Supported and challenged in supervision and in therapy, I was helped to identify the warning signs and to think about why I had ignored them. The experience has stayed with me and forced me to pay attention to therapists’ psychological and physical well-being and safety in a variety of settings.

Beginnings and endings 

Though you might not like to even think about this, engaging with a client is in fact fraught with risk. Whether you work in a team environment or in a more isolated setting, the risks are both psychological and physical.

Because of the nature of the work, and the settings in which it takes place, practitioners are often alone with a client whose level of disturbance is not necessarily known at the outset, leaving the therapist open to the possibility of being subjected to physically or psychologically aggressive behaviour. The first meeting with a client can be one of the two most vulnerable times for therapists. With Mr Ellis, my psychological boundaries (specifically my capacity to think, and therefore to respond ethically) were in danger.

The other most vulnerable time is the ending phase. Disturbed client behaviours associated with attachment disorders are significantly linked with the ending stage of therapy. I knew at the time that ending with Mr Ellis and referring him on to a more suitable setting could precipitate stalking behaviour, or alternatively a vengeful complaint.

To minimise the risks of stalking, cyber bullying and harassment, protect your privacy if you use new social and business media (Twitter, Facebook, LinkedIn) . There is more information about online security at www.staysafeonline.org

The physical environment

The setting poses extra risks for those who do home visits, who work in the evenings or in remote locations, unchaperoned at home (my setting 20 years ago) or in a rented room (perhaps in shared premises). Therapists need to ask themselves (and if applicable, their organisation) “What are the risks to me if I work alone in these settings? And how can I mitigate the risks?”

Inside the consulting room, think about where you sit in relation to exits, and also about the security of significant personal possessions, especially those which contain any identifying details. Outside the consulting room, pay attention to your safety especially in the dark (eg parking areas).

In my experience, the value of personal alarm systems is limited . If you use one, do you know how it works, what would happen if you activated it, how others might be alerted and who would respond?

Some therapists prefer to use a buddy system when working in vulnerable situations, making a pre-arranged phone call or text to the buddy when the session is over. However, this also requires the responder to be trained to know exactly what to do if the expected message is not received.

There is more information about lone working at www.suzylamplugh.org

Referral routes and assessment

Some referral routes are “safer” than others. A form of screening may be offered when a client comes through a known network. Mr Ellis claimed to come through a known network, but was evasive when pressed for details.

A self referral by email or through a website offers no prior screening, so should be followed by a phone conversation. This phone conversation acts as a preliminary assessment, giving the therapist an opportunity to pay attention to their first impressions and feelings, and to bear in mind warning signs. A client who is not straightforward on the phone may be flagging up warning signs. Mr Ellis was not straightforward.

Not all traditions approve of a formal assessment. However, starting a case without one “often leads to unpleasant surprises” . And assessment should continue throughout the therapy.

Your assessment may lead to a decision not to work with the client. I did not continue to work with Mr Ellis. With some difficulty I managed to refer him on to a more suitable setting .

The therapist’s psychological vulnerability and threats to well-being

Why did I ignore the warning signs when I first spoke to Mr Ellis on the phone? One partial explanation is that I was anxious about establishing a private practice in a new area. In addition, although I was just about aware that he was manipulating me, my ability to think was paralysed by the force of his projected material.

Looking back, I can see that I fell for his flattery, and I didn’t want to feel a failure. Ten years later I came to understand that he had ticked all my boxes: from childhood, I was primed for certain roles – denying my own needs, trying to love people better, and being required to meet another’s excessive expectations. I was used to receiving projections (and being manipulated) and I expected to be able to help everybody. I was lucky to disentangle myself without harm to me or the client, and I was helped by therapy and supervision to avoid some of these traps after that.

The work can be immensely satisfying and rewarding. But if you are working most of the time with people who are in difficulty, and with abuse, neglect, violence and trauma, it is vital to monitor and safeguard your well-being, taking active steps to prevent secondary trauma (burnout, compassion fatigue).

Some organisational pressures – and why safety is sometimes ignored

In the current insecure and competitive job market, both qualified and new therapists may hesitate to identify or report risk issues. In hard economic times, organisations may deny the problem, locate it elsewhere, or argue that bringing the problem out into the open will jeopardise the organisation’s own survival .

In conclusion, do not sweep your hunches, feelings and needs under the carpet. Recognise what ticks your boxes, and safeguard your physical and psychological well-being.