13/05/2023
One of the unseen challenges in private practice is how to best look after ‘at risk’ clients.
In my specialist area (personality disorder), it’s very common to have clients who experience significant degrees of difficulty in regulating their emotions, such that they not infrequently resort to risky behaviours such as self-harm and overdosing in order to cope when feeling overwhelmed.
In preparing to take annual leave, a counsellor or therapist working within an organisation might raise a concern with their line manager and where it is deemed necessary, perhaps arrange for the client to be assigned to a colleague for the duration of the leave period in order to ensure a basic level of safety. Working in private practice, this is much more difficult to achieve for a variety of reasons.
Although I’ve been fortunate enough to avoid clients resorting to actual suicidal behaviour while on holiday, the last time I took a complete break from clients, three of them took such significant nosedives in their progression that it now makes more sense for me to avoid as much disruption to their therapy as possible, such that I will continue seeing those most at risk during a break. Obviously, this means seeing them remotely; for some it may mean reducing the frequency of session from twice to once a week, for others, it may mean a change of day, as I will normally arrange all sessions to take place on the same day in order to look after my own needs.
There’s a huge debate to be had here about the competing needs of client vs. therapist; dependency vs. self-regulation; boundary setting vs. progressive maturation.
What’s your view and how do you manage your riskiest client groups?
