Therapists vary on this one, and use their intuition as well as training to decide on the direction of eye movements. In training, we learn that if processing seems stuck, changing the direction may get it moving again, or access other material. In practice, some EMDR therapists find that changing the direction to vertical can sometimes sooth, sometimes deepen, the processing of material. There is no research on this however, so it is therapist and client preference that guides. Clients are free to speak up if they like or dislike a particular mechanical aspect of the bilateral stimulation - as a variety of approaches seem to work.
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