I went into a patient's room recently and there were about four family members present. I introduced myself and proceeded to assist the patient out of bed into the chair. Then we headed to the gym. The family filed in and sat down like they were in a theater, while their loved one and I were merely actors on a stage performing for them. They clapped when good things happened and looked concern when the performance was not as good with balance activity. I felt like "Riverdancing" for them across the stage like Michael Flatley.
I guess family looks at our interaction with their family member just as closely as they watch how their loved one performs in therapy. But there are some things family may not fully understand with our interactions. We do not merely have the patients perform exercises, but also engage them in memory recall, quiz them on how their house is set up for safety, even discuss ADLs that family may not be comfortable with. And there are times families will interject rather than let the patient answer.
Should I ask family to leave? No. I like having families present when I do therapy but I do not like to perform for them and they may not always understand some of the humor we display while doing the activity. Some have stated all we do is laugh and joke around and seemed irritated that we would "pry" into grandma's past like we did. So what if grandma used to run a bordello and swing a six-gun with the best of them? I'm sure they never saw her tattoo and heard the real stories like we do.