When a Carer Joins a Session

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For
Clients who are disabled or living with a long-term condition, their carers or supporters, and therapists
Time
10 minutes, before the session
Format
Six-step agreement and a therapist checklist
Prints
Yes, the agreement and checklist only
Evidence
This site’s own tool

Printable agreement · Six steps

When a carer joins a session

Sometimes a carer, partner, parent or supporter joins a therapy session. It might be for access, such as communication support, help with equipment or with technology. It might be because the client wants to talk about something with them there. This sheet helps everyone agree how it will work, before it starts.

The client decides. The client chooses whether someone joins, who, for how long, and what they hear. The client can change their mind at any time, including in the middle of the session.

Our agreement · Date: ________

  1. Consent. The therapist asks the client, on their own if possible, whether they want someone to join.
  2. Privacy. Whatever is said in the room, the carer will hear. So agree topics first.

    Fine to talk about:

    Not today, please:

  3. What is shared. The therapist does not pass on what was said in earlier sessions, or share notes, unless the client agrees. The usual limits of confidentiality still apply, such as a serious risk of harm. The therapist explains these to both people.
  4. Communication roles. If the carer helps with communication, agree what that means. For example, setting up a device, reading typed words aloud, or repeating. The therapist speaks to the client, not the carer. The carer checks back (“Have I got that right?”) instead of answering for the client.
  5. Boundaries for the carer. The carer’s feelings and needs are real. This session may not be the place for all of them. If the carer needs support of their own, the therapist can say where to look for it.
  6. Pausing, or asking the carer to leave. Agree a signal: a word, a card, or a typed message. When the client uses it, the carer leaves without needing a reason. It isn’t a judgment on them. Online, the carer leaves the room or the call, and the therapist checks that the client is now alone.

    Our signal: ____________

If tension shows up in the session, it can be named as something happening between people (Ours, in Mine, Yours, Ours, System). That is not the same as saying both people are equally to blame.

Therapist checklist

For carers and supporters

  • You may be asked to step out. That is the client’s right. It isn’t a criticism of you.
  • You can say what you have noticed. The client decides what happens with it.
  • Your own support matters too. You can ask where to find it.

To keep a copy, use your browser’s print option and choose “Save as PDF”.

Making it work for you

Other ways to use it

Spoken

The therapist reads each step aloud at the start, and notes the client’s answers.

Typed

The client can send their answers by email or message before the session, so they don’t have to say them in front of the carer.

Low energy

Just agree steps 1 and 6: who joins, and the signal to pause. The rest can follow.

A worked example

Fictional teaching example

Leila has motor neurone disease and uses an eye-gaze device. She asks her husband, Mark, to set up the device and to join for the last 20 minutes. She wants to talk about how they argue over care.

  • Agreed: Mark sets up the device, then leaves. He comes back for the last 20 minutes. Off limits: Leila’s feelings about the future, which she is still working on alone. Signal: Leila types “pause”.
  • In the session: Mark starts finishing Leila’s sentences. The therapist slows things down and says they would like to wait for Leila’s words. Leila types “pause”. Mark leaves.
  • Afterwards: Leila says it helped, and she would do it again for a shorter time. Mark seemed exhausted. With Leila’s agreement, the therapist gives Mark information about support for carers.

Related

Where this comes from

  • A review of routine medical visits found that family companions often gave information and helped patients understand. Patients who came with someone also said less themselves.
    Wolff, J. L., & Roter, D. L. (2011). Family presence in routine medical visits: A meta-analytical review. Social Science & Medicine, 72(6), 823–831. doi.org/10.1016/j.socscimed.2011.01.015
  • A review of three-way consultations found companions were common and usually seen as helpful. Giving information was valued more than domineering or demanding behaviour.
    Laidsaar-Powell, R. C., Butow, P. N., Bu, S., Charles, C., Gafni, A., Lam, W. W. T., Jansen, J., McCaffery, K. J., Shepherd, H. L., Tattersall, M. H. N., & Juraskova, I. (2013). Physician–patient–companion communication and decision-making: A systematic review of triadic medical consultations. Patient Education and Counseling, 91(1), 3–13. doi.org/10.1016/j.pec.2012.11.007
  • The BACP Ethical Framework asks practitioners to work with the client’s informed consent. It also asks them to tell clients in advance who is within the circle of confidentiality, and its limits.
    British Association for Counselling and Psychotherapy (2018). Ethical Framework for the Counselling Professions. bacp.co.uk (PDF). A revised 2026 version becomes mandatory on 3 November 2026.

The two reviews are about medical visits, not therapy. Summaries are this site’s own wording. The agreement and checklist are this site’s own. They haven’t been tested.

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Last reviewed: October 2026.

How to cite this page: Donaghey, C. (2026). When a Carer Joins a Session. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/tools-and-cases/when-a-carer-joins-a-session/ (Accessed: [date]).

Shared under CC BY-NC 4.0, with an extra permission to teach from it on fee-paying courses. Credit the site. See Reusing This Material.