Traditionally, the figure of the psychologist has been associated, at best, with an office with a couch, where a man with glasses, a beard, and a fondness for cats listens to your past traumas, and at worst, with an overwhelming iconography of asylums and straitjackets. However, following the pandemic and the eruption of the volcano on the island of La Palma, the taboo and stigma associated with mental health have been cracking, and a new way of practicing psychology is beginning to gain popularity: Home-based psychological attention.
WHAT IS HOME-BASED PSYCHOLOGICAL ATTENTION?
Home-based psychological attention refers to situations where the psychologist travels to the client’s home, carrying out sessions in their own context to improve their quality of life and well-being.
The idea of home-based psychology emerged in Great Britain around 1950, in the community context of caring for dependent people. Upon realizing its great benefits, its coverage gradually expanded to other difficulties, such as people with motor, intellectual, neurocognitive diversity, chronic diseases like cancer, and people with mental health problems, including agoraphobia, affective disorders, or schizophrenia. Today it is a widely extended model in the Anglo-Saxon context, from which children and adolescents with behavioral problems, families and couples, or anyone wishing to receive psychological attention in their own home, also benefit.
However, despite its advantages, in Spain, and more specifically on the island of La Palma, it remains a novel and scarcely extended modality of intervention, known as Home Care Service (SAD). The essential purpose of the SAD is to provide personal, domestic, psychosocial, educational, and technical support to people in situations of dependency and is a municipal competence.
HOW DOES HOME-BASED PSYCHOLOGICAL ATTENTION WORK?
The chosen approach is person-centered narrative therapy, which involves recognizing the uniqueness of each individual and focusing on the skills, abilities, competencies, beliefs, values, and commitments they already possess that will help them change their relationship with the problems in their lives, thus weaving an alternative story to the problem that brought them to consultation. Following the proposals of different authors (Chimpén, 2012; Brooker, 2003), I will mention some important principles that guide our practice:
- The problem is the problem, and the person is the person, meaning the problems are analyzed separately from the person.
- We work with the deepest respect and genuine curiosity towards the consulting person. In other words, a psychology that is blind to differences (social, generational, in abilities and skills, gender, sexual-affective, ethnic, cultural, religious, political, economic, family, educational, neurocognitive, spiritual, and class) can never understand human diversity.
- As psychotherapists, we recognize that we occupy a privileged place of influence over the other. For this reason, the development of the psychological care plan is carried out through close collaboration between psychologist and consultant in tune with their changing needs. In short, it is a collaborative, individualized, and dynamic plan that focuses on the identity, values, desires, dreams, aspirations of the consulting person and their immediate environment.
- Understanding the narratives through which the consultants make sense of their experience. What meaning do you give to the situation you are living?; What does this say about your qualities as a person?; How have you effectively faced the problem? How did you make this happen? These are some of the questions that allow us to explore the plot of the story and understand what events we have chosen over others to make sense of our experience.
- Offering social psychology support to help people going through difficulties to live a fuller and more nuanced life, because all people are equally worthy of love and respect.
Person-centered narrative therapy is nothing more than a change of perspective: it’s not people who should adapt to us but quite the opposite, public entities, centers, and services must adapt to people to respect the individuality and uniqueness of each of the families, communities, and consulting individuals, recognizing the influence of cultural and social factors.
BENEFITS OF HOME-BASED PSYCHOLOGICAL ATTENTION
Home-based therapy shares the advantages of face-to-face and online therapy. But what are these benefits? What makes this type of therapy a good alternative?
In short, the main benefits of home-based psychology are as follows:
- Comfort of not having to travel: La Palma has its own and differential characteristics compared to other islands due to its geography, impacting its population structure: population dispersion, a deficient transport network, a high aging rate, insularity, and ultra-periphery, making home care an ideal option for those living away from the main population centers (Los Llanos de Aridane and Santa Cruz de La Palma), who have mobility problems or are in a situation of dependency.
- For families: In addition to the possibility of attending to all family members in the same environment. It also allows observing in their natural context, i.e., in the family home, family communication skills and styles, relational dynamics between parents and children. For example, it can be especially useful in the case of dealing with a daughter who shows patterns that challenge norms and limits.
- Greater privacy: The session takes place in a familiar place for the person or family consultant. Although the stigma of mental health is reducing, there are people who would prefer others not to know they are attending psychological therapy. It also saves the anxiety that clinical environments sometimes produce.
- Allows making real changes in the environment
- Gives the person and their immediate environment a central place
- Aims to achieve continuity in the care of people.
- Commits to the design of collaborative, individualized, and dynamic plans where the objectives, actions, and evaluation of psychological interventions will be established.
WHO CAN BENEFIT FROM HOME-BASED PSYCHOLOGICAL ATTENTION?
In principle, anyone who wants to receive psychological attention can benefit from this modality of intervention. However, home-based therapy has profound benefits in:
- Dependent people or those with reduced mobility
- Families and couples
- Children and adolescents with behavioral and emotional problems, learning problems, and reading and writing problems, phobias, enuresis, night terrors, and diagnosed with autism spectrum disorder, addiction to mobile phones, and other new technologies.
- Adults experiencing anxiety about going out, mental health problems, with substance and new technology-related disorders, mood disorders (anxiety and depression).
- People with medical diseases such as cancer or fibromyalgia.
- Grief
HOME-BASED THERAPY A NEW OPTION
As we have seen, home-based therapy has many advantages and benefits compared to face-to-face and online therapy. I currently offer my services in the following municipalities on the island of La Palma: Tazacorte, Los Llanos de Aridane, El Paso, Fuencaliente, Barlovento, San Andrés y Sauces, Puntallana, Santa Cruz de La Palma, Breña Alta, Breña Baja, and Villa de Mazo.
