Real-Time Therapy

door2It has been said that the interactions that occur during a session in a therapist’s office (between the client and the therapist, between family members, or between group members) are a microcosm of the types of interactions that occur in each client’s life outside of that office. In other words, clinicians use the session as an example of what “normally” may occur in the client’s day-to-day life. By and large, this assumption is useful and can lead to a great deal of discovery and subsequent change on the client’s part, if that is their goal. However, for some individuals, office-based therapy is not such an effective intervention.

Currently, many youth and their families are referred to services by the Department of Child Services or through Juvenile Probation. These youth and families have experienced or been involved in circumstances that have either led, or are leading to, the youth being removed from their home. Almost universally, the youth or parent is exhibiting some very high-risk behaviors and/or significant mental health or substance abuse issues. The traditional weekly outpatient appointment is both insufficient and ineffective in working with these families, and more intensive services are needed.

122131_5330Home-based therapy services occur in the family’s or youth’s home, and are likely to occur more frequently than outpatient therapy appointments. Home-based therapy allows a therapist to meet the family where they are most comfortable and get to see what their life is like. There is no need for assumptions about what home-life is like because the therapist experiences home-life with the family and, invariably, other pertinent information is discovered and incorporated into treatment.

  • What are the actual physical conditions of the home?
  • Does the family feel safe in their home or in their neighborhood?
  • Are basic needs being met?
  • Is their home a place filled with people coming and going?

Digital CameraMembers of the family that may never have been willing to come to the office are now part of the “therapy setting.” Therapists gain a much greater understanding of the family and its functioning, the strengths, challenges, and obstacles; and they gain that understanding at a rapid pace. With that understanding and appreciation, the therapist is able to help the family in meaningful ways. The therapist is less likely to suggest ideas or interventions that are unrealistic (or unimportant) for the members of the family; and everyone works together toward the goals they have set and can openly evaluate their work in progress.

Home-based therapy services are most often offered in conjunction with additional home- and community-based services offered by Bachelor degree-level staff. These services assist the family in:

  • determining whether their needs and goals are being addressed
  • maintaining communication among those working with the family
  • 130800_9221evaluating and helping the family determine what additional resources they may need and linking them to those resources
  • helping the youth and/or family learn any skills that are needed to address the behaviors, mental health symptoms, or substance abuse issues that are continuing to negatively impact their work towards their goals

Home-based therapy services are an extremely powerful modality of treatment. Instead of talking in the office about what happens between family members at home, the therapist watches it occur and can intervene at the moment. While seeing a youth for individual therapy in the office can be very effective, imagine the power of an entire family working toward their solutions and goals, in their own environment, together.

—About the author: Dr. Jody Horstman, PhD, HSPP, is the Senior Director of Youth and Family Community Services at Aspire Indiana.  Learn more about Aspire Indiana at or on Facebook at

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