Risk Management:
Psychiatrists and Psychologists: Protect Thyself
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Consider now your own professional integrity and personal safety as a therapist or clinician, often working one-on-one with clients. All of us have (or had) a client or two that gives us pause as we weave the fabric of the therapeutic relationship: clients with a smattering of histrionics, grandiosity, delusions, or overactive sexual fantasies that may complicate the therapeutic alliance. A client’s inappropriate interest in the therapist that threatens to violate professional boundaries is not uncommon. Disgruntled clients or clients who perceive they have been rebuffed may become vengeful, lobbing allegations of sexual impropriety or unethical behavior your way. How do you protect yourself?
Be proactive. Anticipate scenarios with a potential for risk and prepare your response.
Consider the following as it applies to:
Your office
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What obstructions stand between you and the door out of your office? Since our basic instinct is fight or flight, and we don’t want to engage our clients in an altercation, can you exit your office quickly in a moment of personal danger?
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Is a panic button or other security system installed in your office (near your desk or near the chair in which you sit during sessions)? Is there a maintenance plan for routine testing of these devices to make certain they work?
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Do you have a walkie-talkie or cell phone with a pre-programmed emergency contact phone number to alert building security or local law enforcement in the event of sudden danger?
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Have you developed a rapport with local law enforcement and do you maintain some kind of routine communication with these folks so they know who you are, where you are located, what you do, and will waste no time in responding to a distress call?
Your facility or building
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Are building security personnel present and visible and do they patrol the premises often?
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Are closed circuit cameras installed and functional for stairwells, hallways, elevators and reception areas?
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Are the parking lots equipped with sufficient lighting and security presence or observation, such as closed-circuit cameras, etc.?
Your staff and associates
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Are you trained to recognize the various stages of aggression (that is, you are able to identify and define them) and know how you will respond to each? Steve Wilder of Sorensen, Wilder & Associates in Illinois developed “The Aggression Continuum: Six Steps from Calm to Violent” using a ladder to conceptualize the steps leading to a dangerous, unsafe top step. Know the steps in which the individual is:
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calm (non-threatening)
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verbally agitated (anger, not directed toward anyone specific)
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verbally hostile (similar to Step Two, but longer-lasting)
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verbally threatening (anger focused on specific people, demand is for action and consequences will follow if demands are not met)
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physically threatening (looking for potential weapons, moves aggressively toward you)
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physically violent (attack is made on you in some form).
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The appropriate response to each step identified above correlates as follows:
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respect the person’s dignity, listen to his/her concerns, be compassionate
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listen, respect the person; preserve the person’s self-esteem, do not give orders
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maintain non-threatening body posture, respect his/her “personal zone”, allow him/her to vent anger and keep your instructions minimal
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maintain eye contact (avoid a “stare-down”), avoid cornering, give the person options, but anticipate violence.
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know this is “the critical point” … maintain defensive posture, anticipate physical attack.
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self-defense or survival mode (extricate yourself from the danger).
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Do you rehearse threatening scenarios with other therapists/clinicians/doctors in your practice or on your floor to better prepare yourself to respond to scenarios with a potential for danger?