Risk Management: 
Psychiatrists and Psychologists: Protect Thyself
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• Do you videotape the rehearsal so you have something tangible to critique your “performance?”  Remember how helpful it was in graduate or medical school to videotape practice sessions with classmates to simulate client-therapist sessions?  It’s still a worthwhile technique in your professional life. Get out your camera and start recording
• Do you rehearse your lines and know what you will say and practice saying it in a way that affirms your composure while maintaining a modicum of authority (control) of the situation
• Do you have a de-briefing protocol in place to conduct a form of “root causes analysis” of a recent client-initiated event that may predispose him/her, you, your staff and/or other clients to danger? 

Your clients & Your Professional Reputation

• Who are the clients who may be predisposed to accuse you, the clinician, of conduct unbecoming a behavioral health professional?  Identified earlier are those clients who present with issues involving histrionic or attention-seeking behaviors, those with sexual fantasies and addictions, those with paranoid features or tendencies, borderline personalities, etc. These are the folks who are more likely to level allegations of inappropriate behaviors (touching, other forms of physical contact, provocative conversation, hand and other gestures, suggestive body language, eye contact/glances, etc.).  How do you avoid these potentially volatile situations?
• It’s easy to say, “let common sense be your guide.”  But the reality is that schedules, deadlines, personal obligations, distractions, and stress all conspire to divert us from our common sense perspective.  But for those few clients who may present us with a problem at some point in the future, consider some of the following options:
  
  1. Do you schedule a client with the potential to suggest unprofessional conduct as a last appointment of the evening?  Might it be prudent to schedule such clients when you know there will be other therapists or administrative personnel around and in close proximity to your office?
  2. Is this client’s treatment plan conducive to involving a family member, spouse, or close friend (so there is a third party present during the session, assuming you have obtained previously the client’s permission)?
  3. Are you able to consider audio or video taping the session(s) … again, with the client’s permission.    Do you make it your practice to personally review taped sessions periodically for self-evaluation?  If so, routine taping of sessions may be helpful.
  4. Are you able to refer the client to another therapist with similar training and experience as yours, but is of the same sex as the client, to minimize the potential for allegations of sexual impropriety on the part of the clinician?
• As always, documentation is your best friend and your best defense against allegations of unprofessional conduct.  Be sure to objectively document a client’s inappropriate behaviors, thoughts and conversations with you.
• And finally … what about gifts and invitations from your clients?  Does your facility or practice have a policy to respond to such invitations and gifts?
• Certainly no therapist wants to squelch a client’s demonstration of appropriate regard or appreciation for the behavioral health clinician.  Does your policy provide that edible gifts, such as candy, cake, etc. be shared with everyone on staff (said treats are placed at the receptionist desk or in the staff break room)?  For other gifts, does a policy provide that you return the gift or suggest that the client donate the gift to a local charity?  Make a note of these gifts and invitations in the record and the disposition of each to refresh your memory at a later date should a question arise.

With a bit of forethought and pre-planning, you may equip yourself to better avoid or more effectively handle the challenges to your professional integrity and personal safety that are certain to arise occasionally in your career.