Thanks to a recent email from a reader, I learned that there are some therapists in New York City who are making house calls. It seems as though you can simply book an appointment and, sure enough, your doorbell will ring at the prescribed time by your own personal therapist who will work with you from the comforts of your own home. Of course the costs of these sessions are slightly higher (read: significantly higher) but you don't need to worry about taxis, buses or even putting on shoes. You could probably have the session in your bathrobe if you insisted. However, while this arrangement seems like a therapeutic utopia on the surface, there is a problem.
In certain situations home visits are entirely justified. An enfeebled patient should not be denied services because they are housebound. And some people with crippling Panic Disorder with Agoraphobia* could be seen in their homes, at least until they have improved enough to come to the office. Aside from these and a few other possible exceptions, however, going to clients' domiciles for treatment is not in their best interests.
Although many shrinks like to view therapy as similar to traditional Western medicine, there is a fundamental and key difference. Generally speaking, formal medicine is a passive experience. You tell the doctor your symptoms and then he/she addresses it for you. You get the surgery done, you take the pills, and then you wait for results. The brunt of the work is done by the doctor or the procedure or the chemicals. Of course your outcome likely improves if you are an active participant in your health (e.g., eating well, exercising) but when you are ill medicine is something that is done to you.
Therapy, on the other hand, is ideally something you do for you. You do the majority of the work. There's no mistaking the connection between effort and outcome in the therapy world, and the more you want it the better off you will fare. Of course it's entirely possible to be inspired from your own home, but an active participant in therapy views the commute as part of the therapeutic process. I am going to my therapist's office to work on my problems. It is an active step that I choose to do to improve the quality of my life. I take time out of my schedule to make the trip there, engage in the treatment and then leave the office. If a therapist is coming to a client's house simply to cater to convenience, that professional is potentially removing a piece of the motivational pie from the client and, quite possibly, hindering a more positive outcome.
So why do these shrinks make house calls to people who don't require them? Like other businesses, it boils down to dollars and cents. A therapist who runs this type of practice can not only charge more money due to the unique service but probably can throw in fees for travel time and commuting fares. It's a niche that hasn't really been tapped into. However, that's because it's simply a bad idea. As discussed I don't have a problem with therapists making good coin, but you have to be a clinician first and a businessperson second. And when you compromise a client's treatment in even the most subtle ways to make more money, it's a huge mistake.
* Contrary to popular belief, Agoraphobia isn't really a fear of the outdoors, at least not in the shrink world. It's a fear of having a panic attack with no means of escaping to a safe environment. This often occurs when the idea of being in a crowded place or large open area is introduced.