Best practices for virtual EMDR

EMDR over video adds a few constraints that aren’t there in the in-office version — bandwidth, screen size, audio delivery, client environment. None of them are blockers, but each one rewards a small amount of preparation before the session.

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The client’s environment

Before the first session, send a short pre-session note covering the basics. The defaults that matter:

• Private, quiet room — a door that closes. EMDR work is emotionally intense; the client needs to know no one else can hear or see them.
• Stable seating — a desk chair or armchair, not a couch they sink into. Posture matters for visual tracking and for the body scan.
• Good lighting on their face — front-lit so you can read their expression. Backlight from a window is the worst case.
• Plug in or charge to 50%+ — a phone dying mid-set is a real failure mode. Have them plug in before joining.
• Tissues nearby — practical, and signals you’ve thought through the hour.

This is not Rivet-specific — it’s standard telehealth prep. Roll it into your existing pre-session note.

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The browser window

The BLS canvas fills whatever viewport the client is in. That means:

• Phone in portrait works but the canvas is tall and narrow. Horizontal paths read smaller relative to the screen. A phone in landscape gives the stimulus more horizontal range — recommend it for the first session.
• Tablet is the sweet spot. iPad in landscape, Android tablet, both give a comfortable canvas with the client at a natural distance.
• Laptop or desktop works well — full-screen the browser so menu bars and tabs don’t pull focus.
• External monitor with the client at 24”+ distance — large stimulus, natural eye movement range. Excellent for in-office hybrid setups.

In your pre-session note, ask the client to maximize or full-screen the browser window before they join. Browsers handle full-screen with F11 (Windows / Linux) or Cmd+Ctrl+F (macOS), or the maximize button on the title bar.

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Headphones for the audio modality

If you’re running EMDR 2.0 (the default), the audio modality is on. For the audio to work as bilateral stimulation, the client needs stereo audio output with a clear separation between left and right. Recommend, in order:

1. Over-ear or on-ear headphones — best. Full L↔R separation.
2. Wired earbuds — equivalent, smaller footprint. Have these as a fallback if the client doesn’t have headphones.
3. AirPods or Bluetooth earbuds — work, but warn the client that Bluetooth audio occasionally hiccups and the audio modality could stutter during reconnects.
4. Laptop speakers — work, but the L↔R panning is much weaker when both speakers are 6 inches apart. Acceptable for trial; suboptimal for ongoing work.
5. Phone speakers — single mono output on most phones. Audio modality is functionally lost. Either switch to visual + haptic, or ask the client to add earbuds.

Mention headphones explicitly in your pre-session message. The single biggest preventable failure mode is a client with great visual and a mono speaker.

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EMDR 2.0 vs Classic — choosing

Rivet defaults to EMDR 2.0 as the launch mode. The published outcomes are equivalent to Shapiro standard with fewer sets needed. But the choice matters per client. Reach for EMDR 2.0 when:

• You’re trained in EMDR 2.0 and comfortable with the dual-task pacing
• The client tolerates the multimodal stimulation (visual + audio)
• The client engages well with cognitive load — they can count backward, name categories, do mental math without overwhelm
• You want shorter sessions or fewer sessions to reach the same SUDS reduction

Reach for Classic when:

• You’re trained in Shapiro standard EMDR and want to stay in that protocol
• The client is overwhelmed by multimodal stimulation
• The client has cognitive load limits — head injury history, ADHD, active substance withdrawal — that make dual-task prompts counter- productive
• The session is doing resource installation (Phase 2) where the goal is calming, not loading

This is a per-client and per-session choice, not a permanent setting. Switch between the modes in the Configure modal at any time.

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Pace within the session

A few orienting notes that come from EMDR clinical practice, not from Rivet’s tooling:

• Start with a brief test set. Before any reprocessing, run a short set with neutral content — count backward from 50 by 3s, looking at the butterfly, for 20 seconds. Check the client tolerates the stimulus before introducing the target.
• Watch the SUDS curve as you go. Each between-sets card shows the sparkline so far. A descending line is the typical pattern. A flat or rising line is a clinical signal — adjust the rate, switch the dual-task category, or check the target.
• Plan for closure. Don’t run reprocessing into the last 5 minutes of the hour. Whatever the SUDS arc looks like at that point, you need time for the Container resource or another closure tool. The Container template lives in the EMDR templates section for this reason.

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Network conditions

Rivet’s video runs peer-to-peer between you and the client when the network allows it, with an encrypted relay fallback when it doesn’t. About 90–95% of sessions run peer-to-peer; 5–10% relay through Rivet’s infrastructure (the relay forwards encrypted packets only — it can’t decrypt the call). For BLS specifically, the configuration messages and start/stop signals travel on a separate channel from the video and audio, so even on a degraded connection, BLS commands deliver reliably. The visual stimulus itself runs on the client’s device in their browser, so the stimulus quality is not affected by bandwidth. If the connection drops mid-set, BLS pauses on the client automatically. You explicitly restart when the connection recovers. See Practitioner controls.

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What to do at session end

After the last set’s SUDS, the session arc card renders. Before tapping Done, tap Copy to drop the session summary on your clipboard. Paste it into your session note or your EHR. The values clear when the Workspace closes — Copy is the export path. See The session arc.

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