INTERVENTION INTERCHANGE

Thorana S. Nelson, Editor

The Home Visit in Family Therapy

James Morris

KEYWORDS. Family therapy, home-based therapy, family interven-

tions

Over 35 years ago, Ross Speck (1964) noted that the home visit in
psychiatry and social work had been out of style for many years. The
author promoted the advantages of family therapy in the home. How-
ever, it was not until the passage of Public Law 96-272, also known as
the Adoption and Child Welfare Act of 1980, that home-based family
therapy began to proliferate in the United States. The law was enacted
to address concerns that the foster care system had not made reasonable
efforts to avoid out-of-home placement of children. As a result, pro-
grams that work with families in their homes to keep children safe and
in their natural setting have gradually increased.

James Morris is Assistant Professor, Family Therapy Program, Department of

Family Sciences, Texas Womans University, Box 425769, Denton, TX 76204-5769.
Journal of Family Psychotherapy, Vol. 14(3) 2003
http://www.haworthpress.com/store/product.asp?sku=J085
2003 by The Haworth Press, Inc. All rights reserved.
10.1300/J085v14n03_06 95
96 JOURNAL OF FAMILY PSYCHOTHERAPY

Home-based family therapy has been advanced as a promising treat-

ment modality for a variety of presenting concerns (e.g., Thomas,
McCollum, & Snyder, 1999; Henggeler, Pickel, Brondino, & Crouch,
1996). Home-based family therapy has been contrasted with office-
based family therapy to reveal unique distinctions between the two set-
tings (e.g., Christensen, 1995). However, there has been little attention
given to the potential usefulness of the home visit within the context of
office-based family therapy. In fact, the home visit may well serve as a
beneficial first visit within the context of office-based family therapy.

ADVANTAGES OF HOME VISITS

The home visit provides the therapist with an expanded opportunity

to become familiar with the family. The family can be viewed in their
own surroundings, a more natural setting than the clinic office. A home
visit offers an increased capacity for gathering information about, and
making assessments of, the family (Gordon, Arbuthnot, Gustafson, &
McGreen, 1988). What is important to the family can be more readily
revealed to the therapist while in the familys home. For example, the
familys distinctions and preferences about food, entertainment, music,
religion, as well as other areas of family life are more clearly visible
once in the home. Additionally, the home visit affords the therapist the
opportunity to see what is challenging to the family (Thomas et al.,
1999). For example, the family may be struggling financially, may lack
basic housing accommodations, or may be challenged by basic health
concerns. The therapist is able to view the physical characteristics of the
home, including family symbols, cultural symbols, sleeping arrange-
ments, as well as the external neighborhood context.
Visiting the family in their home may well communicate that the
therapist views the family as resourceful and deserving of respect
enough to come to their home for a visit. In this regard, the family may
experience a sense of empowerment (Washburn, 1994). The family is
likely to create an opening for the therapist as a guest in the home.
Visiting the home communicates to the family that the therapist is open,
interested, and willing to venture out from the confines of the office or
clinic. For many families, the office or clinic can be experienced as for-
eign, unusual, and unsettling. The home visit may provide the family
some sense of security and control (Schact, Tafoya, & Mirabla, 1989).
 Intervention Interchange 97

Further, as noted in the clinical example to follow, the home visit is par-
ticularly useful in situations where other family members may join the
process after another family member initiates therapy. The new mem-
bers feeling of being an uninformed newcomer can be addressed by
first visiting with them in the home.
The home visit may also decrease the possibility of no shows or drop
outs as families may experience greater connection with the therapist
(Henggeler et al., 1996). Indeed, the home visit, as a means of increased en-
gagement with the family, may create openings and possibilities with man-
dated clients who might lack internal motivation to participate in therapy
(Christensen, 1995). For example, a home visit can provide a motivational
boost for families who may have otherwise lost hope in a child placed in a
juvenile detention facility. The language of possibility can be communi-
cated both in words as well as in physical presence in the home. The thera-
pist, by visiting the family in the home, demonstrates in practical fashion
the reciprocal roles of participant and observer.

CLINICAL EXAMPLE

John and Sharon had been separated for one month when John began
therapy with the author. John had been involved in an extramarital affair
of approximately six months duration, and was in the process of termi-
nating this relationship. Sharon had asked John to move out of their
home after finding out about the affair. The couple had six children
ranging in age from three years old to 14 years old. John began therapy
by questioning his marital commitment, examining his reaction to the
excitement of the affair, exploring his past decisions, and examining his
future possibilities. As John gradually acknowledged the importance of
his marital commitment, consideration of including Sharon in the thera-
peutic process was discussed. John was concerned about the possibility
that Sharon would feel like an outsider as she joined the therapy pro-
cess. The author proposed a home visit with Sharon and outlined several
possible advantages. First, Sharon would be afforded the individual
time with the therapist to address her concerns and issues. Second,
Sharon would be able to remain in the comfort of her home during the
therapy meeting. Finally, the therapist would have the opportunity to
view the family home. John agreed to the idea and subsequently re-
ceived Sharons approval for the home visit.
98 JOURNAL OF FAMILY PSYCHOTHERAPY

The home visit proved useful in several ways. Sharon expressed her
opinions and concerns in the comfort of her own home. Further, she
agreed to meet a second time in the home with John joining the meeting.
During the home visit the author was able to view the home in terms of
structural arrangement, the importance of spirituality for the family
(e.g., religious books and materials in the living room), as well as spatial
arrangements for a family of eight. Additionally, the couple joined to-
gether to share their remodeling plans with the author. Subsequent con-
joint sessions focusing on rebuilding the marital relationship occurred
at the authors office.

POTENTIAL CONSIDERATIONS

While the advantages of home visits in family therapy are numerous,

considerations must be given to potential disadvantages. Family thera-
pists must assess the relative safety issues involved with visiting a fam-
ilys home. Therapists should inform a colleague concerning the time
and location of the home visit, and should carry a cellular telephone as
needed during the visit. Therapists must plan for the possibility of in-
tense family conflict that may more freely emerge within the confines
of the home (Adams & Maynard, 2000). Further, therapists may be con-
fronted with home settings where there is a potential for immanent dan-
ger present (e.g., hazardous materials in the presence of young children).
The therapist must be prepared to confront and deal with situations that
may require extra-therapeutic involvement.
A home visit may expose the therapist to other challenges, for exam-
ple, colds or the flu, or less than hygienic living conditions (Weighing
the merits of in-home therapy, 1998). The therapist should also con-
sider the extra time involved in making a home visit and plan accord-
ingly in terms of potential loss of available service delivery. Therapists
may consider scheduling more than one home visit during the same
day/evening if the homes are relatively close in proximity in order to
maximize time away from the office or clinic.

SUMMARY

The home visit in family therapy offers various advantages when in-
cluded within the process of traditional office or clinic-based services.
 Intervention Interchange 99

Potential considerations should be reviewed by clinicians prior to im-

plementing home visits in therapeutic practice. The use of home visits
increases the capacity of family therapists to deliver quality services to
a broad range of client populations.

REFERENCES
Adams, J., & Maynard, P. (2000). Evaluating training needs for home-based family
therapy: A focus group approach. American Journal of Family Therapy, 28, 41-52.
Christensen, L. (1995). Therapists perspectives on home-based family therapy. Amer-
ican Journal of Family Therapy, 23, 306-314.
Gordon, D, Arbuthnot, J., Gustafson, K., & McGreen, P. (1988). Home-based behav-
ioral-systems family therapy with disadvantaged juvenile delinquents. American
Journal of Family Therapy, 16, 243-255.
Henggeler, S., Pickrel, S., Brondino, M., & Crouch, J. (1996). Eliminating (almost)
treatment dropout of substance abusing or dependent delinquents through
home-based multisystemic therapy. American Journal of Psychiatry, 153, 427-428.
Schacht, A., Tafoya, N., & Mirabla, K. (1989). Home-based therapy with American In-
dian families. American Indian and Alaska Native Mental Health Research, 3(2),
27-42.
Speck, R. (1964). Family therapy in the home. Journal of Marriage and the Family, 26,
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Thomas, V., McCollum, E., & Snyder, W. (1999). Beyond the clinic: In-home therapy
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Washburn, P. (1994). Advantages of a brief solution oriented focus in home based fam-
ily preservation services. Journal of Systemic Therapies, 13(2), 47-58.
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