Psychologists are increasingly delivering or supervising services in the homes or residences of their clients. However, the very process of delivering home-based services creates challenges to the psychologist-patient relationship and an opportunity for clients to challenge the boundaries in ways that would not ordinarily occur in office-based services. Supervisees or inexperienced psychologists may be unprepared for the boundary challenges that could occur. This article reviews those challenges to professional boundaries and makes recommendations to ensure the quality of psychological services delivered in those settings.

Psychologists have always provided services in institutional settings such as state hospitals or residential facilities. However, psychologists may also deliver services in the homes or milieu of clients through programs such as home-based services for children, multisystemic therapy for juvenile offenders, consultations with athletes, or in-home therapy with older adults (Andersen, Van Raalte, & Brewer, 2001; Henggeler, Schoenwald, Rowland, & Cunningham, 2002; Slattery & Knapp, 2003; VanDenBerg & Grealish, 1996). In addition, psychologists may supervise entry-level professionals or paraprofessionals who treat or evaluate clients in their homes. Some programs require or permit the delivery of intensive services. For example, a court settlement in Pennsylvania requires that state's medical assistance program to pay for intense home-based services for qualified children with serious and pervasive disorders, especially if necessary to prevent a hospitalization or a more restrictive residential placement ( Outpatient Psychiatric Services, 1994).

Psychologists delivering services in these settings may encounter a number of ethical challenges, especially in terms of managing professional boundaries. This article reviews the unique challenges to professional boundaries that may occur when services are being delivered within the homes or natural environments of clients. Recommendations are made for how psychologists can prevent or minimize boundary problems.

Therapeutic boundaries derive from the rules of the professional relationship that distinguish it from business or social relationships. These rules clarify which behaviors are acceptable in therapy, although the same behaviors might be acceptable or...