Out-Of-Office Experiences: Ethical and Clinical Considerations for Encounters Outside the Office Walls
This course discusses numerous interventions that are carried out outside the office walls. They include:
- Home visits for the purpose of assessment and treatment. This includes home visits with home-bound or bed-ridden clients or those who cannot get to the office for lack of organization or means of transportation or due to depression, phobia or other reasons. It has also been used by family therapists for assessment, case management and interventions in cases of child abuse and child neglect.
- In-vivo exposure for treatment of phobias, which may include walking with an agoraphobic client to an open space or flying with a client who suffers from a fear of flying.
- Joining clients in celebrations and rituals, such as weddings, graduations, funerals, confirmations, school plays, gallery openings.
- Going outside the office on an aerobic walk with a non-compliant, depressed client, walking around the block with a restless adolescent, accompanying a client to an important medical procedure, for which she would go on her own, or making a hospital visit to an ill or dying client.
- Adventure, nature or outdoor therapies, which also include vision quests, rope courses and therapeutic trapeze flying activities.
- Incidental, unplanned or accidental encounters between clients and therapists in public places outside the office.
- Working with clients from different ethnic cultures, may require joining American Indian clients in special rituals, attending a Hispanic or Jewish client’s wedding, or making a home visit to an African American family who wants to host the therapist for a special family event.
While analytic or risk management guidelines may discourage therapists from leaving the office, humanistic, behavioral, existential, family, feminist and many other orientations support leaving the office when it is aimed to increase clinical effectiveness. The ethical and clinical complexities involved in any type of out-of-office experience are discussed, and special attention is given to issues of the standard of care, codes of ethics, risk-management and theoretical orientations.
This intermediate course consists of two audios which provide extensive descriptions of the different types of out-of-office experiences and discuss related issues of ethics and standard of care, and finally an audio which provides information on the very few professional associations’ codes of ethics that directly refer to out-of-office experiences. Additional resources and references are provided for further study, but they are not part of the course. Transcripts are provided for all audios.
- Mutz, M., & Müller, J. (2016). Mental health benefits of outdoor adventures: Results from two pilot studies. Journal of adolescence, 49, 105-114.
- Surgenor, H. (2015). Nature and therapy: Understanding counselling and psychotherapy in outdoor spaces. Existential Analysis, 26 (2), 370-374.
- Tucker, A. R., Widmer, M. A., Faddis, T., Randolph, B., & Gass, M. (2016). Family therapy in outdoor behavioral healthcare: Current practices and future possibilities. Contemporary Family Therapy, 38 (1), 32-42.
- Identify what is included and involved in out-of-office experiences.
- Describe when out-of-office intervention can increase clinical effectiveness.
- Identify ethical, standard of care and risk management considerations in out-of-office.
- Scope of out-of-office experiences
- Home visits
- Clinical interventions as part of treatment plan, which are not possible in the office
- Attending clients' celebrations, rituals and life transitions
- Incidental encounters
- Outdoor or adventure therapy
- Dual relationships in the community
- Theoretical orientations
- Boundary crossing, boundary violations and dual relationships
- Confidentiality, time, participation, location and safety considerations
- Standard of care
- Procedure codes (CPT)
- Risk management and slippery slope argument
- Out-of-office experiences as part of healthy dual relationships in the community
- How out-of-office experiences can enhance therapeutic effectiveness