Treating agoraphobia at home

Hello, I had a query regarding treating agoraphobia. If a patient is asking for therapy at home how would we go about this? Also, what would we need to say if there were waiting lists for treatment?

Generally, CBT for agoraphobia is not advised as a home-delivered treatment.

A patient receiving therapy at home runs the risk of having any core beliefs in remaining housebound being reinforced. Treatment at home also creates further dependence on the therapist for treatment. Additionally, a therapist cannot assess a patient’s motivation to attend treatment if they wish to remain at home.

Ideally, patients with agoraphobia need to see attendance to therapy as part of their overall treatment.

However, in certain circumstances, where the illness is agreed to be sufficiently severe initial sessions may take place at a patient’s home.

During these initial sessions collaborative goals are set around venturing outside of the house early in treatment. The psychologist and patient would create a hierarchy of aims with leaving the house as the initial steps.

As soon as a patient is able to leave their house they would be encouraged to continue with therapy at the psychologist’s office.

You will not have to address the resource issues such as long waiting list times in the MRCPsych CASC exam. In the CASC you are only expected to explain the gold standard treatments available.

In reality if a patient does have to wait for therapy it is useful to recommend self-help books and websites that they can use prior to starting treatment.