As a practitioner in the mental health field, I am very aware that there may be serious barriers that prevent people from traveling to my office to find the help, support, and therapy they may require. Examples of these barriers can include; depression; agoraphobia; contamination phobia; obsessive-compulsive issues; suicidality; hoarding; cultural preferences; transportation limitations; physical challenges; dependant children or adults they cannot leave unattended. For people who face these and other challenges, Home Therapy Sessions may be the answer. Others may require home visits to help them learn and develop parenting or life skills.
In order to best serve those in need, I have chosen to offer home visits for consultation, assessment, and therapeutic counselling on a case-by-case basis. Any client wishing home visit counselling will be asked to weigh the pros and cons, and to determine if they can meet the conditions for a therapeutic visit to take place.
The main advantage of Home Therapy Sessions is comfort for the client - it removes the stress or inability to travel and allows them to remain in a familiar and - hopefully - safe environment. For the therapist it allows us to see our client on their home turf, allowing for assessment and therapeutic interventions to take place in context and helps us understand the client better following the adage “Health isn’t a diagnosis, it is how we live.”
Therapy sessions can take place anywhere appropriate; in a living room, porch, backyard, car, nearby park, library, school, church, during a car ride or a walk on a trail. So long as the chosen place is safe and conducive to building a healthy therapist/client relationship and is free of danger, the choice of location for the session is unlimited.
Another advantage of Home Therapy Sessions is that they can help reduce Emergency Room visits and hospitalizations by dealing with problems before they become a crisis.
The therapist and client must establish healthy boundaries both for the client’s protection and to help the therapist maintain their role. Because it is outside of the office structure which is designed to be free of distractions, a home visit can be more fluid and unpredictable, such as; other family members present in the home; pets; phone calls; friends visiting unannounced. Because of this, the therapist and the client must agree on ways to minimize these distractions.
The Client & Therapist Roles
It is important during Home Therapy Sessions to maintain the roles each person has in the therapeutic relationship. The therapist is not a “guest” in the home, they are there in a professional capacity. Clients should understand that they do not have to cater to their therapist as they would a friend coming to visit and understand that the therapist isn’t being rude if they decline the offer of a snack or beverage. The other rule for therapists that is the same whether in their office or in a client’s home is - they cannot accept gifts. To do so can result in the therapist being brought before a disciplinary board of their association and may have their right to practice removed if the incident is serious enough.
Session Length and Fees
The length of sessions for each client is up to each therapist to determine; depending on how the session progresses or the issues involved, many therapists [myself included] will work to what is known as “end point” instead of sticking precisely to the clock. That is; to complete the therapeutic part of the session even if it goes over the one hour time limit by 15 minutes or so.
It would seem logical to assume that the hourly rate for a home visit would be less than an office visit, because there is no need for the overhead costs of maintaining an office. However, most therapists who offer home visits also maintain an office where they complete their session notes, do research on behalf of clients, and consult with other professionals on general topics that can benefit their clients. The other costs to the therapist doing home visits is travel time and expenses that can amount to more than the hourly in-office percentage. So, typically, Home Therapy Sessions are not discounted for those reasons.
Safety & Confidentiality
Great care must be taken both by the therapist and the client during home visits to maintain safety for all and confidentiality for the client. For example; It would not be good practice to have an abusive or controlling spouse or child present during the session. Neighbour and friend visits should be discouraged during the session, and care must be taken to ensure no one can hear what is said during the confidential session - The same rule in the office must apply at home; “What is said in session, stays in session.” it is the client’s decision on what they share with their family and friends.
Another issue that cannot be compromised is the use of alcohol or illicit drugs prior to or during a session. If the client has or is consuming either alcohol or mood-altering non-prescription drugs prior to or during the session, the therapist will end the session immediately and offer to book a new appointment. Clients should understand that if this occurs, they may be billed for part or all of the terminated session.
Providing for healthy boundaries, Home Therapy Sessions can be a positive option for some clients. If you or someone you know might benefit from a home visit by a therapist, please contact one in your community to see if they are willing to offer this service.
Aaron D. McClelland, RPCc www.interiorcounselling.com/aaron