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Voice of Experience: Home visits

By Gregory K. Moffatt December 19, 2022

It was early in the 1990s. I had been in practice maybe six or seven years. I’d paid my dues in general practice, hoping one day to focus exclusively on family and children. At that time, nearly all my clients were children or families with children.  

Most of my clients were either single-parent families, divorced and blended families, or families in the middle of divorce. It was heartbreaking for me to observe the pains of broken families — lost dreams, heartache, the unknown, financial devastation, and the many other factors that can make divorce so painful. These are things we have all seen many times even for those just starting out in the profession. 

One family was limping along trying to salvage their 10-year marriage. I’d seen them and their three children several times in my Atlanta office, but most of my clinical work focused on the marriage.  

The couple faced many challenges in finding times to meet with me. They both worked full time; he was a postal worker and she was a nurse. Their home was 35 miles from my office through heavy Atlanta traffic. For each appointment, they had to pick up children at daycare, scurry home as quickly as possible, change clothes, meet the babysitter and head north to my office to make our 6 p.m. appointment.  

To arrive on time, everything had to go as planned — no car troubles, no late days at work, no late or no-show babysitters. The stress of a long day at work, coupled with the rush to get out the door on time, often led to arguments in their 45-minute drive to my office. If this happened, they were so harried when they arrived that it took several minutes for them to recenter before we could get down to business in our session. 

Despite all of that, we were making progress until one day I got a call just 30 minutes before they were supposed to arrive. Everything had gone wrong that day, and they were not only canceling the appointment but also withdrawing from therapy. 

That is when I had an idea. I suggested we have a final session the following week, and I would help them find a referral. But this time, I offered to meet them in their home. They heartily agreed. 

Their dimly lit living room was full of commotion: Pets were running around, and I could hear young children in a nearby bedroom. But I realized the only one who was uncomfortable was me. They were more relaxed than I’d ever seen them. Although it was a less-than-ideal environment for therapy, they were comfortable in their own space. I saw them in a way I’d never seen them before. 

It was then that I realized that I was unintentionally adding to their marital challenges by the very nature of my practice. They had to spend extra money on babysitters — money they didn’t have. And before each appointment, they spent the entire day dreading the potential problems they might encounter trying to make it to my office by 6 p.m. — my latest appointment option. 

After this realization, I offered to meet with them twice a month in their home and they agreed. Six months later when we terminated, their marriage was much healthier. Just a year or so ago, I received an email from the wife. They are still married, their children are grown, and life has settled. 

Home visits create numerous challenges for us as counselors. Most obviously, boundary crossing is an issue, but in the home visits I’ve done, I’ve never had any problems arise from these boundary crossings. Until about 50 years ago, half of all physicians made house calls without any issue. And some still do! 

Safety, of course, is a concern, but social workers have made home visits for decades demonstrating that safety issues can be managed.  

Instead of making a home visit, I could have offered a later appointment time or one on the weekend, but that would have compromised my own family life boundaries. Finding a closer referral could have worked, but that would have required them to start over.  

While I admit these challenges, among others, need to be considered, if we really want to pursue diversity and consider cultural issues, shouldn’t that include the challenges I faced with this family? I am confident that I opened my mind to alternative methods of delivering clinical services in an ethical and responsible way.  

Just like telehealth, there is no one-size-fits-all approach. For example, I couldn’t meet alone with an individual client at their home. Although there are many limits to offering in-home services, I’ve never regretted making that decision. 


Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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