Engaging with clients outside the office has generally been discouraged or called unethical, similar to the way in which uninformed risk management and ethics “experts” have traditionally viewed dual relationships, bartering, self-disclosure by therapists or gift exchange between clients and therapists.
Once we go beyond the “don’t list” and take off distorted “risk management glasses” we can carefully and intelligently look at encounters between therapists and clients outside the office. Then we come to realize that indeed meeting clients outside the office is at times unavoidable or unexpected and can also be part of a sound treatment plan.
Social workers, for example, especially those who are involved with child protective agencies and child custody disputes, are trained to conduct home visits because it is obvious that a home visit is more likely to give them relevant information regarding their recommendation for child placement. Obviously, therapists who conduct equine therapy or adventure-wilderness therapy do not conduct therapy in their brick and mortar offices.
For different reasons, I have made home visits to bedridden clients or to home-bound clients who were too paranoid, agoraphobic or deeply depressed to leave the house. I have visited a few clients in their board and care or hospital settings when they were unable to come to my office.
Needless to say, the therapists who work with the homeless population meet their clients where the clients are, rather than in the therapists’ offices. Once psychologists go beyond the “only-in-the-office” dogma, they easily realize that with certain clients, walking side-by- side on a nearby trail can be more effective than sitting face-to-face with the client in the therapist’s office.
After working with a very shy and timid young client who mastered his fear and trepidation of appearing in front of an audience and finally participated in a school play, at his and his parents’ request I went to watch him perform on the stage.
An architect client who, with my help, completed a complex, unique and expensive project wanted to give me a first-hand sense of his unique work via an actual tour of the final structure that he proudly designed.
Along the same line of thinking, a couple of clients who work hard and long on their pre-marital relationship invited me – in fact insisted – that I attend their wedding. To my surprise, during the ceremony, they pointed at me and told everyone attending that my therapy with them was a big factor in arriving at that special moment of union and commitment.
I once accompanied a client, who was working in therapy on issues of grief and guilt, to his child’s grave – his first visit there in 20 years. A large family, with whom I did intermittent long-term family therapy for over 20 years, invited me with the strongest encouragement to attend the funeral of one of their family members who had participated in the therapy over the years.
Other types of out-of-office encounters between therapists and clients take place when they unexpectedly meet each other outside the office in the community. These kind of unavoidable happenstances between therapists and clients occur regularly and at times frequently in rural or small communities, at 12 step meetings, on college and university campuses, on aircraft carriers or remote military bases.
Once we establish that out-of-office encounters take place for a variety of reasons and in varying situations, we realize that while some are part of a sound clinical plan to enhance therapeutic effectiveness, yet others are accidental and unavoidable.
It is important to be aware that none of the major professional codes of ethics prohibit an out-of-office encounter or even mention it. In fact one can argue that when codes of ethics, such as APA’s Code of Ethics, discuss the principle of beneficence, which advocates that psychologists strive to benefit those with whom they work, it actually advises psychologists to employ out-of-office interventions when they are likely to benefit the client.
Finally, when therapists conduct therapy outside of the office walls they are advised to articulate their clinical rationale, what took place and the outcome of the encounter in the clinical notes.
Significant or unpredictable out-of-office encounters should also be noted in the clinical records. Some complex out-of-office interventions are ill-advised with certain clients in certain settings. Complex out-of-office interventions or encounters may require a consultation with an open-minded and informed expert.
Ofer Zur, Ph.D., is the director of the Zur Institute Inc., which provides over 125 online continuing education courses for mental health practitioners, including an online course on “Out-Of-Office Experiences: Ethical & Clinical Considerations for Encounters Outside The Office.” His website is located at: www.zurinstitute.com