adjusts stimulation from their own screen; the client does not need to touch any controls. Keep your eyes on the client's video between and during sets, as you would in the room. Clinical decisions about set length, interweaves and when to continue or stop follow your EMDR training — see EMDR Phase 4.

Stop the stimulation, end the BLS session from your side and complete closure on video before the client leaves the call. Remote-specific closure considerations are covered in remote EMDR closure and grounding. Record your clinical notes in your own record system; a BLS tool is not a clinical record.

Privacy and data handling for BilateralSync are described on the security page.