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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A home office allows easier time management to transition between professional and personal life. There is no need to commute and no parking constraints. Working close to one’s family and community facilitates attending personal events such as kids’ activities and volunteering.
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There are potential financial benefits. For example, there is no need to pay additional rent and sometimes utilities can be packaged into the residential services. There are also possible additional shared tax deductions involved in the expenses of maintaining an office in a residence.
2.
Potential Benefits for Clients
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Many clients prefer the cozy feeling that a residential space may offer versus going to an office that is based in a hospital, clinic, or commercial office space.
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Some clients, especially youth, feel less anxious about meeting a new psychiatrist in a home office setting. They may feel that a home office is less self-stigmatizing.
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In many cases, the home office is located in a less dense population area, giving more privacy for clients.
3.
Clinical and Ethical Risks
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There is an unavoidable boundary crossing of self-disclosure in having a home office. At the very least, disclosure of the hometown and residential dwelling will be known by the client.
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There may be unintentional intrusions including family members, friends, or pets. Privacy and confidentiality may be more difficult to maintain for both the psychiatrist and client.
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Safety concerns may arise for clients with unanticipated threatening or violent behaviors.
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For clients, it may be more difficult to discriminate between the psychiatrist’s professional life and personal life and to maintain appropriate boundaries.
The following guidelines may help in the decision-making process of opening a home office:
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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.
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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.
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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.
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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.
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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.
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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.
Footnotes
Mary S. Ahn, M.D., Assistant Professor, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
Dr. Ahn reports no competing interests.
Bibliography
Gutheil TG, Gabbard GO: The concept of boundaries in clinical practice: theoretical and risk-management dimensions. Am J Psychiatry 1993; 150:188–196
Ofer Z: Boundaries in Psychotherapy: Ethical and Clinical Explorations. Arlington, VA, American Psychological Association, 2007
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Published online: 1 July 2014
Published in print: Summer 2014
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