Returning to therapy in the COVID age: Is Telehealth becoming the new house call?

Written by Amanda Rubio

The first time I conducted an official home visit or house call was in 1996. I was working as an in house social worker at a nonprofit Law firm called, Lawyers for Children, in lower Manhattan. 

I was new on the job, I think it was my first week there, anyway, we drove up to Washington Heights in a black Town car. I remember getting out of the car and feeling so out of place, in more ways than one. I was the Puerto Rican girl with the fancy lawyer in the black car who came to talk to the Puerto Rican boy about his feelings. As he sat there he looked scared, Im sure he was wondering what these people came to talk about and why they were in his already crowded apartment on that foggy afternoon. I quickly realized most of my time at that job would be conducting home visits across the nation. I turned in my resignation a month later and took a job as a school social worker at PS94. 

Flash forward to 2021 and here we are offering telehealth and seeing patients/clients in their garage, basements, sun rooms, cars, bedrooms, living rooms, I mean can we all agree, this is a house call, right? The baby wakes up from a nap, the dog comes over to say hi, someones mom is yelling something in the background and we are able to be there to see and hear, to experience their experience of the experience, in real time. This is all fascinating! Is this the future?  Are virtual house calls a better way to be of service to our patients/clients or are we intruding?

In turn, our patients/clients get to experience us in our home. No matter how staged our office appears to be, the dog suddenly barks like crazy, sometimes there are repairs being done to our home, the computer freezes, the doorbell rings, Amazon arrives, we lose power, our wifi sucks that day, and on and on!  It is nearly impossible to maintain the old school standards of absolutely no self disclosure during telehealth. According to Counseling Today “counselor self disclosure can potentially derail progress and take the focus off the client, but if done sparingly and professionally it can build trust, foster empathy and strengthen the therapeutic alliance.”  We can only hope we doing our best work during these new and challenging times and maybe this change is for the better. Virtual house calls may very well improve and strengthen the therapeutic alliance between counselor and client allowing us all to be real, be seen, and be heard. After all this is what authentic connection is all about, isn’t it?