The Unconventional Counselor: A Guide to Home-Based Therapy

Mother and daughter with therapistCounselors 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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  • Taylor

    Taylor

    May 14th, 2013 at 11:08 PM

    I’d imagine this would be far more comfortable for the clients because they are at home.Some people would also have trouble speaking out to a counselor in his office and may not be too comfortable at some place other than home. All in all home based counseling sounds great from a client’s point of view.

    But I’m surprised you have mentioned home based clients are not consistent. I would have imagined appointments to be more inconsistent than home visits. Why does this happen with home-based counseling?

  • Nina

    Nina

    May 15th, 2013 at 1:51 AM

    Oh boy. First homeschooling now home therapy so just where does it stop exactly.

  • Parham

    Parham

    May 15th, 2013 at 1:54 AM

    I think it’s so great that some people are willing to look outside the box and see what it is that society most needs at the present. Rather than saying, “This is how we’ve always done things,” they are willing to say, “This is where society is right now. Let’s see what we need to do to meet the most people’s needs,” or, “This is a part of the population being left out that we can serve.” So, my hat is off to those therapists willing to give this a go.

  • harper p

    harper p

    May 15th, 2013 at 1:56 AM

    I can see how this would be true

    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”.

    If you only do this every once in awhile it means you have to be able to get to know people real fast and get them to like and trust you real fast otherwise you won’t be able to get much done in the little bit of time you have with them

  • jackolyn

    jackolyn

    May 15th, 2013 at 1:58 AM

    shew i’d be so scared to go into somebody’s house by myself i don’t think i’d ever relax enough to get anything done because

    PEOPLE ARE CRAZY!!!!!!!!!

  • Mama K

    Mama K

    May 15th, 2013 at 2:00 AM

    My daughter just started doing home therapy and I have to admit that it scares me half to death. These are people with mental issues and potentially volatile home lives. And, my baby is walking right into the lions’ den. It’s bad enough that she would see them in an office by herself, but to go into someone’s home? She could be kidnapped just like those girls were in Cleveland (I think it was Cleveland anyway) and I may never see her again. The thought of someone hurting her just keeps me awake at night.

  • deb

    deb

    May 9th, 2017 at 2:22 PM

    So important to teach your daughter how to stay safe. Also teach her what to look for with regard to boundaries and behavior. She will develop a good discerning spirit.

  • Keelie

    Keelie

    May 15th, 2013 at 2:02 AM

    My grandson’s therapy lady just started coming. To his house to see him. And my son and his family. And he just turned the whole lot of us. Into DSS. I hate that man. Who just tore my family apart.

  • Benji

    Benji

    May 15th, 2013 at 2:03 AM

    I just started doing home therapy and I absolutely love it. I am able to get a really good idea of what the home environment is like and how it impacts my patients. I am really excited about it and feel that I will be able to make a tremendous difference, even more so that I would have been able to otherwise. And, I do agree that a lot of times patients cancel because of transportation issues. Now, no more excuses!

  • Pearl

    Pearl

    May 15th, 2013 at 2:05 AM

    Is this really a disadvantage particular to home based therapy?

    “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.”

    It seems to me like that is something therapists have to face on a regular basis. EAch client needs something different.

  • beverly

    beverly

    May 15th, 2013 at 2:07 AM

    only one thing i got to say about this

    ain’t nobody got time for that

    ain’t nobody comin up in my house and lookin at my business and tellin me how to run my family

  • Alma

    Alma

    May 15th, 2013 at 2:09 AM

    My colleague tried this for about a year and finally gave up. Too many no-shows causing too much wasted time. Very frustrating when you hear a TV, knock on the door, the TV turns off, there are scuttling of feet and whispers, you ring the bell, and no one answers.

  • Faith

    Faith

    May 15th, 2013 at 3:53 AM

    While I do see the upside of in home therapy I think that there could be a downside too, in that this is their home environment, where much negativity and manipulation could have potentially taken place. Who’s to say that this will not trickle into the therapy sessions? If they are comfortable there then maybe old habits will be harder to break there. That’s just a thought. I think that there are times when you have to take someone out of their comfort zones to enforce the most change, and make the most meaningful steps forwatd.

  • Nellie

    Nellie

    May 18th, 2013 at 5:41 AM

    See the pros and cons of this kind of arrangement.
    But mainly if I was the therapist I am not sure how safe I would feel going into someone’s home.
    I think that I would feel a lot better in neutral territory, even if not in my office, some place in the open where there would be little chance for something to go wrong, or at least if it did we would be in public with others aorund.
    I kind of feel like this might be putting the therapist in harm’s way.

  • Olivia

    Olivia

    December 2nd, 2013 at 9:39 AM

    I’m pretty late on this discussion, but I have to comment. I am currently doing this type of therapy and it is absolutely AWFUL. Like other posters have mentioned, clients often feel less accountable for participating in sessions, i.e.- don’t answer the door, aren’t home, etc. resulting in me completely not getting paid and wasting an entire day I could have used with clients who are active. But my biggest concern is my own safety. We are sent out completely alone into often unsafe neighborhoods and homes to work with people who have violent histories and are known to be mentally and emotionally unstable. I am getting out of here as soon as possible!

  • Ashlie

    Ashlie

    August 5th, 2015 at 7:27 PM

    I just brought my daughter to a doctor she is 8 and the counselor called and asked to come by to see her …I think today some people are just really busy and its,in the privacy of their home….and when you have 2 small children and a 3 month old also hear these horror stories if your house isn’t spotless and judgemental proffesionals…I agreed but if it’s an all the time thing I just can’t..but I’ll guess we will see..but same way u feel about the counselors as I live in a safe neighborhood I feel the same way about people who lose their families..we watch who we let into our inner circle and I believe that’s where society is at..we want the best for our children but drs appointment should be kept at an office or give options office or home…I feel very strongly about this…but I can’t say no you can’t come see my child…just hope it’s a 1 time thing.in your home your washing clithes doing dishes making dinner and lunch snacks yall have to understand it’s alot for a family to take on in home counseling I could go on and on but I’m sure yall get it and I hope yall stay safe…

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