Boundaries in online couples therapy: “Can anything exist without boundaries?”

• Published date: 01 December 2024
• Author: Alon Aviram
• Date: 01 December 2024
• DOI: http://doi.org/10.1111/fare.13053

RESEARCH

Boundaries in online couples therapy: “Can anything

exist without boundaries?”

Alon Aviram

The Paul Baerwald School of Social Work and

Social Welfare, The Hebrew University of

Jerusalem

Correspondence

Alon Aviram, The Paul Baerwald School of

Social Work and Social Welfare, The Hebrew

University of Jerusalem, Mt. Scopus,

Jerusalem, 9190501, Israel.

Email: alon.aviram1@mail.huji.ac.il

Abstract

Objective: This research delved into the experiences of cou-

ples and therapists in online couples therapy with an

emphasis on therapeutic boundaries.

Background: Although the popularity of online therapy

has surged, limited understanding exists about the mean-

ings and experiences tied to therapeutic boundaries in this

context, underscoring the need for its examination to

enhance online therapy’s effectiveness.

Method: A purposive sample of 51 participants, including

36 individuals (comprising 18 couples who underwent sep-

arate interviews), and 15 couple and family therapists were

interviewed in four online focus groups. Constructivist

grounded theory guided the data analysis to discern thera-

peutic boundary dimensions.

Results: The analysis identified three dimensions of thera-

peutic boundaries: (a) boundaries between the therapist

and couple, (b) boundaries between the couple and their

family, and (c) boundaries between the therapists and their

own families.

Conclusion: The study offers insights into the nuanced con-

cept of liminality within therapists’and couples’transition

to online couples therapy, particularly emphasizing disrup-

tions in conventional therapeutic paradigms.

Implications: To uphold the integrity and bolster the thera-

peutic alliance in online couples therapy, there is a compel-

ling need for therapists to transition toward novel means

of establishing boundaries, moving away from traditional

constructs.

KEYWORDS

couples therapy, liminality, online therapy, teletherapy, therapeutic

boundaries

Received: 8 August 2023 Revised: 23 January 2024 Accepted: 5 April 2024

DOI: 10.1111/fare.13053

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits

use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or

adaptations are made.

© 2024 The Author(s). Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

Family Relations. 2024;73:3473–3492. wileyonlinelibrary.com/journal/fare 3473

Over the past few years, the field of family and couples therapy has seen a rapid transition from

in-person to online environments (Machluf et al., 2022), pushing therapists and clients to con-

duct therapy from home. The unique framework of online couples therapy has been explored

through various lenses, including telepresence (Aviram & Nadan, in press; Bouchard

et al., 2011), ethics (Hertlein & Earl, 2019), the therapeutic relationship (Aviram &

Nadan, 2024; Kysely et al., 2019), and telesupervision (Aviram & Nadan, 2022; Hardy

et al., 2021). However, little attention has been paid to what happens to boundaries—guidelines

and limits that exist within the therapeutic relationship to create a safe and effective environ-

ment for healing and growth (Hartmann, 1997; Smith & Fitzpatrick, 1995)—in therapy, when

the client and therapist enter and exit the online therapeutic space.

The transition to telehealth in couple therapy, both during and after the COVID-19 pan-

demic, provides a rich context to explore this issue. The integration of telehealth has been mar-

ked by increased accessibility, addressing challenges such as scheduling conflicts and childcare,

which were persistent even before the pandemic (Hardy et al., 2021; Maier et al., 2021). Thera-

pists have reported positive experiences with telehealth, praising its utility and control over ther-

apy sessions (Hardy et al., 2021; Maier et al., 2021). Nonetheless, challenges such as

technological disruptions, managing high-conflict scenarios, and the need for targeted training

and guidance in online therapy have been consistently noted (James et al., 2022). Especially per-

tinent to the notion of boundaries within therapy is the observed transformation in the thera-

peutic alliance and the merging of work and home environments noted during the pandemic

(Mateescu, 2021). Therapists have experienced challenges in establishing a safe therapeutic

space and concerns about clients being overheard by others (James et al., 2022). Additionally,

the transition has led to a blurring of therapists’work–home boundaries, with increased oppor-

tunities to work outside regular hours, potentially leading to boundary crossing (Orlowski

et al., 2022). This shift in perspective is crucial in understanding the evolving nature of bound-

aries within the therapeutic relationship as therapy moves increasingly into the online space.

The swift transition to virtual settings for family and couples therapy demands a reassessment

of conventional therapeutic boundaries. With the ongoing development of telehealth, it

becomes critical for the field to examine more thoroughly the ways in which these boundaries

are established and upheld in the online therapeutic environment, safeguarding the therapy’s

integrity and efficacy (Hardy et al., 2021; Maier et al., 2021).

The scholarly field has not yet fully explored the effect of transition to online practice on the

concept of therapeutic boundaries in the context of online couples therapy. Through interviews

with couples and therapists who engaged in online couples therapy, the present study aimed to

address this gap by offering a deeper understanding of the perceptions and meanings ascribed

to “boundaries”by clients and therapists. The inductive exploration was guided by the follow-

ing research questions: (a) What has been the experience of transitioning to online therapy and

its effect on the therapeutic relationship? (b) How are boundaries experienced by couple thera-

pists and clients? (c) What are the similarities and differences in the perception of boundaries

between therapists and couples in online couples therapy?

BACKGROUND

Couples therapy

Couples therapy is a common intervention aimed at addressing issues within a spousal relation-

ship, with the goal of enhancing relationship quality and minimizing the risk of separation or

divorce (Lebow & Snyder, 2022). It emphasizes the interplay between two individuals and

dynamics that emerge from the genuine self-expression of each person within the relationship

3474 FAMILY RELATIONS