This workshop explores the intersection between risk assessment, the ethical framework, and clinical dilemmas therapists could potentially face when working with high-risk clients.

Dealing with complex clinical situations is an inevitable part of our practice as therapists in private practice. This includes predicting risk and acting upon the identified risk, in line with our ethical commitment to safeguarding vulnerable clients. Risk assessment is an integral part of our clinical practice as psychotherapists, irrespective of our theoretical orientation, or approach to therapy.

Although practising under the rubric of psychotherapy, following the set ethical frameworks (UKCP, BACP, NCPS), we do not have a standardised risk assessment tool that can be used across the board to consistently assess risk. Furthermore, there is no set threshold or guidelines on when one should react to risk behaviours, or suicidality in the consulting room. This means the therapist must rely on their clinical judgment, hold a delicate balance between action and inaction on risk, and bear the consequences of action or inaction. Not acting on potential risk could lead to unintended harm to clients, complaints or even death by suicide. Conversely, acting on risk could also be seen as a failure, depending on the context. 

The therapist's actions in their ethical duty of care when attending to risk could conflict with what is considered proper on paper. These gaps and tensions leave therapists in a very vulnerable position where their clinical judgments and their decision-making at any juncture could be subject to scrutiny and being considered as failing to sufficiently assess risk, failing to adhere to the ethical standards, and failing the client. 

Unlike other mental health professionals such as psychiatrists and psychologists, risk assessment is not a big part of our psychotherapy training, yet it is at the core of the work that we do. Risk assessment as a concept lies in the medical model, where the focus is on pathology and stopping people from dying. Our work is non-medical but psychosocial - meaning-making, reflective, sitting with despair, bearing, processing, working through, containment etc.

The way therapists assess risk, and the subsequent actions and decisions they make is dependent on many factors including their approach to therapy, relationship with the clients, their countertransference, subjective and objective risk assessment, and as well as their own level of competencies in assessing risk.

Since therapy is concerned with nurturing and alleviating human suffering and emotional distress, we are not always conscious of how highly litigious it is as a profession. The regulatory bodies have the duty to protect the public, which means in the event of complaints being made by clients, or if there is unintended harm to the client, or therapists not robustly attending to the risk, therapists are left in a very vulnerable position where they must justify their decision making, and how it aligns with the set ethical framework.

Complaints about therapists' perceived failures in assessing risk are viewed through a legalistic lens. The way legal professionals interpret the ethical framework is different to how therapists do, which again creates a conflict of interest.

This workshop will help you reflect on your practice and gain an appreciation of how risk assessment is embedded in our day-to-day practice, and how you can navigate potential tensions between set ethical guidelines when managing risk.