Out-of-office Experiences (aka OOE)
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As previously discussed, the adoption of rigid risk management practices has taken a serious toll on client care in the medical field in general as well as on mental health services. In the following I want to hone further in on the ill-advised rule 'never leave the office with a client.' This rather irrational 'one size fits all' dictum bears the consequence that mental health services are denied to the agoraphobic, the paranoid, and the millions of home-bound patients. It equally interferes with treatment for 'side-by-side' (rather than face-to-face) oriented clients who could benefit from a walk on a local trail rather than the standard face-to-face mode in the office. Equally, it denies services to disorganized, homeless, or poor clients who are not capable of finding their way to a therapist's office.
I have incorporated Out-of-Office Experiences (aka OOE) into my therapeutic practice by making perfectly legitimate, clinically sound visits to home-bound or hospitalized patients, as well as conducting sessions with the mentally ill homeless at street corners. I met with one highly distrustful and resistant adolescent client on the basketball court after he refused to show up at the office. My approach—meeting him, a dedicated athlete, on his turf—provided a good context for connection, particularly since this was also my game! With this tactic I succeeded in gaining my client's trust and, most importantly, engaging him in psychotherapy (albeit somewhat unorthodox!). An older, rather depressed and isolated old lady with three beloved dogs, from whom she would not separate, refused to come to my office due to her dogs, but agreed to a walk-and-talk session on a nearby trail. She was also a 'side by side' kind of a woman.
Other legitimate contexts for disregarding risk management's arbitrary injunctions against interaction outside the office include: engaging in adventure/outdoor therapy; going on a therapeutically initiated tour with an architect client to her newly designed house pursuant to the therapist's helping her find her 'voice' via architecture; attending the funeral of a client at the request of the spouse whom the therapist has seen in couples therapy intermittently for 20 years; or attending a theatrical performance of a young client whom the therapist has successfully helped to overcome shyness and stage fright.