Risk in private practice

Risk management for therapists is a complex and, yes, risky business.

If you go on a risk management course, you may be told to reveal absolutely nothing about yourself, not to accept a small Christmas gift, not to meet clients outside your office….

As therapists, we can become so stifled by the things we think we can’t do that we become indecisive, fearful of our own professional judgement, and worried at every turn about being sued.

In our opinion, good risk management for the private practitioner is not about creating a list of what you can and can’t do. It shouldn’t be based on fear, but on sound clinical and ethical judgement.

Here’s our definition of risk management:

Risk management is the practice of minimising risk to your clients, yourself and others, whilst maintaining high levels of patient care.

Some examples of good risk management for the private practitioner:

1. Do what it takes to help your clients, but make sure you treat them with respect, do them no harm and avoid conflicts of interest.

2. Provide a safe and comfortable environment for your clients and yourself. Carry out a risk analysis of your premises, to identify potential hazards. Establish what would happen in an emergency, for example if there was a fire – are there clear exits?

3. Treat your clients with the utmost confidentiality: keep their records in a secure place (both hard copies and electronically) and never share their details with others unless you have their explicit permission to do so. At the start of therapy, you should make any limitations to confidentiality clear in writing.

4. Always practice according to the law and the ethical guidelines of your professional associations. Keep your skills and knowledge up-to-date with Continuing Professional Development (CPD).

5. Carry out an initial assessment of every client to determine their problem(s), any previous instances of harm to themselves or others and the objectives of your treatment. Always ask for the details of their GP and any medication they are taking before treatment.

6. Keep good records of treatment plans, consultations, consents, correspondence, any referrals to medical practitioners and termination of treatment.

7. Practice within the limits of your expertise, and seek advice from qualified and experienced professionals. Refer your client to a suitable professional if necessary.

8. Be careful about crossing boundaries, but don’t apply strict rules against them. These may include touching or hugging your client, making home visits, accepting gifts, and disclosing personal information.

9. Appoint a therapeutic executor to make sure that your clients are looked after in the event of the sudden closure of your private practice due to death or illness.

10. Carry professional indemnity – it is there to protect you and your clients.

Take action

Read the following articles about risk:

Keeping your clients safe

Risk management for clients can mean many different things. Psychotherapists or counsellors need to think about the risk of self-harm or suicide. Other practitioners may be concerned about the risk of injury to their client, either due to an accident on their premises or associated with the treatment itself. Risk management also refers to important issues such as client confidentiality.

Taking care of yourself

It’s important, as a private practitioner, to take steps to reduce the risk to yourself. This article focuses mainly on the potential physical risks posed by clients, but also discusses the emotional and professional risks faced by private practitioners.

The therapeutic executor

What would happen to your private practice, and your clients, if the practice had to be closed due to death or serious illness? Every private practitioner should appoint a therapeutic executor and have the right plans in place.

Useful downloads

Exclusive members of the Private Practice Hub can download some useful documents about risk assessment, lone workers and home visits.