Research on Counselor and Client Safety

Inhalt

Abstract

Research on Counselor and Client Safety

Research on Counselor Safety

Research on Client Safety

Key Elements of Risk

Managing Risks

References

Abstract

There can be several issues that present themselves while involved in a crisis situation. One of the major concerns is that of safety, for both the client and the therapist. Literature has provided us with a mecca of information regarding what research, if any, has been done on best practice for maintaining safety in a precrisis and crisis situation.

Research on Counselor and Client Safety

In sifting through the literature reviews on both therapist and client safety procedures, ethics, and standards, there appeared to be common traits. In all the articles referenced, the authors note that research and development into the study of just what is best practice for safety, primarily when faced with a pre-crisis or crisis situation, is surprisingly little. The referenced articles also found that the subject has been minimized in therapist training. With the emergence of emphasis being based on multi culturism and diversity, the issue of safety has been surpassed. This shift in focus during training and practice has led research teams to begin to develop new frameworks and concepts for teaching new therapists and therapists in training to prepare for crisis, while ensuring their own- and that of the client’s- safety.

Research on Counselor Safety

The articles on client safety and therapist safety had a common theme. This theme is that they included details on both client and therapist safety. In an article by Hipple & Beamish (2007), the authors place a focus on the importance of supervision while providing therapy- especially in a crisis situation. The article states that the clients that arrive in crisis “are often experiencing a multiplicity of problems and at times are overwhelmed.” (p. 2). Therefore it is important to be ready to face the needs that exist for a crisis client.

The article points out that the therapist needs to have a working knowledge on the specific state laws that involve the notions on involuntary commitment as well as their duty to warn. The therapist should also be aware of center agency and state specific ethical codes, back up procedures, how to report safety concerns, assessment tools and checklists to determine level of support needed, and the agencies formal crisis policies (p. 2).

The article by Hipple & Beamish also mention ways that a therapist, particularly one who is still in training, should follow certain linear steps when dealing with a client in crisis. Some of the steps include but are not limited to: formally assess the client for risk of self-harm and/or harm to other, including homicidal and/or suicidal tendencies, gain informed consent from the client, and attempt to deescalate.

McAdams and Keener (2008) published an article in the Journal of Counseling and Development. The article focused on both client and therapist safety. The article also provided a working framework for reducing client violence and client suicide. The authors state that the therapist needs to have “mandatory responsibilities” (p. 389) that pertains to client and therapist safety. Responsibilities include: learning to see a crisis coming- knowing the signs by either observation or formal assessment, or both. Learning company procedures can inevitably keep the therapist from harm by understanding simple precautionary measures designed and set in place by the agency they work for. The therapist should also know their own limits. If the therapist feels unsure, incompetent or unable to handle a crisis situation, they need to call in for assistance (p. 390).

As a therapist, keeping oneself safe in a sometimes volatile crisis situation involves many components. First, the therapist needs to understand and obey by the working state and agency laws and ethical codes that are provided involving consent, confidentiality and involuntary commitment. The therapist should learn to recognize the signs of risk for a crisis with a client. This includes knowing how to observe and assess for dangers. The therapist should also enable a support team that can be called upon if needed to help in an escalated situation.

Research on Client Safety

In an article by Short et al (2008) published in the Journal of Psychiatric Services, the authors give several techniques and methods for safety procedures in a crisis situation. The article includes a list of “do’s and don’ts” for giving a client bad news (p. 1377). The list was designed to help minimize the risk for harm to clients, particularly inpatient. The authors suggest that therapists need to be aware of the surroundings. The client and therapist should be in an area that allows them to be visible to others. The guidelines presented also include how to assess the environment and remove objects that may become a weapon or tool to inflict self-harm for a client. Strategies are discussed on how to learn and follow safety procedures on giving emergency medications, removing a client from the situation, calling for backup, and allowing team members to take over (p. 1377).

Another way that therapists can help reduce the risk of harm to a client, especially when in a crisis situation is to simply minimize the potential. In an article by O’Donahue and Engle (2013), the authors describe that the occurrence of risk to client safety is a “consequence of poorly intentioned or compromised practitioners” (p. 315). O’Donahue and Engle state that if safety is violated it is due to diagnostic errors, errors in practicing or level of care, and/or administering errors (p. 316). By simply minimizing the actual risk for safety issues, then it is not compromised. The authors give examples of how to reduce risk in clinical settings, including follow through such as creating safety plans for clients.

By learning to reduce client safety concerns before they happen, understanding the environment and context of the crisis situation, allowing support systems to intervene, knowing basic strategy and procedure and giving careful considerations to diagnostics, potential risks and assessments, the therapist can help become an asset when securing the client’s safety.

Key Elements of Risk

In summary, the literature presented many key elements to risk. One major theme across all articles was minimizing the risk by careful observation and assessments. Overall, it was explained that therapists have the responsibility to understand and follow procedures and guidelines when it comes to clients in a crisis situation. The mention of proper training and supervision is another theme throughout all the articles. Client and therapist safety can be an issue in a crisis situation, however, understanding protocol, reducing diagnostic errors, and assessing the client for risk can help reduce the compromising of safety.

For example, a client has arrived at the therapist’s office in a state of crisis. They disclose to the therapist that they lost their job, only two weeks after their wife left them. In previous sessions, the client has disclosed that he has had some suicidal thoughts. The therapist can try to establish consent of information from the client, letting him know that if he discloses anything that may violate his safety or others they must report it. The therapist should then follow procedures of the agency and state, including assessment for suicide risk. James & Gilliland (2013) give several examples of various assessment tools available for use in this crisis, including clinical interviews, SAD PERSONS and BASIC. If the therapist feels beyond the scope of their competence, supervision should be called in. if the client begins to get hysterical, has a psychotic break or becomes violent, then the therapist should follow procedures including recommending psychiatric evaluation.

Managing Risks

In all the articles the authors provide frameworks for reducing and minimizing risks to client and therapist safety. Little research has actually been done as to the effect of de-escalation techniques and therefore little empirical evidence is provided. It has been noted that what evidence based research has been done, has shown that by reducing errors, noticing signs of risk before it happens and having proper training and knowledge can all lead to less compromised safety for both client and therapist. According to James and Gilliland, crisis intervention such as telephone suicide hotlines has been proven to be an effective intervention in controlled studies and meta-analysis.

References

Hipple, J. & Beamish, P. (2007). Supervision of counselor trainees with clients in crisis. Journal of Professional Counseling, Practice, Theory and Research. 35(2). 1-7.

James, R. & Gilliland, B. (2013). Crisis Intervention Strategies. Belmont, CA: Brooks/Cole: Cengage.

McAdams, C. & Keener, H. (2008). Preparation, action, recovery: A conceptual framework for counselor preparation and response in client crisis. Journal of Counseling and Development. 86(4). 388-398.

O’Donahue, W. & Engle, J. (2013). Errors in psychological practice: Devising a system to improve client safety and well-being. Journal of Professional Phycology: Research and Practice. 44(5). 314-323.

Short, R., Sherman, M., Raia, J., Bumgardner, C., Chambers, V. (2008). Best practices: Safety guidelines for injury free management of psychiatric inpatients in precrisis and crisis situations. Journal of Psychiatric Services. 59(12). 1376-1380.