‘We Still Found a Way to Connect’: Adapting EMDR for the Digital Space—Insights From a Qualitative Study of Therapists and Clients

Introduction: Online eye movement desensitisation and reprocessing (EMDR) therapy has grown rapidly since the pandemic, but its adaptation to digital format remains varied and lacks standard guidelines. This study explores key considerations for effective online EMDR, helping to build the emerging evidence base for this modality. Objectives: This study aimed to identify key adaptations and strategies for effective online EMDR therapy from therapist and client perspectives. Methods: Using a qualitative exploratory design, semi-structured interviews were conducted with 10 EMDR therapists (experienced in both online and offline delivery) and 10 clients who received online EMDR. Data were collected through purposive sampling and analysed using thematic analysis. Results: Three key themes emerged. Practice essentials outlined clinical modifications, such as comprehensive assessment, client education, appropriate technical setup, a clear code of conduct, and specialised training, to support effective sessions. Therapeutic containment highlighted proactive risk management strategies, including extended stabilisation, slower-paced trauma processing, robust safety planning, appropriate referral pathways, and management of privacy and disruptions. Applying Core EMDR Principles for Online Delivery encompassed strategies for effective online delivery, such as maintaining a grounded therapist presence, fostering flexibility, integrating technological advances, and defining clear client contraindications. Conclusions: The findings offer practical guidance for clinicians transitioning to online EMDR, outlining key modifications to ensure safe and effective virtual trauma treatment. By integrating therapist and client perspectives, this study provides valuable insights to inform clinical practice and the development of future guidelines. Trial Registration: ClinicalTrials.gov identifier: CTRI/2023/09/057999.