Handling the Unexpected
When you enter a client’s space, there’s a lot of room for the unexpected—far beyond what school prepares you for. In-home work brings unique challenges, from encountering unsafe living conditions to navigating cultural differences, family conflicts, or personal discomfort. While these experiences can feel overwhelming at times, how you manage your reactions, maintain professionalism, and uphold cultural humility will shape your effectiveness as a clinician.
Home Safety & Environmental Risks
Navigating physical hazards when going in home can be difficult, but it is important to address them promptly to ensure your safety as well as your client's. Some common examples of home safety and environmental risks are:
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No running water, exposed wires, unstable flooring/strairs
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Strong odors, clutter, mold, pests (roaches, ants, etc.)
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​Pets and animals
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Firearms and visible weapons
How to Approach Home Safety & Environmental Concerns
Stay Calm & Trust Your Instincts
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First, take a deep breath and stay calm.
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Distinguish between feeling unsafe vs. uncomfortable—everyone’s sense of normal may be different.
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Approach clients with curiosity, not judgment, but trust your instincts.
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Use your observations as insight into your client's circumstances.
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In those cases, always follow your agency’s protocol or personal safety plan
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Privacy Issues & Managing Disruptions
Unlike office-based therapy, in-home sessions often come with privacy concerns and unexpected disruptions. These challenges can be particularly common early in the working relationship, before clear boundaries and expectations are established.
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Lack of a private space in the home to have a session.
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Family members walking in unexpectedly or sitting in on sessions.
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Distractions from phones, TV, video games, or household responsibilities.
How to Approach Privacy Issues & Disruptions to Session
Boundaries, Boundaries, Boundaries! ​
One of the most important skills to develop as a clinician in home is being comfortable with having tough conversations around boundaries! With the unpredicatability of in home settings it is important to:
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Identify your negotiable vs non-negiotable boundaries (e.g ask yourself what are you willing to be flexible while being in home)
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Establish boundaries early on!
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Be courageous, confident, and have the hard conversations if needed.
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Feel empowered to manage the environment as needed (e.g. asking for a place to talk privately, placing pets in another room, asking to turn off the TV)
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Cultural Norms & Home Practices
When working in home, you may encounter cultural norms that may differ from your own. These may include expectations around hospitality, physical space, and communication styles. It's important to view these as opportunities to build rapport, demonstrate respect, and practice cultural humility. Some examples are:
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Offering food or drinks as a sign of hospitality and respect.
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Hugging or cheek kisses as a customary greeting.
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Removing shoes before entering the home
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Greeting everyone in the room or acknowledging elders first as a sign of respect.
How to Approach Cultural Norms &
Home Practices
Navigate the Space with Care & Transparency​​
Practicing cultural humility doesn’t mean you have to accept things that make you uncomfortable, but it does mean communicating your boundaries transparently while being as flexible as possible. Here are some key strategies to navigate cultural practices professionally and respectfully.
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Ask questions instead of assuming (ex: “Would you like me to take my shoes off before entering?”)
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If you have to decline, express gratitude and appreciation (ex: “Thank you for offering! I just ate, so I’m not hungry, but I really appreciate your kindness.”
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Normalize differences without judgment – Differences in cultural practices are not “wrong” or “strange,” just different.
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Reflect on your own biases and reactions – Be mindful of where your personal discomfort comes from and how it might impact your responses.