Ask the Expert: Psychotherapy: New Evidence and New Approaches
I’m considering moving my psychotherapy office into my home. What are the particular issues that I should be concerned about?
Reply from Mary S. Ahn, M.D.
Opening a home office to practice psychotherapy (with or without medication management) offers unique advantages for both the psychiatrist and the client. Despite the potential benefits, the psychiatrist should carefully consider the clinical and ethical issues before making the decision to move to a home office.
1. | Potential Benefits for Psychiatrists
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2. | Potential Benefits for Clients
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3. | Clinical and Ethical Risks
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The following guidelines may help in the decision-making process of opening a home office:
•. | Home office practices may have different connotations regarding the physical space. At the very minimum, a home office should have a physically separate entrance, waiting area, restroom, and office from the rest of the residence. | ||||
•. | Minimize opportunities for clients and family members/pets to intersect. Advise family members and household employees of the separate home office space and offer specific advice and guidelines to maintain the client’s privacy. | ||||
•. | Initiate and maintain a strict set of boundaries to maintain the frame of psychotherapy for clients. Anticipate that clients may bring up personal questions more frequently in such a setting and be prepared to respond. | ||||
•. | Carefully screen potential clients before setting up an initial meeting. For my home office, I conduct a detailed phone interview before agreeing to accept a client for consultation and possible ongoing treatment. Some factors include screening out clients with a history of violence or active safety concerns, clients with major boundary issues, or those who are complex and may not benefit from a solo practice. | ||||
•. | Always try to remain cognizant of what is communicated to clients nonverbally by a home office. For example, the size of the home, neighborhood choice, and unanticipated encounters with family members. | ||||
•. | Participate in a peer consultation group or at the very least consult with someone who can offer ongoing supervision of issues that arise with a home office. |
Psychiatrists should continue to actively weigh the clinical implications of doing psychotherapy out of a home office when working with any client.
The concept of boundaries in clinical practice: theoretical and risk-management dimensions. Am J Psychiatry 1993; 150:188–196Crossref, Google Scholar
:Boundaries in Psychotherapy: Ethical and Clinical Explorations. Arlington, VA, American Psychological Association, 2007Google Scholar
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