The Unconventional Counselor: A Guide to Home-Based Therapy

Counselors and their work are changing and developing constantly. Some counselors are choosing to work in one particular area of home-based counseling with children and families. These families are comprised of varying cultural and socio-economic status. Because working with these families is often inconsistent, sporadic, or engaged in crisis, the traits of a professional working in this area include positive “rapport, warmth, optimism, humor, and commitment” [4].

There are several advantages of performing in-home therapy, including, as a therapist, being able to build rapport, observe child and family functions outside of an office setting, make assessments, and model consistency and routine [3]. Additionally, research is showing that children in families who attend more sessions in therapy (approximately greater than 50%) have better outcomes than those families with poor attendance, [1]. It is more efficient or convenient at times for the counselor to come to the client, given transportation issues or hectic schedules.

The disadvantages for in-home counseling include safety concerns for both therapist and family, as well as lack of consistency. It can also require extra scheduling time (accounting for travel) [3].

Unfortunately, there is not a singular theory that can encompass the needs for home-based therapy. Instead, home-based therapy combines techniques cognitive behavioral therapy, multisystemic therapy, social leaning theory, solution-focused therapy, and psychoeducation for families [2]. These provide additional barriers for counselors doing this work, because they must be trained in several areas and remain flexible when executing them on a case-by-case basis.

Personally, I recommend that in-home counselors create their unique approaches to working with children and families. At the same time, I recommend that they remember basic ethics training. I have titled the professionals in this field “unconventional counselors.” We are those counselors who are trained, licensed, and affiliated with certain larger entities. We act as our own strongest agent of change.

Here’s a list that might be helpful for a first-time home-based therapist:

  1. Create your own personalized “on-the-go” counselor toolkit. Each counselor toolkit is going to be different based on your client population and your own therapeutic strengths. The more you are genuine to your own self, the more honest your toolkit is going to be.
  2. Be prepared and well-trained in flexibility. This is not the kind of position that you take lightly, nor is it one in which you participate in routine hours or appointments. Be ready to have at least two back-up plans in case your scheduled day does not go as planned.
  3. Clients that receive in-home counseling are notorious for inconsistency, whether that manifests with appointments, progression, or regression.
  4. Supervision, supervision, supervision. Adopting the role of an in-home counselor is based in a familial approach. In our world, however, a familial approach does not mean a family of origin. This may include other professionals (caseworkers), fictive kin (long-term friends of the family), foster parents, and alternate community supports. An ethical “unconventional counselor” will always seek consultation and professional supervision from other professionals.

References:

  1. Carrasco, J. M., & Fox, R. A. (2012). Varying treatment intensity in a home-based parent and child therapy program for families living in poverty: A Randomized Clinic Trial. Journal of Community Psychology, 40, (621-630). doi:10.1002/jcop.21492
  2. Macchi, C. R. & O’Conner, N. O. (2010). Common Components of Home-Based Family Therapy models: The HBFT Partnership in Kansas. Contemporary Family Therapy, 32, 444-458. doi: 10.1007/s10591-010-9127-1.
  3. Morris, J. (2003). The home visit in family therapy. Journal of Family Psychotherapy, 14(3), 95-99. doi:10.10.1300/J085v14n03_06
  4. Thompson, S. J., Bender, K., Lantry, J., & Flynn, P. M. (2007). Treatment engagement: Building therapeutic alliance in home-based treatment with adolescents and their families. Contemporary Family Therapy: An International Journal, 29(1-2), 39-55. doi:10.1007/s10591-007-9030-6

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