Four ways therapists can set boundaries with telehealth clients at the start of care

Over the past several years, teletherapy has become more popular than ever before. And in removing the time, location, and space constraints of traditional in-person therapy, therapists have greater flexibility in the ways they serve their clients. This enhanced flexibility has helped to remove barriers to life-changing care for thousands of people.  But it’s also brought about some challenges when it comes to setting appropriate boundaries with clients. As therapy goes digital, providers must prioritize setting and maintaining boundaries in new ways.  By communicating about boundaries from the very first session, you can create a safe, predictable space for your clients to learn and grow.  

1. Clarify your policies for no-shows, cancellations, and session length

Some of the most important boundaries for therapists are deceptively simple. They involve things like cancellation, no-show, and session length policies. Like all other service-based businesses, it’s important to structure your private practice to ensure you have the time and resources to deliver the very best care possible. And you can’t do that without a predictable schedule or clear policies.  How can you support your clients in adhering to your boundaries? It starts with a clear discussion of your practice policies during the intake session. As part of your first session, provide documentation of your policies for your clients to sign and be sure to talk about:

• How long you’ll wait on the virtual call before considering the appointment a no-show
• Exceptions to your no-show policy for technological issues or emergencies 
• How far in advance they need to cancel an appointment to avoid being charged
• How long sessions are scheduled for, and what they should do if they feel they need more time (like schedule a second appointment later in the week)
• Set clear expectations about session start and end times

Starting and stopping your sessions on time allows you to maintain your schedule, take appropriate notes, and see to other important tasks. Your clients need to know exactly when their sessions will begin and end, especially if you offer a 50-minute “therapeutic hour.”  Bringing clarity and predictability to your session timelines will help eliminate confusion. This can be especially helpful for clients who live with anxiety. But, as you set and discuss your policies around time, it’s also important to be mindful of different cultural expectations about timeliness.  Keep in mind that some clients may come from cultural backgrounds where there are less rigid expectations around timeliness or punctuality. Depending on the population you work with, it may be helpful to build some extra flexibility into your schedule or provide more frequent reminders about session start and stop times. 

2. Explain how (and when) clients can contact you

Each therapist has their own preferences regarding client communication between sessions. As you’re conducting an intake session, talk to your clients about how they can connect with you between sessions, especially in case of emergencies. Specify your “business hours” and let your clients know whether you want to be contacted by phone, text, or via your teletherapy platform. If you don’t offer crisis support, let your client know who they can contact in the case of an emergency.  Be clear that calls or messages are for administrative purposes only (as opposed to an extension of their session) and communicate about when your clients can expect to hear back from you. Let them know that contact outside of sessions should be reserved for things like scheduling or billing so you can focus on providing the best care possible. 

3. Set clear expectations around social media 

In recent years, there’s been a rise in therapists acting as mental health influencers on social media. Critics say that using social platforms to offer advice or answer questions blurs the line between content creators and mental health professionals. And when boundaries get blurry, there is greater potential for harm to clients and professional risk for providers. At the same time, private practice therapists are business owners and social media is a powerful marketing tool. Many mental health professionals use social media to demonstrate their expertise, build their personal brands, and grow their client base.  Of course, building a digital presence for your business is different from using social media to engage with clients online. Connecting with clients on social media could result in the kind of harmful dual relationship that is prohibited by the American Counseling Association’s Code of Ethics. As you explain your policies to clients, let them know ahead of time that you don’t engage with clients (current, former, or otherwise) on social media. You can also get ahead of this by adjusting your privacy settings to be less discoverable on any personal social media platforms you use.

4. Create a balance of compassion and boundaries

As a therapist, you’re likely a deeply compassionate person who values your relationship with clients. But it can be difficult to balance a desire to demonstrate empathy and compassion with the need for boundaries within the therapeutic relationship.  What do you do when your client is tugging on your heartstrings, asking for something that would violate your policies? What if they ask you to disclose something about your personal life that could shift the focus away from the client and onto you?  In these moments, it’s important to remember that establishing healthy boundaries isn’t about shutting people out or being cold. Rather, boundaries represent a set of norms that keep everyone safe and honor your professional standards. In enforcing your boundaries you can demonstrate empathy, fortify the structure of the therapeutic relationship, and provide meaningful growth opportunities for your clients. 

Building a private practice with help from Rula

As a therapist, you’ll inevitably have moments when your clients rub up against your boundaries. By setting clear boundaries at the start of care, you’ll be better equipped to navigate challenging situations during the course of care.  At Rula, we know that therapists often need support in setting boundaries and creating business policies that work for their private practice. That’s why we offer weekly case consultations, the option to join our thriving online community to connect with peers, and ongoing training to upskill and work out the kinks of private practice.  To learn more about how Rula can help you navigate client challenges and create a thriving private practice, visit our website.