Michal Livia Krumer-Nevo

Background: Social workers’ entry into patients’ homes can serve three functions:home visits, in-home outreach meetings, and home-based psychosocial therapy.We focus on the latter, a distinct practice in social work, yet research and training in this field is scarce.Aims: To examine the challenges and the coping practices of social workers involved in home-based therapy.Method: Ten semi-structured in-depth interviews were held with social workers engaged in home-based therapy and analyzed using thematic analysis. Findings: Experiences of confusion, disorientation, embarrassment, and fear were found among the social workers. We conceptualized them as a challenge to the three main arenas defining the therapeutic setting: spatial, concerning questions such as how to deal with a closed door, and where to sit and under what conditions; interpersonal, concerning questions such as the offering of food and drink, dealing with patients who arouse fear, and the presence of the therapist as witness and figure for modeling; temporal, concerning questions of maintaining the boundaries of the therapeutic hour and defining the treatment period. Confronting these challenges, the social workers employed different practices following their one of two positions: either imposing the clinical-office setting on the home space, or assimilating into its chaoic space. Conclusions and implications for practice: The findings suggest a reorganization of the field of psychosocial therapy in the home space, affording a differentiated approach to the spatial, interpersonal relationship, and temporal arenas. They clarify the two positions that social workers take in practice which influence their modes of action. There is need for further theoretical development of the positions and practices and their inclusion in social work training, in order to promote the professionalism of psychosocial therapy in the home space.