Health

Parents Are Eavesdropping on Their Kids’ Virtual Therapy Sessions

Young people doing therapy at home have to speak in code and hand signals.

by Shayla Love
May 14 2020, 4:20pm

Illustration by Hunter French

In a TikTok video from April, private practice therapist Lindsay Fleming showed one way to get around nosy parents eavesdropping on their young adult and teenage children's virtual sessions.

“Last week we were talking about the 'math class' you were taking…” Fleming says, while holding a piece of paper that reads: How did facetiming your ex go?

“While you were working on that 'math,' did you practice before you took the quiz?" Fleming asks pointedly. Another piece of paper: Did you say what we practiced?

After a meaningful look at the camera, Fleming says, “You feel good about it? After you turned in the quiz, was it the same or different? How are you feeling?” A final note, that reads: Back together or ‘friends’ but never going to talk again?

The video got 1.6 million likes, and the comments are bursting with gripes of how hard it's been to find private time and space for therapy now that appointments are virtual because of the pandemic.

Online therapy isn't inherently a bad thing; cognitive behavioral therapy done over the phone has been shown it can be similarly effective as in-person sessions. While in 2018, not even half of psychologists said they did their appointments online, this was largely because of regulatory issues, not client or therapist preference. Practitioners weren’t reimbursed as much from insurers for online sessions, and were concerned about violating HIPAA—a federal law that protects patient privacy.

These barriers to teletherapy have been lifted due to the pandemic. In March, the Department of Health and Human Services Office of Civil Rights said it would waive any penalties for HIPAA violations, essentially giving therapists permission to use apps and various software platforms to do their sessions. Individual insurance plans vary, but many have started to include more telehealth options in the past weeks.

Anything that makes therapy more accessible to more people is a good thing, but there’s one crucial aspect missing when doing therapy at home: a guaranteed private space to talk. For young adults who are home from college, or teenagers doing virtual sessions for the first time, family members are getting in the way.

While at home, it can be hard for young adults and teens to talk openly about conflicts with their families, even though those are some of the most common issues young people may need to discuss.

Some parents or siblings intentionally listen in, while others simply forget about appointments, and barge in. For young people in therapy, it's creating an environment where they don't feel completely able to share what's on their mind. They're forced to take their sessions to cars and parks, or come up with creative solutions with their therapists like hand signals and talking in code or through text.

Fleming said that when her sessions started to move online, she talked with her patients’ families to set up consistent times and places that everyone was on board with. “But as the days started to blend, parents started popping in,” said the Chicago-city based therapist. “Not always trying to listen, but like, ‘What are you doing? Oh, I forgot, your therapy is this hour.”


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Wendy Robinson-Miller, a therapist in private practice in Chicago focusing on teens and young adults, said that some parents aren’t even aware that their kids should be given privacy. She’s had to be firm with them, saying that if they want to talk to her about their child they have to set up a different appointment.

"There’s this one hour of time that’s supposed to be just for them," Fleming said. "When their parents are popping in—it becomes less about them and their space. That hour being gone on top of a global pandemic—it’s a double whammy.”

Anna, an 18-year-old in Wisconsin who didn't want to use her last name for privacy reasons, said her mom and her sister are now home all day, not at work or school. She has AMPS, amplified musculoskeletal pain syndrome, and goes to therapy to help with the mental health ramifications of her chronic pain and to learn relaxation techniques that can help.

She has to do her sessions in the backyard, or in the car. “I could do them indoors but with my family being home I feel eavesdropping is fairly easy,” she said.

Her parents have always wanted to be part of her therapy sessions, and ask about them frequently. “They don’t understand that I'm not gonna open up to them about every little thing," Anna said. "I feel self conscious that I'm going to be overheard. I usually am interrupted no matter what I do.”

Ash, 20, has therapy every Tuesday at 3:30. But Tuesday is her father’s only day off. If she wants to talk about her dad with her therapist, she’ll use a codeword: butternut.

“I do have privacy but I cannot talk about my dad," said Ash, who didn't want to use her last name for privacy reasons. "If I was heard talking as such, I would get questioned about it. I know my dad gets very offended when people talk about him. If you tell him something he did is wrong, he won't accept it.”

She said her mom is very supportive of therapy, but her father believes it's making her “overthink.”

Stacy McCarthy, a therapist who works with clients from middle school to college-aged in the suburbs near Chicago, has had two clients recently tell her that they think someone is listening to their sessions. For one of her patients, it’s a sister that she has a contentious relationship with. Another worries his parents are listening.

“Even when sessions weren’t online, this person asked for a lot of reassurance,” McCarthy said. “Like, ‘You’re not going to tell my parents right?’ Now that we’re doing it in the home, he’s not asking me that, but he’s also not touching certain topics with a 10-foot pole.”

"Parents started popping in. Not always trying to listen, but like, ‘What are you doing? Oh, I forgot, your therapy is this hour.”

Marquis Norton, a licensed professional counselor specializing in young adults in Virginia, said typically, it’s the therapist's responsibility to make sure that their office is private—that's why many therapists have a noise machine outside their door. In shifting to teletherapy, therapists lose that control. “It’s up to the clients, what environment they’re in,” he said.

McCarthy told her patient he could turn on a fan or music, or try to go to a quiet place in the house away from everybody—but he’s still uncomfortable. “We're still going to have our session, but it's going to be really hard to get to anything meaningful,” she said. “If you're already kind of nervous and hesitant about opening up, this is not going to help you.”

While at home, it can be hard for young adults and teens to talk openly about conflicts with their families, even though those are some of the most common issues young people may need to discuss.

For college-aged students, they may have just adjusted to their independence before finding themselves dealing with their parents' rules again. Robinson-Miller said that her patients having the most trouble are the ones who’ve had to move back home.

“’They’re already dealing with so much,” McCarthy said. “Boredom, fear, disconnection, lack of structure. Some are angry or disappointed. It’s so important they have their time with me because if they’re not expressing those emotions, a lot of them are stuffing it away, and that never ends well.”

Fleming said that many of her patients are scared of disappointing their parents by talking about them, how they're doing in school, or the fact that they're struggling.

“Even saying the words, ‘I’m stressed,’ or ‘My mom puts too much pressure on me,’—they feel guilty," Fleming said. "A lot of them think they shouldn’t be complaining because they have such a good life, and look at what others are going through. There’s so much pressure in how you’re supposed to act, what you’re supposed to say, that it’s important to feel like you have a safe place where no one’s judging you. When you think a parent might be listening, it takes away your ability to speak freely.”

Mackenzie, from New Mexico, said that her parents interrupt her therapy sessions at least once every appointment, if not more. “They will ask me mid-session who I am talking to, [it’s] very frustrating.”

She’s been at home since December; she was planning to move to Austin but that’s been postponed because of COVID-19. She didn't want to use her last name to conceal her identity.

“My emotions have been a complete roller coaster right now," she said. "One day I’ll be happy to embrace slowing down and work on creative things that have taken the back burner lately. The next day I’ll wake up and dwell on my move that’s been postponed and the uncertainty of this whole situation we’re all going through, so it’s nice to have a neutral party to talk it through with.”

Her parents are generally supportive, but her mom doesn’t get why she’s been doing it so long (about a year) or why she needs weekly sessions. “My dad has never experienced any type of therapy so he really doesn’t get it," she said.

Mackenzie doesn’t think her parents are purposely listening in, but she doesn’t feel like she has privacy. “They’ll come down to my room, clearly can hear I’m talking to someone and knock on the door until I answer then ask who I’m talking to," she said. "Every session, at least once without a fail. This makes it hard to feel comfortable fully opening up when I know they could be lurking around the corner at any time.”

She now uses the phone, rather than video, so that it’s less obvious when she’s in therapy, and easier to put her therapist on hold while her parents are knocking on her door. “It’s hard to fully open up when part of the session is spent discussing them,” she said. Mackenzie has even changed her sessions to every other week to help reduce the interruptions.

Ally Leacoma, a 20-year-old from Ohio, does her therapy sessions in her car, parked in a nearby elementary school parking lot. She said her house is small and the sound travels—there’s nowhere she could go that would be private.

“Even when sessions weren’t online, this person asked ‘you’re not going to tell my parents right?’ Now that we’re doing it in the home, he’s not touching certain topics with a 10-foot pole.”

“Most of my sessions consist of at least one small conversation about my relationship with my mother and doing sessions in my house would not allow those conversations to happen,” she said. “Removing myself from the earshot of anyone is the only way, for me, to ensure I'm being as open and honest as I can.”

Parents don’t always understand the importance of their children having their own space and time for therapy. McCarthy finds that this response can be based in fear. “There’s anxiety, like, ‘What’s happening with my kid? I need to know,’” she said. “And right now, obviously, things are super uncertain. So everybody’s anxious, they’re on high alert.”

On Norton’s TikTok, he’s made videos explaining how what’s said between a therapist and their client is private—even if inquiring parents want to know.

“A message to the parents with children in therapy,” one video from April says. “Is he/she having sex? Tell me about her boyfriend? What did you guys talk about today?” Norton dances along to the final caption: “I can not disclose unless he/she is a danger to themselves or others.”

Especially for teens and young adults, trust is an important ingredient in the therapeutic relationship. One of the biggest predictors of success in therapy is the strength of the relationship with the therapist, McCarthy said. “To do that you need to have a confidential relationship.”

To that end, many therapists are coming up with creative ways to protect their clients' privacy. One of the therapists that Norton supervises has started to do a “room scan.” He asks his patients to show him the space they’re in, and they go over it together—closing doors and making sure it's a secure and private area.

Fleming has been asking some of her patients to journal before their sessions, and then send her pages of topics they want to talk about. Then she can ask them questions (in their headphones, unheard to eavesdroppers) and they can respond without naming names, or being vague.

“They don’t have to say, ‘Hey can we talk about my mom or my boyfriend,’” Fleming said. “If somebody is overhearing, they’re not going to know exactly what someone’s talking about.”

McCarthy lets her clients text her if they want to give her a heads' up about something that’s going on before a session so they don’t have to give a lot of background out loud. When talking to her client whose sister may be listening in, McCarthy turns to the chat function on the software platform she's using.

Some of Robinson-Miller’s patients have little signals they can give to indicate to her that someone else is nearby. One teenager wrinkles their nose when someone walks in, another has a hand signal. One client moves out of their camera's view for a moment.

“Then I know not to ask about certain things, or change the tone of what we’re talking about,” Robinson-Miller said. She also uses proxies to talk about a person’s feelings, like the lyrics to a song. A patient will pick out lyrics to signal to her that they’re sad, or worried about a relationship. “We talk about issues through the song, and they feel like they have more privacy," she said.

She said she'll continue to use these out-of-the-box techniques to get her patients what they need. “I think it's really essential to the work that I'm doing,” Robinson-Miller said. “I might not be doing as in-depth therapy as I've done in the past, but keeping that connection is super important.”

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Tagged:
mental health
Coronavirus
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COVID-19
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