Home-Based Therapy

Home-based therapists recognize that it can be challenging to get to an office for a therapy appointment due to illness, disability, personal crisis, or for lack of finances, transportation, or childcare. Home-based therapy can be a solution to these obstacles, in the same way that many rural doctors still make house calls.

In addition, when treatment is provided in the home, the relationship between therapist and client is likely to develop more rapidly, because clients are more relaxed at home than in an unfamiliar office setting. As a result, progress and healing can occur more readily.

Home-Based Therapy for Families

Sometimes office-based therapists offer in-home services when specific skills, like parenting, can be demonstrated and practiced in the home. This allows the counselor to observe the parent-child relationship in action, providing insight into family dynamics. For example, home-based therapy can be particularly beneficial in therapy for children showing disruptive behavior patterns and for children with high-needs or developmental delays. Other family therapy benefits may include:

• Ensuring all family members are in attendance and engaged in the therapy process.
• Offering support to foster parents and children, especially in new placements.
• Focusing on family preservation for families who may be facing the removal of a child into foster care.
• Removing barriers and defenses in teens by meeting on their territory and allowing the therapist to learn more about the teen by observing his or her personal space.

Ethical Concerns Related to Home-Based Therapy

Therapy that takes place in the home can raise ethical concerns regarding therapeutic boundaries, confidentiality, and role confusion. The same factors that may prove beneficial to treatment, such as observing a family in action, can also create challenges to treatment. For example, a therapist may have a difficult time maintaining the focus of a therapy session due to the presence of a rambunctious dog, a fussy child, or other distractions. Similarly, the presence of other family members, friends, or neighbors may make it impossible to maintain confidentiality or for the client to speak openly. In addition, concerns beyond the scope of therapy may arise if the therapist unintentionally witnesses activities such as underage drinking or animal cruelty. Therapists providing home-based therapy should make a concerted effort to maintain professional boundaries during home visits, and those seeking home-based therapy will have to be mindful of its limitations.

What to Expect from Home-Based Therapy

An in-home therapist may be accompanied by another therapist who serves as a partner during the process. This provides both the client and the therapist with additional support and resources as needed. Not all home-based therapists work in a team, but many do. For example, therapists tend to work in a team when responding to a crisis-line phone call.

If you think home-based therapy is right for you, meet with your therapist to determine how to proceed. Establishing when and how often in-home therapy sessions occur will depend on what you and your therapist decide. Home-based therapy can be used intermittently, as a supplement to office sessions, or as the primary approach.