Mental health service providers have begun serving older adults in their places of residence. Providing psychotherapy in an elder's home presents numerous benefits and challenges, compared with in-clinic work. Because many of these differences are complicated, clinicians must make quick decisions and can benefit from guidelines to formulate responses. Based on each of the four authors' 10 to 15 years of experience, this article presents advantages to be gained by providing services in the home, including development of rapport, accessibility of information, and participation by the client with transportation challenges. The authors present a number of challenges such as interruptions, maintenance of professional boundaries, difficult transferences and countertransferences, threats to confidentiality, and safety issues. Decision-making guidelines are offered.

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Older adults exhibit psychotic symptoms for various reasons. Treatment may require medical and psychiatric intervention, family support, community services, etc. The role of psychotherapy, however, has received little attention. This article describes a psychotherapeutic approach to treating older adults with psychotic symptoms based on the literature and the authors’ own experience. The approach includes reaching out to identify individuals in need of help; clinical engagement to develop a working relationship; linkage with needed services; and helping individuals reduce the link between triggers and psychotic symptoms. Differences between treating a person with delusional disorder versus schizophrenia are discussed.