Mode of Therapy – Home Based Therapy

In a therapeutic relationship, the potential success of any mental health counseling session depends upon the level of trust and comfort between client and therapist. For the best results, therapy should take place in the most secure environment possible to create an atmosphere conducive to sharing and healing. For this reason, many therapists spend a great deal of their time and resources on improving their office space, providing comfortable seating, a warm and inviting atmosphere, and welcoming décor to ensure that everyone, regardless of personal taste or background, feels at ease.

However, even if a therapist puts both time and money into customizing the office space, to the client, it never feels as safe and comfortable as his or her own home environment. This is one of the advantages of home-based therapy. It allows patients an opportunity to feel the maximum level of comfort and ease in their surroundings since they are in their own space ― their “safe haven” ― during the entire session.

Home-Based Therapy: What Is It?

For those unable or unwilling to seek therapeutic support outside of their homes, home-based therapy is a welcome option. Therapists can determine if home-based therapy is something they plan to offer their patients, and, if so, which one of the different types of home-based therapy they want to use.

Home-based therapy is typically offered by:

• Community support organizations
• Social workers
• Child protective agencies

Home-Based Therapy: What to Expect

In many ways, in actual practice, home-based therapy is similar to traditional therapy. The therapeutic sessions are typically scheduled weekly or on a schedule determined necessary by the clinician, and they are held privately. Ideally, only those who are actively participating in the session are in the home at the time of therapy; if this proves impossible, those who are not involved stay in a different room to ensure the privacy of both client and therapist.

Many in-home therapists elect to work with a partner who serves as an additional level of support during the therapeutic session, and, in some situations, one or more members of the family may participate in the counseling session.

In many cases, counselors prefer home-based therapy since it typically makes it easier to connect with the client and his or her immediate support network in a controlled environment. These situations include:

• Child protective agencies often utilize home-based therapy; it gives the social worker an opportunity to observe the living arrangement and the family dynamic and determine the safety level of the child in the home setting.
• Community support organizations may elect to utilize home-based therapy because it reduces their overhead by eliminating the necessity for an organized meeting space for therapeutic sessions.
• Those serving the physically or mentally disabled may choose home-based therapy since it reduces the cost and complication of transporting disabled persons.

In all these situations, having the therapist come into the home to provide counseling increases the patient’s level of security and sense of well-being, thereby making the therapeutic session more practical and impactful.

Home-Based Therapy: Challenges and Issues

The benefits of home-based therapy cannot be overstated, especially from a client’s perspective. However, from a therapeutic point of view, a handful of ethical and practical issues must be considered prior to scheduling home-based sessions. The sessions must take place in an environment that is not problematic to effective counseling, and the therapist must consider all aspects of the home setting with these issues in mind before the initial session takes place.

In some situations, it’s impossible or highly unlikely that individuals could receive ongoing counseling and support outside of their home. They may have issues with reliable transportation or emotional instability that make it difficult to leave their property. When these types of problems are present, home-based therapy may present an ideal, if not the only, option.

However, home-based therapy can create additional complications for the therapist, including:

• Reduced ability to see numerous clients in one day. Home-based therapy sessions are typically longer than the traditional 50-minute session time, and travel time from one location to another must considered as well. These factors reduce the number of sessions a therapist can schedule in one day.
• Loss of control over the therapeutic environment. Lack of control can change the pace and tone of the counseling session, requiring the therapist to adapt rapidly and seamlessly to the manner in which the counseling session is progressing. Additionally, the therapist must remain aware of potential issues that could derail the session.
• Privacy concerns. Since the home-based environment is unfamiliar, it is often difficult for the therapist to identify potential lapses in privacy. Lack of privacy presents a barrier to effective therapy, because the client may not be willing to discuss personal issues if family members are within hearing range.

In most of the situations in which home-based therapy would truly benefit the client, these obstacles can be overcome. Therapists can accommodate clients by scheduling fewer appointments a day, and they can have initial consultations to discuss issues such as boundaries and privacy and implement a plan to reduce distractions.

If implemented correctly, home-based therapy offers advantages for the therapist as well as for the client. In the following situations, home-based therapy:

• Provides an opportunity for a change in the working environment, which can help prevent professional burnout.
• Allows the therapist to reach a previously inaccessible portion of clientele who are not candidates for traditional counseling, helping the therapist grow his or her practice.
• Reduce overhead costs by eliminating the need for regular office hours.

For these reasons and others, some therapists look at home-based therapy as a welcome opportunity. While the advantages are clear, home-based therapy should be reserved for those situations that truly merit this type of intervention. Moreover, it should not become a regular alternative to therapy in traditional settings.

Home-Based Therapy: Risks, Limitations, and Ethics

Given certain circumstances, home-based therapy offers many benefits, but the quality of the therapy offered and the boundaries between client and therapist must not be altered by the change in environment.

Home-based therapy is ideal in those situations in which the client is unable to leave his or her home for regular counseling because of physical disability or mental instability. Moreover, when an assessment of the home environment is necessary, again, home-based therapy presents an attractive option. However, therapists should be aware that after they initiate home-based counseling, it becomes easier for professional boundaries to begin to erode. The therapist must maintain a professional demeanor and keep the focus of the therapy session on the client. The therapist is not to be regarded as a guest in the home, but, instead, as a professional conducting a medical evaluation.

Additionally, the therapist must consider all safety precautions. If the home is an unstable environment for the client, then the therapist may be entering a dangerous situation. Rather than attempting to intervene in arguments or conflicts that may lead to violence, the therapist should maintain back-up support and remain aware of those potential scenarios that demand the intervention of law enforcement. This is especially important when working with children or with those vulnerable members of society who are unable to protect themselves.

The role of the therapist does not change simply because the venue has moved. As a therapist, you must feel comfortable enough in your professional role to remain unaltered by entering into a new environment. Receiving training in home-based therapy methods prior to the beginning of these types of therapeutic methods helps the therapist maintain those necessary boundaries and identify potential safety issues.

Sources

• https://www.goodtherapy.org/learn-about-therapy/modes/home-based-therapy
• http://www.zurinstitute.com/homebasedtherapy_clinicalupdate.html
• https://www.mass.gov/doc/in-home-therapy-practice-guidelines/download