Home Office: When The Therapy Office Is At Home

Guidelines: Home Office

• Home offices present therapists and clients with several challenges, advantages and burdens to therapists, clients and therapists’ family members or co-inhabitants.
• The home office significantly increased the crossover of the therapist’s professional and personal life.
• Home office practice dates back to the time when Freud, Mahler, Jung, Winnicott, Bettelheim and other forefathers and foremothers practiced, at least sometimes, from their homes.
• Home offices come in different formats and arrangements. Some offices are located in detached units with separate driveways and entrances, distanced from the main residence. On the other end of the spectrum are the offices that are located in the therapists’ living rooms, offices or designated bedrooms within the homes. In between these two arrangements, there are many variations in regard to which entrances or which bathrooms clients use and what part of the therapists’ private home they get to see.
• Although many therapists work from their homes, there have been no formal studies on the impact on therapy, the motives of the therapist and the emotional and other consequences to the therapist and their families.
• Woody Allen’s movie, Deconstructing Harry, while true to the producer’s exaggerated style, illustrates the complexities of a home office and how the close proximity of office and home may affect therapists, clients and spouses. In this particular movie Woody Allen is married to a psychoanalyst working out of their home. When she discovers her husband had an affair with one of her female clients (whom he had originally met in the living room-waiting room), she, understandingly, cannot contain herself. She leaves her client on the couch in the middle of an analytic session, bursts in on her husband in another room and roundly curses him for his transgression. The client, of course, can hear the screaming and every word of the argument from the couch. The therapist intermittently returns to the therapy session and makes a poor attempt to appear concerned and focused on the well being of the client. Although grossly exaggerated for effect, the movie illustrates how private information about a therapist’s marriage and emotional life, especially at times of crisis, can more easily be revealed to clients in a home office environment. It highlights the issue of greatly diminished role transition time for the therapist working in a home office setting and clearly illustrates how therapists may sometimes be so distracted by their personal issues that thoughts of the clients’ well being recede into the background.

Advantages for Therapists:

• Therapists who work out of their homes have the ability to flow more easily between the personal-familial and the professional realms.
• No need to commute.
• Avoidance of high-density population areas.
• Financial benefits (no rent).
• Supports ease in household management.
• Access to the comforts of home.
• Therapists are in closer proximity to family and community obligations, children’s schools, etc.
• Can increase the amount of time with significant others.

Advantages for Clients

• Usually a friendlier and warmer environment than the standard professional office.
• Provides a focus for processing of boundary issues.
• Provides additional information about the therapist.

Clinical Concerns:

• Unavoidable, significant therapist’s self-disclosure.
• Issues of privacy and confidentiality.
• Safety and containment issues for volatile and violent clients.
• Pre-therapy screening concerns.
• In-person interruption by family members, pets, neighbors.
• Interruptions by music, children’s play, screaming, etc.
• Concerns for therapists’ family.
• Sense of intrusion.
• Potential issues of safety.
• Need to be discrete or quiet at certain times.
• Can overhear crying, yelling, pounding in the therapy room.
• Role confusion — not knowing how to interact with clients.
• Complications regarding scheduling home based activities around the need to be quiet while therapy takes place.
• Providing boundary guidelines for visiting guests.
• Confusion for young children regarding why a parent is at home but unavailable.

Additional Considerations:

• From an ethical point of view, there is no injunction in any of the major professional organizations’ codes of ethics against home-based practice. Such practice conforms to the standard of care.
• When practicing from a home office, a therapist has a responsibility that involves a series of conscious decisions that involves what is communicated through non-verbal self-disclosure and how these communications affect the clinical issues of their clients.
• Screening and safety considerations are of paramount importance as there are fewer external safety systems than one might find in a traditional office practice.
• You may want to Google your clients before they come to the house for safety reasons unless you have already screened them in a standard office. If you Google your clients before the first session, you may want to include in your Office Policies and Informed Consent form something like:
  

  SOCIAL NETWORKING AND INTERNET SEARCHES:
  At times xxx may conduct a web search on his clients before the beginning of therapy or during therapy. If you have concerns or questions regarding this practice, please discuss it with me.

• Average and highly functioning clients and those who can benefit from the warm and casual ambience and the self disclosure involved in a home office are likely to be good candidates for this setting.
• Informed consent with regard to home office practice involves informing clients and family members, in detail, about specific physical and relational boundaries. Negotiating these boundaries is not a one-time event prior to therapy; it is often a continuous and dynamic process and as such can also be part of the clinical process.
• Issues of parking, which bathroom to use where one waits, where one can wonder, etc. must be discussed and clarified.
• Consult in gray area cases, in complex cases and in cases where therapy may need to end or be changed to a traditional office.
• The highest level of satisfaction for those who work at home and their family members involves successfully managing time, places and people along a continuum of segmentation and integration with careful attention to the unique personal preferences of clients, therapists and therapists’ family members.
• Discuss the concern of boundaries, intrusion, etc. with family members. Obtain input from those involved and provide clear guidelines. Make this an ongoing, dynamic process.
• Running a home-based practice often involves additional attention to zoning, tax and insurance considerations. Tax implications often mean that therapists may be able to deduct a portion of their house and related expenses as a home office deduction. The IRS has a publication to help with this information called Publication 587, Business Use of Your Home, available at www.irs.gov.

Risk Management for Those Who Practice Outside Their Homes:

• If you are practicing in your home, getting informed by taking this online course is a simple and solid risk management strategy.