The evidence, first
Most pages about online trauma therapy either assert that it works or worry that it does not. The research is more useful than either.
Randomised trials comparing video-delivered trauma treatment with in-person work have repeatedly found no statistically significant difference in symptom reduction.
A twelve month service evaluation at Cardiff and Vale University Health Board went further: patients who received EMDR online finished treatment with lower PTSD scores than those treated in the room.
The consistent caveat across that literature is fidelity. Online trauma work succeeds when the therapist adapts the protocol properly and fails when the same session is pointed at a webcam. That is a difference in practitioner rather than in medium, and it is the only thing you should be asking about.
How EMDR is actually delivered by video
Bilateral stimulation, the mechanism at the centre of EMDR, transfers remotely without much difficulty.
It can be done with guided eye movement following a moving point on screen, with alternating audio through headphones, or with self-administered tapping that you carry out while the therapist paces it. In practice a combination is common, and which one suits you emerges in the first session or two.
Headphones matter more than people expect. Alternating audio is unusable through laptop speakers, and it is often the most reliable of the three. Get a pair before you start.
Over a hundred EMDR sessions have been delivered by video in this practice, including some of the best outcomes it has had, several of them with clients I have never met in a room.
What genuinely changes online, and it is not the protocol
The preparation changes.
In a consulting room, the end of a difficult session has a natural buffer: standing up, walking out, a corridor, a street, ten minutes before you are anywhere. Online there is no buffer at all. The session ends and you are still in your kitchen, with a meeting in nine minutes.
So three things get agreed before any processing starts.
A stabilisation phase, which is not optional and is not a delay. Resources, grounding, and a demonstrated ability to come down before anything is opened up.
A plan for a session that ends hot, including what you do for the following twenty minutes and how to reach me if something continues.
A room. Somewhere you will not be interrupted, with the door shut, for the whole hour. This is the single most common practical obstacle and it is worth solving properly rather than working around for six months.
Get those right and the remote work is not a compromise. Get them wrong and it is worse than nothing.
What is treated
Single-incident trauma, such as accidents, assault, sudden bereavement or medical events. This is what EMDR was built for and it can resolve faster than talking around it ever will.
Complex and childhood trauma, where the material ran through years rather than leaving one memory behind. This is slower, and I am going to be honest about it: EMDR does not resolve complex trauma the way it resolves a single event. It is part of the work rather than the whole of it, and the rest is depth psychotherapy.
Trauma alongside addiction, which is extremely common and which changes the order of the work rather than the content of it.
When medical treatment comes first
This is psychotherapy, not medical treatment. Withdrawal from alcohol or benzodiazepines can be dangerous and occasionally life threatening, and needs to be managed by a GP, an addiction psychiatrist or a medically supervised detox rather than attempted alone. Where that is what is needed, it is said at the assessment and the referral is made.
The same applies where a psychiatric assessment should come first or run alongside the work, and where the right answer is residential treatment rather than weekly sessions. Therapy does the work that follows stabilisation, and it does that work better once stabilisation is in place.
When this should not start yet
If you are drinking or using daily, trauma processing is not where to begin. A substance that is doing the regulating will destabilise rather than resolve, and the sequencing is part of what the assessment decides.
If you are in acute crisis, or medically unwell, that comes first.
If you have nowhere private, that is solved before processing rather than around it.
Practicalities
Fifty minutes, weekly, by secure video, anywhere in the UK or internationally. In English or French.
I have practised EMDR for over twenty years and worked with trauma for twenty-five.
Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Doctorate of Professional Practice at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.
Related: online therapy · EMDR in London · trauma therapy London
If you are in distress, Samaritans is free on 116 123, day or night. In an emergency call 999 or go to A&E.
Common questions
Does online trauma therapy actually work?
Yes, and the evidence is unusually clear. Randomised trials comparing video-delivered trauma treatment with in-person work have repeatedly found no statistically significant difference in symptom reduction. A twelve month service evaluation at Cardiff and Vale University Health Board found that patients who received EMDR online finished treatment with lower PTSD scores than those seen in the room. The consistent caveat across that literature is fidelity: it works when the therapist adapts the protocol properly, not automatically because it is on a screen.
Can EMDR be done online?
Yes. Bilateral stimulation can be delivered remotely, either through guided eye movement on screen, alternating audio through headphones, or self-administered tapping, and the protocol holds. Over a hundred EMDR sessions have been delivered by video in this practice, including some of its best outcomes. Headphones make a material difference and are worth having before the first session.
Is online trauma therapy safe?
With proper preparation, yes, and preparation is the part that changes online. Before any processing begins there has to be a stabilisation phase, an agreed plan for what happens if a session ends while you are still activated, and a room at your end where you will not be interrupted. Those are not formalities. They are what makes the difference between remote trauma work that helps and remote trauma work that destabilises.
What kinds of trauma can be treated remotely?
Single-incident trauma such as accidents, assault, sudden bereavement or medical events tends to respond well and sometimes quickly. Complex and childhood trauma can also be worked with online, though it takes longer and EMDR is part of the work rather than the whole of it. What cannot be done remotely is medical stabilisation, and that distinction is made at the assessment.
When should online trauma therapy not start yet?
If you are drinking or using daily, processing trauma tends to destabilise rather than resolve, because the substance is doing the regulating. If you are in an acute crisis, or medically unwell, that comes first. And if you have nowhere private to take a session, that needs solving before processing begins rather than being worked around.
Do I need to be in the UK?
No. A substantial part of this practice is international, in English or French, including clients across the Gulf, Asia, Europe, Africa and the Americas. Registration is with the United Kingdom Council for Psychotherapy and the Health and Care Professions Council.