Re:Your place or mine - therapy in the clients home

Hi Laurette
I too work in New Zealand and have also in the post specialised in working with older adults. Elderly clients are usually less mobile due to disability or inability to drive, so it is more usual to see them in their homes. Although this seems to be common to all countries, in New Zealand we have less extensive public transport services than, say, a place like London, so it can be even more difficult for an elderly person to visit a therapist's office.
Generally, I prefer to see people in my office for therapy, due to the distractions inherent in the home situation; however, distractions are less common in an elderly person's home as, for instance, they don't usually have childcare issues. I usually negotiate a contract on not answering the phone etc to reduce the chance of interruptions. If you get too many distractions, therapy becomes very difficult.
An advantage of seeing the elderly person in their home setting is that you can more accurately assess their general coping with daily living tasks, which is important when designing behavioural assignments. However, if you usually do the therapy in your office, you can still get this info from one or two home visits, or from another practitioner who may have carried out a home assessment.
I can sum up my usual practice as follows: if the client can come to the office, that is preferable for psychotherapy (as long as you have some way to assess the situation at home); if they can't make it in, I go to them (as long as we can agree on minimising the distractions).
I can't find much literature on the subject of CBT with elderly in the home setting (there is plenty on CBT with elderly clients, though) but here is one reference you may find helpful:
Monitor on Psychology (APA website) Volume 31, No. 1, January 2000. Staying in control: Behavioral interventions put older people back in the driver's seat, in more ways than one. BY REBECCA A. CLAY
Regards, Wayne Froggatt, New Zealand Centre for Rational Emotive Behaviour Therapy (www.rational.org.nz).

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Re:Your place or mine - therapy in the clients home, by Laurette, 09/02/03

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