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date: 13 November 2019

Abstract and Keywords

Interactions between patients and therapists outside the walls of the office include different forms, for example, home treatment, outdoor or adventure therapy, and clinical interventions not possible in the office such as in vivo desensitization in the treatment of phobias. Such interactions pose particular ethical questions pertaining to confidentiality, time, location, flexibility, complexity, unpredictability, and safety considerations. Furthermore, they raise complex issues in regard to the standard of care, the acceptability of such intervention and its legitimacy as a reimbursable medical procedure. Professional organizations’ codes of ethics neither specifically mention out-of-office experiences nor state that they are unethical. It is argued that clinically driven, out-of-office interventions with the patient’s welfare in mind are clearly within the standard of care, and are neither unethical per se nor lead to exploitation or harm. Sometimes, not leaving the office can even be unethical as it deprives patients of the best possible care.

Keywords: home treatment, home-based therapy, in-home therapy, out-of-office treatment, outdoor therapy, adventure therapy, equine therapy, informed consent, ethics, harm

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