Home-Based Therapy

The principle of Home Based Therapy is an essential principle in the ReachingOut framework and contributes to several major levels to the success of therapy (Thompson et al., 2009). In many cases, especially in public service, the obstacles in sustaining an ongoing therapeutic process with an adolescent may be purely technical – difficulties in transportation to the clinic, finding appropriate child care, or inconsistent, overloaded schedules. Therefore, conducting the sessions at the patient's home allows reaching a broad population that would have otherwise been denied the possibility to participate in therapy (Kazdin & Wassell, 1999). From another angle, it should be noted that a direct connection has been found between parent-therapist consensus and treatment continuation, the frequency of session cancelations, and termination of the therapeutic relationship by the parents as opposed to the professional recommendation of the therapist. Such relation exists because, in most cases, the parent is the one responsible for deciding when to stop going to therapy. He is providing transportation of the adolescent to the sessions (and paying for it)(Armbruster & Kazdin, 1994; Gould, Shaffer & Kaplan, 1985; Pekarik & Stephenson, 1988 in Hawley & Weisz, 2003). Presumably, without an agreement with the parents on therapy goals, the parent's motivation to continue their child's therapy would be compromised. Of course, the balance changes when the adolescents themselves are in control of attendance. By conducting the sessions in the adolescent's home, the parents no longer possess an active role in maintaining the sessions. In this way, the meetings are set up directly with the adolescent. Home Based Therapy also provides a coping strategy with resistance to treatment. Many researchers have recommended that to reduce resistance to therapy; it is recommended to initiate "specialized engagement interventions," including conducting the sessions outside the clinic (Santisteban et al., 1996; Stanton & Heath, 2004 in Waldron et. al., 2007). When compared to therapy conducted in the clinic, carry out therapy in the adolescent's home has been related to increased participation and attendance of adolescents in sessions (Slesnick & Prestopnick, 2004, Thompson et al., 2009). Moreover, home-based therapy has been found to improve the compliance with treatment requirements, the therapeutic alliance and patient engagement in the process (Lay, Blanz, & Schmidt, 2001 in Thompson et al., 2009). Home-based therapy has been found more efficient than multi-family interventions (Liddle, 1995), peer groups (Liddle et al., 2001), individual counseling (Henggeler et al., 1991 in Thompson ET. al., 2009), and parent education (Joanning, Quinn, & Mullen, 1992). Bringing the adolescent to the clinic is, in fact, sending for them to come to the therapist's world (Barkan, 2002). By reaching out to the adolescent's natural environment, the therapist makes the first move towards encountering the adolescent's world. Entering the adolescent's room, with the pictures on the walls and other artifacts, provides a rare glimpse into the adolescent's individual identity. It enables conduction of Participant Observation and acquiring a better understanding of their internal world (Patton, 1990; Yin, 2003; Baxter, 2008). Observing the child's unique qualities and strengths, acknowledging them openly and considering them, is imperative both for the creation and reinforcement of the therapeutic alliance and for achieving specific therapeutic goals (Berger, 2006). Another significant advantage in home-based therapy is that it provides the therapist with an opportunity to witness the patterns of family interaction, which could provide the therapist with invaluable first-hand information that may assist diagnosing the problems and understanding the situation. In many cases when the therapy conducted between an adolescent and a therapist in his clinic, the adolescent may not expose the therapist to the existence of certain relevant issues, nor would the therapist consider their existence independently without direct evidence. When the therapist is only exposed to the adolescent's version of events, it is by definition a partial and limited version and does not enable creating a comprehensive, reliable perception of the situation (Cheung, 2006 in Thompson et. al., 2009). Fairbairn (1954) states that a child's connections with others are determined according to the object relations he has very early in life. He coined the term "internal object relation", describing a relationship, which exists only in the person's mind. That is created as a pathological substitute for the child's external reality, in order to avoid the actual exchange and interaction with others that exist in their external reality. It develops when the caregivers do not meet the psychological needs of the child. Reality then is replaced by fantasized inside presences, internal objects, to which the child relates to fantasized connections, the internal object relations. Those fantasized connections projected upon external interactions the child upholds. For a therapist in the clinic, who is not exposed to the actual situations in real time, the child's version of events does not always enable a distinction between descriptions of fan-fantasized connections and the actual occurrences. Even meeting an adolescent in their natural environment does not enable's the therapist to witness most occurrences in real time. It is therefore recommended to compare several versions of events they did not witness. Thus can be achieved by talking to parents, teachers, friends or others significantly involved in the life of the adolescent’s life. (Lincoln & Guba, 1985; Sandelowski, 1986; Krefting, 1991, Baxter, 2008). Incorporating family members has been proven empirically to be efficient in working with adolescents, as well as treating the adolescents within their social and family environment (Liddle et al., 2001; Stanton & Shadish, 1997; Carrol and Onken, 2005; Pringle and Flanzer, 2005 in Truneckova & Viney, 2008).