When your client’s cat jumps onto their lap mid-session, their partner walks through the background in pajamas, or you hear their children arguing in the next room, you’re experiencing something more-or-less unprecedented in the history of therapy: mutual domestic intimacy. Telehealth doesn’t just bring therapy into clients’ homes—it invites them into yours, too. This new level of access requires a new approach to boundaries.
The traditional therapy office was a neutral space that belonged to neither therapist nor client. Now, you’re both navigating the complex dynamics of being guests in each other’s most private spaces while maintaining the professional relationship that makes therapy effective. Let’s explore how to manage this new intimacy without losing therapeutic effectiveness.
The Double-Edged Sword of Domestic Access
What You Gain Seeing clients in their natural environment provides unprecedented clinical insight. You witness their actual living conditions, family dynamics, and daily stressors in real-time. A client who minimizes their home stress might reveal a different story when you hear constant interruptions or see their chaotic background. You get authentic glimpses into their world that no amount of verbal processing could provide.
What You Risk This same access can blur the professional boundaries that make therapy safe and effective. When therapy happens in bedrooms, kitchens, and cars, the frame that contains the therapeutic relationship starts to dissolve. Both you and your clients may struggle to maintain the mindset that this is professional healthcare, not an intimate friendship.
Setting the Frame Before You Start
The Space Conversation During your telehealth intake, explicitly discuss space expectations with new clients. This isn’t about being controlling—it’s about creating conditions where therapy can be most effective.
Essential questions to cover:
- Do you have access to a private space where you won’t be interrupted?
- How will you handle household members who might need something during our session?
- Are you comfortable being on camera, and do you have adequate lighting?
- What’s your backup plan if your usual space isn’t available?
The Interruption Protocol Establish clear expectations about interruptions before they happen. Many therapists use language like: “Life happens during telehealth, and that’s okay. If you need to step away or handle an interruption, just let me know. We can pause the session, and you can return when you’re ready.”
This normalizes interruptions while maintaining your role in managing the session flow.
Managing Your Own Domestic Exposure
The Professional Background Dilemma Your home office setup communicates volumes about who you are as a person, not just as a therapist. That family photo on your desk or the art on your wall reveals personal information that clients wouldn’t normally access. Some therapists feel this enhances connection; others worry it compromises professional boundaries.
Practical Strategies:
- Virtual backgrounds: Useful but can be distracting if they glitch
- Dedicated therapy wall: Position your camera facing a neutral wall or bookshelf
- Strategic positioning: Angle your setup to show minimal personal space
- Embrace selective sharing: Decide what aspects of your space you’re comfortable sharing
When Your Life Intrudes Your dog barking, delivery notifications, or family members needing something urgent will happen. How you handle these moments teaches clients how to handle their own interruptions and models healthy boundary-setting.
Effective responses:
- “Excuse me for just a moment while I address this”
- “I need to briefly step away to handle something—I’ll be right back”
- “I’m going to mute myself for a moment to address that noise”
Avoid over-apologizing or extensive explanations about your personal life.
The Intimacy of Seeing Real Life
When Clients Show Too Much Clients in their home environment may forget professional boundaries. They might answer sessions in bed, wearing inappropriate clothing, or in spaces that feel too intimate for the therapeutic relationship. Address this directly but gently:
“I want our sessions to feel comfortable for you, and I also want to maintain the professional frame that makes therapy most effective. Could we talk about finding a space that feels both comfortable for you and appropriate for our professional relationship?”
The Family Interruption Challenge Children, partners, and roommates will interrupt telehealth sessions. These moments can provide valuable clinical information, but they also require careful navigation:
- Brief, polite acknowledgment: A simple “Good morning” or “Hi there” maintains basic courtesy, then immediately redirect to your client
- Avoid extended engagement: The boundary isn’t about ignoring people—it’s about not getting drawn into conversations or letting family members become part of the session without proper consent
- Process interruptions therapeutically: “I noticed you seemed stressed when your partner interrupted. How do you typically handle competing demands for your attention?”
- Maintain client confidentiality: Family members might overhear sensitive content, so address this proactively
Pets as Therapeutic Partners Animals often become unofficial co-therapists in telehealth sessions. A client’s dog providing comfort during an emotional moment can be therapeutically beneficial. However, establish boundaries around excessive pet disruptions that interfere with session focus.
Addressing the Elephant in the Room: Bathroom Sessions
Yes, clients sometimes take sessions from bathrooms—sometimes because it’s their only private space, other times due to poor boundary awareness. This requires direct but compassionate intervention:
“I understand privacy can be challenging in your living situation. Let’s talk about finding a space that works for both privacy and maintaining our professional relationship. The bathroom doesn’t feel like the right environment for our therapy work together.”
Cultural and Socioeconomic Considerations
Housing Realities Not every client has access to a private, quiet space with good lighting and internet. Some live in overcrowded housing, lack dedicated work areas, or deal with ongoing noise and interruptions. Your boundary expectations need to account for these realities while still maintaining therapeutic effectiveness.
Flexibility Without Compromise You can be understanding about challenging circumstances while still maintaining necessary boundaries:
- Work with clients to identify their best available space options
- Help them problem-solve common challenges in their living situation
- Maintain professional expectations while showing empathy for limitations
The Unexpected Therapeutic Value
Authentic Moments When a client’s toddler melts down during session, you see their actual parenting in action—not just their report of parenting struggles. When their roommate’s loud music interrupts a trauma session, you witness real-time stress responses. These moments can accelerate therapeutic progress by providing authentic material to process.
Modeling Healthy Boundaries How you handle your own interruptions teaches clients about appropriate boundary-setting. When you calmly address a delivery notification or pause to handle a barking dog, you demonstrate that boundaries can be both firm and flexible.
Technology Boundaries Matter Too
The Mute Button Protocol Establish clear expectations about muting. Some clients constantly mute and unmute themselves, creating disconnection. Others never mute, creating distracting background noise. Address this explicitly:
“I’d like us to both stay unmuted during our conversation so we can have a natural flow, but please mute yourself if there’s background noise that might be distracting.”
The Recording Question Be explicit about recording policies. Some clients assume they can record sessions for their own reference, while others worry you might be recording them. Clear communication prevents misunderstandings that can damage trust.
When Boundaries Need Reinforcement
Signs You Need to Address Boundary Issues:
- Sessions regularly start late due to client environment issues
- You frequently can’t hear the client due to background noise
- Family members regularly interrupt or try to join conversations
- Clients take sessions in inappropriate locations repeatedly
- You find yourself distracted by what you see in their background
- The professional frame of therapy feels consistently compromised
How to Address Boundary Violations:
- Name the pattern: “I’ve noticed that interruptions have become a regular part of our sessions”
- Explain the impact: “This makes it difficult for us to maintain focus on your therapy goals”
- Collaborate on solutions: “Let’s brainstorm some strategies that might help”
- Set clear expectations: “Moving forward, I’d like us to…”
- Follow through: If agreements aren’t kept, address it directly
The Termination Question
Some therapeutic relationships work better in person than via telehealth, and that’s okay. If boundary issues consistently interfere with therapeutic progress despite multiple attempts to address them, it may be appropriate to discuss transitioning to in-person therapy or referring to a therapist who specializes in the client’s specific telehealth challenges.
Creating New Rituals for Professional Connection
Session Beginnings and Endings Without the ritual of entering and leaving an office, telehealth sessions can feel abrupt. Create new rituals that help both you and your client transition into and out of therapy mode:
- Start with a brief check-in about their current environment
- End with a moment to acknowledge the session’s completion
- Use consistent language that signals professional boundaries
The Technology Check-In Make space for a brief technology and environment check at the beginning of sessions. This normalizes addressing practical issues while maintaining focus on therapeutic work.
Training Your Household
The people you live with need to understand that when your office door is closed (or you’re at your designated workspace), you’re in session with clients. This means:
- No interruptions except for emergencies
- Keeping noise levels appropriate
- Understanding that your professional space is off-limits during work hours
The Long-Term Perspective
Telehealth boundary management is still evolving as both therapists and clients develop new norms for this hybrid of professional and personal space. What feels awkward now may become more natural with practice. The key is maintaining intentionality about boundaries rather than letting them erode by default.
Ongoing Assessment Questions:
- Are these boundary challenges improving over time or becoming entrenched patterns?
- Is the therapeutic work progressing despite environmental challenges?
- Do both you and your client feel comfortable with the current arrangement?
- Are there specific skills or resources that could help address ongoing challenges?
The Bottom Line
Telehealth creates unprecedented intimacy between therapists and clients. This can enhance therapeutic connection and provide valuable clinical insights, but it requires proactive boundary management to prevent the therapeutic relationship from becoming confused with friendship or losing its professional effectiveness.
The goal isn’t to recreate the traditional therapy office in digital space—it’s to create new professional boundaries that work within the reality of telehealth while preserving what makes therapy effective. This requires ongoing communication, flexibility, and willingness to address boundary issues directly when they arise.
Remember: boundaries in telehealth aren’t about being rigid or unfriendly. They’re about creating the conditions where therapy can be most helpful for your clients while maintaining your own professional well-being. When done thoughtfully, telehealth boundaries can actually enhance the therapeutic relationship by demonstrating that professional care can coexist with human flexibility and understanding.
Consider developing written telehealth policies that address common boundary issues, and review these with clients during the informed consent process. Clear expectations prevent most boundary problems before they start.