Boundary Challenges in Online Therapy

Maintaining clear boundaries is an aspect of therapy that we all understand and value the importance of. When working in person, we have full control over what the space looks like, the ‘feel’ we wish to convey to help our clients feel safe, who and when someone enters this space, and when the session is ended. Whereas, meeting our clients online means conducting sessions in their space, their homes, with no control over the room they choose to be in, and reduced influence over the potential for interruptions and boundary transgressions.

This decrease in control over boundaries can lead to an array of challenging issues, both practical and ethical, which are unique to working online. To explore these I will share some examples across the main online media, video, audio and telephone, instant messaging (IM) and email. 

It is not uncommon in video sessions for the door to open behind the client and a child’s head to peep around, unseen and unnoticed by the client, or for it to be apparent that the client is in a public space. As an online supervisor, I encourage my supervisees to find the confidence to be firm, while sensitive, in stating the importance of a private, uninterrupted space and to rearrange and end the session. For many therapists, this can feel challenging as the client may insist they are happy to go ahead, which can lead the therapist to focus on the BACP ethical principle of client automony. Here, I might highlight another aspect of the ethical framework – that they need to be trustworthy in using their knowledge to guide the client in understanding what is appropriate, thus adhering to the principle of beneficence.

When conducting a session via audio or the telephone, it is difficult to ascertain whether the client is alone. It then becomes important to listen out for hints of another presence having breached the confidential boundary, and to consider issues of risk and safeguarding. An uncharateristic hesitancy from your client may be one clue to the possible presence of someone else in the room. A long pause, silence or a stumbling reply from your client, when you ask if there is another person present, could be indicative of an affirmation. In this instance, your clinical judgement and professional ethical framework will help you decide whether it is safe or appropriate to continue the session.

A potential boundary issue that can arise within instant messaging (IM) counselling sessions is the client making contact in between sessions. Many people’s preferred mode of contact these days is messaging, and their familiarity with this, along with its inherent informality and the online disinhibition effect, can lead clients to forget the professional boundaries of the therapeutic relationship and message their counsellor when distressed. This highlights the importance of establishing clear guidelines around contact when contracting, along with appropriate sources of immediate support when needed.

When counselling via asynchronous email it can be tempting to push past your own session time boundary, as it takes time to read, reflect on and compose a reply. It is also not uncommon for the client to write more than can be read and responded to within the session time. Setting a word limit and giving the client guidance on what to focus on when writing the email supports this boundary.

Finally, I want to emphasise the importance of boundaries to maintain your self-care when working online. Online counselling can be more intense emotionally and utilise more energy than in-person sessions, and yet it often comes with a temptation to squeeze our work hours more tightly. Ensuring we have enough time between clients for screen breaks and to move our bodies is a vital part of boundary setting, and supervision can support us to notice when, and think about why, we are challenging our own boundaries.