In Support of EMDR Online

With thanks to my EMDR Consultant colleague Deb Fish for the following article, summarising an online discussion of using the internet and video-conferencing for remote, online EMDR with clients. We spoke in November 2017, and the article appeared shortly afterwards in the house journal of the EMDR Association UK and Ireland EMDR Now.

(Deb works in private practice, and also for the NHS in Dorset, within secondary services, and fuller summary here Some key points from EMDR Online discussion Dec 8 2017.)

EMDR ONLINE DISCUSSION

In response to a Jiscmail question for do’s and don’ts when offering EMDR therapy online, Mark Brayne, EMDR Europe Consultant, kindly and very deftly organised and chaired a well-structured and informative online discussion – in the process introducing most of the participants to the professional, online platform, called Zoom.

Seventeen EMDR therapists (one of whom was based abroad), participated in this event, with varying ranges of experience and qualification – from the very recently trained to (mostly) accredited Practitioners and a sprinkling of Consultants.  Some were venturing into online EMDR with trepidation, focusing upon resourcing, whilst others were enthusiastic and experienced, with many successes behind them.

To briefly summarise key points discussed:

To offer online EMDR therapy or not?

Online EMDR therapy can offer clients more choice, as it helps overcome geographic and logistical constraints.  Whilst some therapists might find it less satisfying than in-person sessions, it can nonetheless feel very close and intimate, and from a client’s perspective facilitate an effective treatment outcome.

As with in-person EMDR therapy, client readiness, stability and risk need to be carefully assessed, to determine the most suitable treatment option.  For containment, the client needs to feel safe both with technology, and relationally.

What online platform to use?

Although Skype is familiar to therapists and clients, with encryption now acceptable to the UKCP, the connection quality can be inconsistent.  Skype also uses more bandwidth than Zoom and VSee, which can be problematic at midday, for those in countries such as Germany and Finland.  WhatsApp is encrypted, and popular with younger clients, although it too can have variable quality.  Facebook and Facetime were considered less appropriate, although professional and personal accounts can be separate.

What form of bilateral stimulation to use?

The participants had tried and tested various options including: the butterfly hug, asking clients to tap on their own knees or the table in front of them (with eyes following from side to side).  Some watched a moving dot via YouTube on a phone or tablet app.   Others used headphones, with the client stopping and starting BLS from an app such as BSDR Player.  With couples work, clients could face each other and do knee taps.

How to get started?

It is essential for your technology and apps to be up to date, and to be able to coach a client to use a particular system.  For professionalism, consider what will be visible around you, for a neutral backdrop.  Also, is the telephone your standby plan, if needed?

Address safety procedures and expectations for treatment.  Find out specifically where the client will be located during the session, what equipment they plan to use, the size of screen, how uninterrupted confidentiality can be ensured for the session, as well as space for them to quietly unwind afterwards.  You might also want an agreement with the client not to record or share session content with others, e.g., via social media.

What about professional liability insurance?

Check with your own insurer if you are planning to provide online EMDR therapy.  However, Towergate include indemnity for online clients in the UK and abroad, provided the therapist is UK-based.  Balens also cover online work, although they exclude clients in the US and Canada.

Additional considerations to explore:

  • If working internationally, might you be liable for tax in the jurisdiction where the work is being done?
  • One participant recommended the Association of Counselling and Therapy Online as helpful for best practice guidance: https://acto-org.uk.
  • If the client were to dissociate how could you deal with it?

The consensus was that this event was engaging, informative, motivational and validating.  Thanks to online technology and Mark Brayne’s generous involvement and expertise making it possible, we were able to feel connected, despite being geographically dispersed.  Thanks to everyone who contributed to this stimulating discussion.