I started my private practice in August 2003, when I designed, coded, and wrote my professional website. Within a few weeks, I was receiving numerous inquiries. The practice took off at a speed I’d not anticipated, and I was greatly pleased. Since I was just starting out, I sub-leased an office a few evenings a week; soon, however, I found I was getting full, and I wanted to expand. In December I began to discuss the option of co-leasing an office with a friend, and then a series of events erected solid barriers to that prospect.

My beau’s project was cancelled and we thought he might be laid off. Although that didn’t happen, the future of his job remains dubious, and he’s resorted to searching for a new one. This raised the possiblity of relocating to another city or out of state. Then his father became seriously ill, and we felt we could not move forward on the job issues until we knew if he would survive (he is recuperating slowly). Additionally, at the end of March, the therapist from whom I sub-leased asked me to find another office, since she needed her space. Not being in a position to sign a long-term lease, I’ve had to use an executive office, consolidate my clients to one day a week, and not accept new clients. You can imagine how disheartening it feels to constrict a process that was working robustly.

I still don’t know if I’ll remain in Austin, and that will become clear in the next few months. The positive aspect of this situation is that is has challenged me to think of other ways I can practice that do not depend on my having an office. People have suggested online counseling (via email); it’s intriguing, but I’m not prepared to do that. There are security issues that concern me, and I’m not willing to set up a system of encryption, etc. at this time. In addition, email therapy works for a limited range of problems; in-person interaction, with the non-verbal gestures and immediacy of communication, is a much richer environment for therapy.

However, I have provided telephone therapy and, in my last job, would see clients at their homes. So it occurred to me this evening: what about providing home-based psychotherapy (or sessions at the client’s office), and for clients who are too far to travel to (or who can’t get to me), offering tele-counseling? For the latter, I need to set up a payment system online, so that clients can pay for sessions; then we’d arrange a time for the phone session and have it. As for at-home counseling, I’m aware of the challenges of that. First, for me there is wear-and-tear on my car (although the miles would be deductible expenses). Plus there is the aggravation of driving in increasingly zany traffic. My last job required a lot of driving and burned the pleasure of it out of me.

Second is the possibility of no-shows, i.e., driving to the home and finding the client gone. This happens in the office too, but being in-office provides opportunities to catch up on paperwork, email, research the Internet, and so on. Also, I need to think about the billing. If I’m stuck in traffic and arrive late, do I deduct from the fee a pro-rated amount, or if our schedules allow, have the entire session?

Third, I need to research more articles (e.g., in The Journal of the American Medical Association) that cover the efficacy of home-based psychotherapy. I also need to be thorough in developing a client explanation form that defines the boundaries of therapy, since being in someone’s home (mine or theirs) does blur them somewhat. It will require greater vigilance.

Concerned parties might ask me about safety, and whether it’s a good idea to go to a client’s home. This doesn’t faze me. For several years I went into homes all over the city, in wealthy and poor neighborhoods, to provide at-home counseling to people diagnosed with schizophrenia, bipolar disorder, depression, and a host of other mental ailments. One of my clients lived in a housing project in which a policeman shot a mentally ill client (who attacked a city housing employee with a knife) and her neighbor in the next apartment was murdered by a knife to the throat. They did not find the assailant. So I’ve learned to be mindful and observant; have discovered that places which carry fear-inspiring reputations are often not as scary as the stories would suggest; and have developed an attitude of acceptance that if something bad is going to befall me, then it will do so, and I’ll deal with it. I was once assaulted in my own home, so I know that danger lurks everywhere. I try to use good judgment but don’t fret.

Despite all these issues, which I view as solvable problems, the idea of providing service in these two ways to private-pay clients reanimates my spirit.

Anyhow, I could have one office day a week, and perhaps one or two days seeing clients at home or in their office. Hmmm. Need to think on this more.