What if They Can Hear Me?

The sanctity and privacy of the therapeutic conversation has been an underpinning principal to the extent that it is enshrined in ethical guidelines that protect clients from breaches of confidentiality by practitioners. More difficult is managing the curiosity of family members when sessions are held with an individual or subsystem, and a parent, partner or child is found listening at the door.

Telehealth presents even greater challenges as it is impossible to know who else is in a room when the therapists view is limited by a screen. While overtly addressing the issue, seeking co-operation from all family members and testing this is not always successful. Burgoyne, N.& Cohn, A (2020) in their paper Lessons from the Transition to Relational Teletherapy During COVID-19 make some useful suggestions. Downloading a white noise app onto the mobile phone and setting it outside the door is a clever strategy when working with adolescents who fear being overheard by parents which has the additional benefit of removing the distraction of the phone in the session. Individual and couple sessions can be successfully conducted in the privacy of a car which, if strategically parked, can also allow parents to watch children while they meet. Going for a walk or sitting in a park can also solve the problem. Zoom and Teams has the provision of breakout rooms which can be utilized if the session becomes potentially dangerous or a private conversation is indicated. This effectively replicates the request in real life that one person go to the waiting room but does necessitate at least two devices.

However, there are some situations where no boundary is respected, and the only solution is to move rapidly to actively invite the intruder to join to discuss their concern for the client. It may mean the end of therapy but is better than an ongoing struggle for control that cannot be effectively exercised and will inevitably put the therapeutic process at risk.

Burgoyne, N.& Cohn, A Lessons from the Transition to Relational Teletherapy During COVID-19 Fam Proc 59:974–988, 2020

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