There are many instances in psychotherapy where therapy takes place outside the traditional office. These may include:
- Home visits to bed-ridden or home-bound clients
- Cases requiring child abuse/neglect assessment
- Pre- or post- adoption assessments
- Adventure therapy and equine therapy
- Hospital or board and care visits
- Treating the homeless on the street
- In vivo exposure, such as agoraphobia or fear of flying
- Conducting lunch therapy with an anorexic at a restaurant
- Playing basketball with a highly resistant adolescent client
Other examples of therapists interacting with clients outside the consulting room include:
- Attending a school play with a shy client
- Home tour with an architect-client
- Attending a wedding with a client couple
- Going for a walk on a nearby trail with a client who prefers side-by-side interaction or with clients who feel claustrophobic, fearful or paranoid in the office
- Attending the funeral of a client’s loved one
Beyond the Office Walls – A Free Article on Out-of-Office Experiences
Important considerations for Out-of-Office Experiences:
- Make sure that you have a clear clinical rationale for conducting therapy outside the office and that you have articulated it in the clinical record.
- There is nothing in the Code of Ethics that prohibits clinically-driven out-of-office experiences.
- None of the above mentioned out-of-office experiences with clients constitutes a dual or multiple relationship.
- Informed consents, office policies and good record keeping are extremely important.
- Make sure you operate within your scope of practice and within the standard of care.
- Consult on difficult issues.
Areas of Basic Understanding Necessary for Conducting Home Visits, Home-Based Therapy, or In-Home Therapy:
- Populations: Home-bound, depressed/suicidal elderly, dementia, Alzheimer’s and other disabilities, cultures that strongly prefer home visits, those diagnosed with autism, depression, agoraphobia, social anxiety, etc.
- Advantages: Patients are seen on their own turf, in their real lives, opportunities arise to compassionately observe the conditions patients live in, more personal than sterile medical offices, can be more effective and less expensive.
- Boundaries: There are many boundary concerns with home visits. They include issues of space, role, timing, who is present, power and control, confidentiality, safety and security, self-disclosure, food and drinks, gifts, interferences, and much more.
- Supervision and Training: Supervision, training, peer supervision, debriefing, and experienced therapists accompanying novice ones are very important in home-based therapy.
- Summary of the most important concerns of Home-Based Therapy