In-home intervention with families in distress: changing places to promote change

This article examines the benefits of in-home family therapy with severely distressed families through the analysis of four cases that demonstrate the creative use of this intervention with families whose children were placed in a full-time day care facility. Although the efficacy of home intervention with distressed families has been documented, the case illustrations here analyze the process more fully--the how and the why it works. The first three cases explicate the contribution of home intervention to the engagement of social worker and client. Each case highlights how home intervention enhances the therapeutic alliance by promoting change from a different starting point--the client (home as a secure base for change), the worker (viewing the client from a different perspective), and the client-worker interaction (power sharing in setting boundaries). The fourth case (in vivo narrative reconstruction) serves as a striking example of how the home--as a multisystemic, intergenerational container of the family's past, present, and future--can be enlisted as a partner in reconstructing silenced chapters of the family narrative.