Home-based therapy is also called home-based psychotherapy, home-based counseling, or in-home therapy. It takes place when a therapist provides counseling in a person's home. Home-based therapy has helped many people reach their treatment goals.

Father and son portraitWhat Is Home-Based Therapy?

Home-based therapy takes place at the home of a person in therapy rather than in an office. It can help people who have difficulty getting to private practices or mental health facilities. Factors that could keep someone from getting care include money issues, age, chronic medical issues, agoraphobia, and responsibilities at home or work.

Community health organizations and child protective agencies provide many home-based therapy programs. Private practice therapists may offer in-home sessions if it seems to be the most beneficial form of treatment, whether access to care is a problem or not.

What to Expect in Home-Based Therapy

An in-home therapist may be joined by another therapist who acts as a partner during treatment. This can provide both the person in therapy and the therapist with more support and resources. Not all home-based therapists work in a team, but many do. For instance, therapists may work in teams when responding to a crisis-line phone call.

Home-based counseling is usually provided at the kitchen table or in a living room. In these settings, children and teenagers may feel more comfortable. They might allow the therapist to see their room or belongings. The ability to see a home environment and observe how people use their space can help therapists build good connections quickly. This personalized approach may not be as easy to achieve in an office.

Home-based therapy sessions typically take place at the houses of people in treatment. But, they may also be held in other locations. The counselor and person in therapy can decide to have sessions in the park or discuss treatment during a walk on the beach.

If you think home-based therapy is right for you, meet with a therapist who practices it to find out how to proceed. Choosing when and how often in-home therapy sessions will occur depends on what works for you and your therapist. Home-based therapy can be used occasionally, as a supplement to office sessions, or as your main approach.

Types of Home-Based Therapy

Psychologists, psychiatrists, marriage and family therapists, counselors, social workers, and other mental health professionals can practice home-based therapy. A range of approaches may be used in a session. These include individual therapy, couples therapy, play therapy, and family therapy. Home-based therapy can treat many concerns, including:

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  • Personal and emotional issues: Examples of these include anxiety, depression, and posttraumatic stress.
  • Juvenile delinquency: Home-based therapy can be useful when working on unhealthy coping mechanisms and behaviors. 
  • Family issues: At-home family therapy can help with relationship building, communication, conflict management, and problem-solving. It may also reduce stress and build up a family's strengths.
  • Marriage counseling: Home-based marriage counseling may improve intimacy and help resolve conflicts.
  • Developmental issues or brain injury: Therapists may provide home-based therapy for families of a person with developmental issues or a brain injury. These therapists can help create strategies for supporting a child’s development at home and in their community.
  • Intensive psychiatric care: Some therapists offer intensive in-home psychiatric care for children and teenagers. They support young people who have been discharged from residential treatment facilities or psychiatric hospitals.

Why Therapists Offer Home-Based Therapy

Home-based therapists know it can be hard for some people to get to an office for an appointment. Illness, disability, personal crisis, lack of funds, transportation issues, or childcare are all reasons a person might not be able to get to therapy. Home-based therapy can address many of these obstacles.

When treatment is provided at home, the therapeutic relationship may develop more quickly. This is because people in therapy can be more relaxed in their own homes than in an office. Instead of relying on self-reporting, therapists may get deeper insights from seeing how and where people live. As a result, effective treatment can progress, and healing may happen more easily.

Home-based therapy can also be helpful for therapists. They may be able to transition more smoothly between personal, family, and work duties, especially if they also work from home. Therapists who work from home and offer home-based therapy may have less workplace stress, more family time, and no regular commute.

People who are homebound can benefit from different forms of distance therapy. However, they may also prefer face-to-face interaction. Since they are never seen at a therapist’s office, people who choose home-based therapy ensure that their privacy is protected. Home-based therapy makes mental health services more accessible to a wider range of people. It may also be less expensive than traditional therapy at an office.

Home-Based Therapy for Families

Home-based therapy can be effective when teaching skills used at home. For example, parenting and communication skills can be greatly improved or fine-tuned. This type of therapy allows therapists to observe interactions between family members as they occur naturally. Because of this, therapists may find out more quickly how to approach treatment. The therapist can also confirm that basic needs are being met at home and share local resources.

A therapist may be more successful at lowering the defenses of teenagers by meeting them in their own territory. Home-based therapy can also increase the chances that all family members wil attend and participate in treatment.

Parents at risk of losing custody of their children may be targeted for home-based counseling. This type of counseling focuses on family preservation. One of its goals is to help prevent a child from going into foster care.

Ethics of Home-Based Therapy

Therapy that takes place in the home may raise ethical concerns. These concerns could be about boundaries, confidentiality, or role confusion. Factors that can benefit treatment, such as observing a family in action, may also make treatment challenging.

Role confusion can occur in a few ways. As a guest in another person’s home, a therapist may not know how to treat the person in therapy. Also, children with parents using in-home therapy may feel confused if they do not understand why the adults are unavailable at home. 

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Therapists might have difficulties maintaining the focus of a session due to an active dog, a fussy child, or other distractions. If other family members, friends, or neighbors are present, it may make maintaining confidentiality difficult. It may even hinder a person's ability to speak openly. Concerns beyond the scope of therapy can arise if the therapist unintentionally witnesses activities such as underage drinking or animal cruelty. Boundary issues can come up if the therapist is asked to loan money, answer the door, or run an errand for the person in treatment.

Finances must also be considered when considering home-based therapy. For example, should a therapist include travel in the cost of treatment? Should they stop the clock or keep it going when distractions pop up? These concerns should be addressed before treatment begins.

In addition, some people may not be good candidates for home-based therapy. Some may feel unsafe or uncomfortable in their own home. Others in treatment may be volatile and hard to control. They may try to override the therapist because they feel empowered by the fact that treatment is being provided in their home. Therapists accustomed to maintaining control of a therapy session may find these aspects of home-based therapy challenging.

Home-based therapy is becoming more common. But, there are concerns about the qualifications of therapists who offer this form of treatment. Many colleges do not offer training in home-based therapy. As a result, inexperienced therapists may not be able to provide the quality of care needed by those in treatment. 

Therapists who provide home-based therapy must keep professional boundaries during home visits. People who wish to use home-based therapy may find it helpful to be mindful of its limits.

References:

  1. Cortes, L. (2004, April 1). Home-based family therapy: A misunderstanding of the role and a new challenge for therapists. The Family Journal, 12(2), 184-188. doi: 10.1177/1066480703261980
  2. Friedman, D. (2012, September 1). Home is where the client is. Counseling Today. Retrieved from http://ct.counseling.org/2012/09/home-is-where-the-client-is
  3. Home based counseling. (n.d.). Child and Family Agency of Southeastern Connecticut. Retrieved from https://www.childandfamilyagency.org/what-we-do/home-based-counseling
  4. Home office: When the therapy office is at home. (n.d.). Zur Institute. Retrieved from http://www.zurinstitute.com/homeoffice_clinicalupdate.html
  5. Lafleur, C. & Henry, U. (n.d.). Foundations of in-home therapy. Retrieved from http://www.aamft.org/handouts/510.pdf
  6. Stivers, C. (2015, August 31). 7 reasons why clients and counselors prefer home-based counseling. The Family Therapy Blog. Retrieved from https://thefamilytherapyblog.com/2015/08/31/7-reasons-why-clients-counselors-prefer-home-based-counseling
  7. Zur, O. (2015). In-home therapy and home visits. Retrieved from http://www.zurinstitute.com/home_based_mental_health.html