bilateral stimulation

Bilateral Stimulation in Telehealth EMDR Sessions: A 2026 Guide for Therapists and Clients

Telehealth changed how a lot of EMDR work happens, and it raised a practical question that neither therapists nor clients had to think about before: if the session is on a screen, how does the bilateral stimulation actually happen? This guide covers what the research says about remote EMDR, the four ways bilateral stimulation is delivered over video today, and how to choose between them. Written for both EMDR therapists building a virtual practice and people using tappers at home between sessions.

Short answer: bilateral stimulation over telehealth is usually delivered one of four ways: on-screen visual or audio stimulation shared by the therapist, the client self-tapping (butterfly hug), a client-held tactile device the client controls, or a tactile device the therapist controls remotely through a web portal. Each has real trade-offs in cost, dissociation risk, and how much control the clinician keeps.

Does remote EMDR actually work?

The research base for remotely delivered EMDR is small but consistent so far. A 2024 systematic review in Frontiers in Psychiatry by Kaptan, Kaya and Akan screened the literature under PRISMA guidelines and identified 16 studies of EMDR delivered online, reporting reductions in PTSD, depression and anxiety symptoms broadly in line with what face-to-face EMDR studies report.

The review authors note the same caveat that anyone reading this should keep in mind: many of the included studies had small samples, no control group, and relied on self-report measures. Promising is not the same as settled. Read the review.

EMDRIA, the EMDR International Association, maintains an overview of the online EMDR literature and practice considerations that is worth reading in full if you are a clinician deciding how to structure virtual sessions. See their Online EMDR Therapy overview.

Nothing here is a claim that any device treats or resolves a condition. ALMA tappers are wellness devices inspired by EMDR therapy, not a treatment, and remote EMDR is a clinical process delivered by a trained clinician, not by hardware.

The four ways bilateral stimulation is delivered over video

In practice, clinicians running virtual sessions pick from four delivery methods. The choice usually comes down to who needs to hold control of the pacing, how well the client tolerates screen-based stimulation, and budget.

1. Screen-shared visual or auditory stimulation

The therapist shares a moving dot or alternating tones through the video platform. Zero cost, instantly available, and the therapist controls speed and set length directly. The downsides are real: video compression and lag can make a smooth left-right sweep stutter, alternating audio depends entirely on the client having decent stereo headphones, and some clients find sustained screen focus fatiguing or activating.

2. Self-administered tapping (butterfly hug)

The client crosses their arms and alternates taps on their own shoulders while the therapist paces verbally. Free, needs no technology, and works when a connection drops. The limitation is that the client is doing two things at once, keeping rhythm and processing, and rhythm often drifts exactly when processing gets difficult.

3. Client-controlled tactile devices

The client holds a pair of wireless tappers and sets intensity, speed and duration through an app on their own phone, following the therapist's verbal direction. The tactile channel stays off-screen, which many clients find easier than watching a moving dot for long stretches, and there is no lag between the two devices because they talk to each other locally rather than through the video call. The trade-off is that the therapist gives verbal instructions instead of turning the knob themselves. This is how ALMA works today.

4. Therapist-controlled tactile devices

The client holds the device, but the clinician adjusts speed, intensity and set length remotely through a web portal while the session runs. This keeps the clinician in the same control position they have in the room. Wevana currently markets a free therapist portal for exactly this, and app-based platforms such as EMDR Tappers offer real-time therapist-driven stimulation without hardware. If remote clinician control is your non-negotiable requirement today, those are the honest recommendations to look at.

On the ALMA roadmap: a video session feature that lets a therapist control a client's ALMA tappers remotely is in development and not available yet. We mention it here because clinicians ask, not to suggest the feature exists today. Everything described about ALMA above reflects what ships now.

Comparison: bilateral stimulation options for telehealth

The table below compares the practical characteristics of each approach. Device prices change often, so treat the figures as of August 2026 and check current pricing before purchase.

Method Cost Who controls pacing Best for
Screen-shared visuals or tones Free Therapist Getting started, occasional virtual sessions
Butterfly hug self-tapping Free Client, paced verbally Backup when tech fails, grounding work
ALMA tappers (client app control) $139 Client, directed verbally Clients who also want between-session use
TouchPoints About $190, varies by retailer Client Wrist-worn, hands-free wear
Wevana tabs plus therapist portal Device cost, portal advertised free Therapist, remotely Practices that need remote clinician control now
App-only platforms Free to low one-time cost Therapist or client No hardware budget, testing the format

What clinicians should set up before the first virtual session

Most of the friction in remote bilateral stimulation is logistical, not clinical. A short setup call removes almost all of it. The items below are the ones therapists report mattering most.

  1. Agree on a stop signal in advance. A raised hand works when audio drops. This matters more remotely than in the room, where you can read posture easily.
  2. Have a fallback method ready. If the device or connection fails mid-set, switching to butterfly hug keeps the set intact rather than ending it abruptly.
  3. Confirm the client's physical setup. Seated, feet on the floor, camera far enough back that you can see shoulders and hands, not just a face.
  4. Run a device test before the session, not during it. Charge level, pairing, intensity comfortable at the lowest useful setting.
  5. Know the client's location and local emergency contacts. Standard telehealth practice, and non-negotiable for trauma work.

Why some therapists give clients a device they own

A client-owned device does something a screen-shared dot cannot: it stays available on Tuesday at 11pm. Many clinicians who work virtually recommend a device the client keeps precisely so that self-regulation practice continues between appointments, within whatever the therapist judges appropriate for that client.

That is the use case ALMA was built around. The tappers are moulded in food-grade silicone that is soft and reassuring to hold, sized to sit comfortably in the palm, waterproof to IPX7, and controlled from an iOS or Android app for intensity, speed, light and session duration. Battery runs 3 hours or more on a USB-C charge. At $139 they sit below most wireless alternatives, which matters when a therapist is recommending something a client pays for themselves. Many users report feeling calmer during and after use, though individual experience varies.

If you are weighing devices for a practice rather than personal use, our guide to choosing EMDR tappers for your practice goes deeper on durability, cleaning between clients and cost per session. You can see full specifications on the ALMA tappers product page.

Frequently asked questions

Can EMDR be done properly over video?

The available research suggests remote delivery produces outcomes broadly comparable to in-person sessions, based on the 16 studies covered in the 2024 Frontiers in Psychiatry systematic review. The evidence base is still thinner than for face-to-face EMDR, and suitability is a clinical judgement your therapist makes with you, not a general rule.

Can my therapist control ALMA tappers from their end during a video call?

Not today. ALMA tappers are currently controlled by the person holding them, through the ALMA app on their own phone, while the therapist directs pacing verbally. A therapist-controlled video session feature is on the roadmap. If remote clinician control is essential for your practice right now, Wevana's therapist portal and app-based platforms such as EMDR Tappers already offer it.

Do tactile tappers work better than on-screen visuals for telehealth?

There is no strong comparative evidence ranking stimulation channels for remote sessions specifically. What clinicians report anecdotally is that tactile stimulation avoids two telehealth-specific problems: video lag distorting the rhythm of a visual sweep, and screen fatigue during long sets. Our comparison of tappers versus EMDR apps covers the trade-offs in more detail.

Can I use tappers on my own between telehealth sessions?

Many people do use bilateral stimulation devices independently for calming or wind-down routines, and that is separate from EMDR reprocessing work. Reprocessing trauma memories is structured therapeutic work and should stay inside sessions with your therapist. If you are in EMDR treatment, ask your clinician how they want you to use a device between appointments.

One last note. ALMA tappers are a wellness product inspired by EMDR therapy. They are not a medical device, they do not diagnose or treat any condition, and they are not a substitute for care from a qualified professional. If you are working through trauma, work with a trained EMDR therapist. EMDRIA maintains a public directory of certified clinicians.

Sources
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