Family therapy in the home

Abstract

There is good evidence in other areas of therapeutic endeavour that home-based therapy may have advantages over clinic-based work for some patients. There are some families who have real dificulties in attending clinics. Despite these facts little has been written on the topic. This brief article reviews some of the objections to home-based family work and suggests possible solutions for the interested therapist.It is a cold and gloomy night, just starting to rain. As you park the car, you are sure you can hear the sounds of other cars being broken into. You are already ten minutes late because you discovered, after you had left the office, that you only had the flat number and the name of the tower block but not the street name. Hurrying to the entrance you notice the lack of lighting and start to feel scared. The lift is not working.When you reach the flat there is no door bell or knocker and you can hear the TV playing loudly -perhaps they won't hear you and you can go home with honour salvaged. You knock lightly and a furious barking alerts the occupants to your presence. Amidst the chaos of barking dog and shouting children you realize the family had forgotten the appointment. They are in the middle of a meal. You accept their apologies and wait for the meal to finish.Afterwards you gather in the lounge. The chairs (there are not enough) are arranged in a respectful arc, their focus the large television set in the corner. This is left on and children wander in and out during the meeting. Halfway through a neighbour calls round and is invited in by the family. There are no

‘Seeking permission’: an interviewing stance for finding connection with hard to reach families

“…argued in that ‘Home‐based services are an effective tool for working with high‐risk families who do not respond to traditional in‐office services’ (p. 403). In the home therapy literature early papers were written in the UK by Cottrell () and Messent (). Cottrell looked at issues of seating, attendance, disruptions and timing.…”

“…Will we look foolish?’ (Frosh et al., ; Reimers et al., ). Although there are constraints in working in the home (Cottrell, ), one advantage of doing so is that we can experience the challenges the family face in their lived context. Families don't have to describe their interactional patterns or their physical environment; they show it to us.…”

Common Components of Home-Based Family Therapy Models: The HBFT Partnership in Kansas

“…Families who experience physical barriers often lack transportation, live a considerable distance from a mental health agency, or include a family member who has physical conditions limiting mobility. Visiting the home increases access to and inclusion of family members who might not otherwise attend therapy in the office (Cortes 2004;Cottrell 1994;Schacht et al 1989;Woodford 1999;Zarski et al 1991;Zarski and Zygmond 1989). Psychological and emotional barriers are reflected when a key family member resists attending treatment in the office (Schacht et al 1989;Zarski and Fluharty 1992;Zarski and Zygmond 1989), or when family members fear and distrust social services and assume that attending therapy in an office may jeopardize the family's perceived security (e.g., immigration status).…”

“…Several studies have suggested that a home-based approach has demonstrated reasonable degrees of effectiveness in addressing the following clinical issues: children identified as "seriously emotionally disturbed" or as having a "serious emotional disturbance" (Cherniss and Herzog 1996;Curtis et al 2004;Fuller 2004;Schmidt et al 2006;Sexton and Alexander 2000;Stinchfield 2004;Woodford 1999;Woolston et al 1998;Zarski and Fluharty 1992); children and adolescents exhibiting antisocial behaviors, juvenile delinquents, and those involved with Juvenile Justice Services (Cherniss and Herzog 1996;Curtis et al 2004;Sexton and Alexander 2000;Woodford 1999;Woolston et al 1998;Zarski and Fluharty 1992;Zarski and Zygmond 1989); children with autism (Cottrell 1994); children in need of foster care (Fuller 2004); and families more broadly defined as multiproblem, at-risk, or multi-challenged (Adams and Maynard 2000;Cortes 2004;Johnson et al 2002;Schacht et al1989;Slattery and Knapp 2003;Snyder and McCollum 1999;Zarski and Zygmond 1989). Each of these articles has revealed that families involved in HBFT have experienced greater benefits than those who engaged in traditional, office-based treatment approaches.…”

“…By contrast, in the family's home, that relationship begins with the therapist as the guest accommodating to the family's familiar environment. Cottrell (1994) describes varying degrees of anxiety a therapist may experience while visiting the home. Issues of safety, perceived lack of control over the environment, and the distances traveled to get to the family's home also produce a degree of anxiety, stress, and even burnout that the therapist must manage effectively to engage in the work while in the home (Adams and Maynard 2000;Christensen 1995).…”