Risks in Psychotherapy Practice

 1.0      Introduction

While caring for the needs of other clients, psychotherapists are exposed to several risks, especially due to burnout and fatigue in the process. By its nature, psychotherapy is supposed to be an exercise where one counsels and guides through sometimes long-term illness,, es and to a certain extent, some patients will never fully recover. Thus, there is emotional investment needed in this type of work, and as such, they are exposed to potential losses while executing their obligations. Risks involved vary from social, psychological, to relational aspects. The essay expounds these risks and presents a balanced view on the need for insurance.

2.0      Risks in psychotherapy

Psychotherapy involves understanding and committing to helping reduce emotional pain that clients may have. This is often a long-term process given that the nature of the job involves talking with clients with rarely, if any, physical intervention. Clients usually have a wide array of problems, such as depression, trauma, anxiety, and stress, among others. Dealing with these problems involves involve development of relationships with clients to create a trust that is much needed in the therapy process. The end goal of this is therapeutic healing that is needed, but certain unlikely outcomes may happen to the therapist and may lead to potential loss. According to Gill and Crenshaw (Termination Challenges in Child Psychotherapy, 2016), there is a special challenge when dealing with young people when sharing thoughts and feelings; they tend to be “unpredictable and inconsistent”. Madden (Legal Issues in Social Work, Counseling, and Mental Health: Guidelines fr, 1988) further explained that this behaviour points to the risk that psychotherapists undergo, especially in the long run when faced with dilemmas. This refers to the point where the therapist decides regarding confidentiality, which in both cases may result in either harming a client or the potential failure of the procedure. Therapists may be sued, or worse, clients with suicidal tendencies may harm themselves, and therapists left to bear the results of a failed intervention. In such cases, there is a need for a lawyer to cover costs that may be associated with clients or other litigants.

3.0      Burnout Risks

One of the roles of therapists is to offer hope to patients and give them reason to live, when patients themselves are committed to ending it. Walfish, Barnet, and Zimmerman (2017) explained that therapists do not often end this desire, but they are supposed to help patients manage these challenges. In cases where patients fail to take this responsibility, therapists are often blamed for the resulting events. Willer (2013) argued that therapists may face overwhelming emotions in such events to extents that affect their work. They may themselves need professional services of other therapists, which may be costly. Such losses can cause trauma if therapists are not well prepared. Some of the effects on them may include alcohol abuse, overeating, overspending, or overworking. Therapists are humans, and they are liable to such cases at some points in their lives. Those needing professional care may need to be insured to cover medical expenses, especially given that they would not be able to work and deliver effectively. The decision to seek insurance is well-advised for different people, depending on their tolerance. Koocher and Keith-Spiegel (2008) added that psychotherapists, though they offer help to others, do need help from their peers as well. They do not have the lowest divorce rates, and in any case, they face even tougher challenges due to an emotionally draining career that may affect their relationships. This explains reasons such professionals need to be indemnified with good insurance coverage.

4.0      Confidential information

Release of confidential information is a common cause for litigation, given the seriousness of issues related to privacy and confidentiality. Sometimes, it would be necessary for that to be done, but where it is found illegal, therapists are liable to meet costs in case they are sued by clients. In normal cases, according to the American Psychological Association (APA) (2017), information may be released if there is a court order or in other cases where the life and health of a client or their associations are affected. In the UK, there are limits to confidentiality if there are grounds that permit such. Tribe and Morrissey (2015) noted that there are limits to what information can be shared if there is a common good. Even in such cases, clients would still pursue legal processes if they felt their rights to privacy and confidentiality were violated by their therapists.

5.0      Personal attacks

Reeves (2010) clarified several risks that can result in losses that psychotherapists can suffer from due to constant exposure to them. Situational risks, one of the classes involved the potential of suicide by client, self-injury and self-harm, safeguarding, the need to protect children, violence to others, and terrorist threats. Clients suffer from illnesses where they can attack counsellors, offering them lessons. These may seem like isolated cases, but continued exposure to such cases may cause physical and emotional injury. These may need counselling from other psychotherapists or physicians. Without indemnity, continued exposure may drain the resources of psychotherapists, which may make it impossible to carry out their duties. However, insurance may not be the only solution that psychotherapists need to handle their duties. They need to be trained on risks to expect such self-care, the possibility of burnout, vicarious traumas, and the use of personal material in work that involves considerable. Personal risks that affect family relationships may be costly to psychotherapists and may not be indemnified. Thus, where possible, there is a need for counsellors to be prepared and indemnified to minimise the potential of incurring such personal risks.

One of the insurance providers in the UK, Blackfriars Group (Blackfriars Group, 2017), explained that psychotherapists need to be indemnified because of the level of risk that their duties and losses that are likely to be incurred. According to the provider, when things go wrong and the litigious nature of the world, their professionalism is even more exposed if they are not indemnified. The main aim of insurance is to cover them in the event of an unintended breach of contract professional’s failure to discharge their duties. They often have an unpredictable job environment with clients having expectations that may not always be possible.

6.0      Misunderstood relationships with clients

Personal involvement of psychotherapists in affairs of clients may sometimes go to the extent that they may get sued when things do not go in the direction anticipated by clients. As was noted, different clients may have different expectations, some of which may involve psychologists directly. Clients seek help, but in the process, they sometimes fail to distinguish the personal life of the person offering them professional help. For example, Savill (2009) noted a case where a client sued a psychologist for ending a two-year relationship with her. While discharging his duties, the client allegedly fell for the psychologist. It is not possible to meet all clients’ needs, as in this case, where a client felt her lover was unrequited and was taken advantage of due to her condition. Clients failing to distinguish professional job and the personal life of psychotherapists leave the latter exposed to litigations that may be costly in time and cost to respond to them. Such cases need lawyers to protect their psychotherapist clients, but these services are not cheap. These costs are expected and as such, they need to be indemnified with an appropriate insurance in sufficient amounts, depending on their levels of exposure.

Sometimes, the relationship between clients and therapists takes such a long time that they get involved in personal affairs with clients. Such was the case, as Luck (2014) explains, ned where after seven years of therapy, a client developed a relationship with a counsellor, though this was later found by The British Association for Counselling and Psychotherapy (BACP) to have been a case of professional misconduct. The emotional state of the client was taken advantage of and abused, and unprofessional approaches were used. While such cases point to a poorly regulated field of practice in the UK, there are a lot of other cases where clients see therapists as unhelpful and demand a refund or compensation for failed medical intervention. This is because there is no standard condition agreed on for how a recovered mental state should be assessed. Dealing with different clients with unique expectations implies that one cannot predict how it would end, and when a case would be lodged against them. It could be several years after care was discharged. Jenkins (Legal Issues in Counselling & Psychotherapy, 2002) added that therapists work in a highly unpredictable legal environment where they are vulnerable to “legal challenges in the future”.

7.0      Defamatory losses

Psychotherapists are likely to suffer defamatory cases from clients who feel aggrieved by the service improperly discharged. Such cases may cause them to lose business and associated income from customers who shy away from the same. In this case, insurance will be useful to provide income for the business. Sometimes, clients could demand to be reimbursed and any losses suffered be paid by therapists. Where courts find a substantial claim and award claimants any damages suffered, insurance companies would be handy to meet these needs. Insurance companies are useful in such a case, especially given that there is no way of predicting which client, when,n, andon what grounds they would use to sue therapists they associated with for purposes of providing needed care.

8.0      Self-harm and litigations

Where a client is harmed while undergoing therapy sessions, the therapist is often blamed for negligence and can be sued in such cases. According to Hiscock and Lovett (2008), there is a need for insurance in case a client is harmed during treatment or unintended harm is inflicted on themselves. Therapists offering care to mentally ill people cannot predict how a client would respond to treatment. Where a life is lost or significant harm is caused, patients’ relatives can seek compensation and further action through legal means. Such suits can result in loss of time and financial stress to professional therapists unless they are indemnified against such losses.

In worst cases, therapists sometimes face potential harm from patients themselves. As was explained, some of the patients are mentally ill, and wrong judgment can mean they face the wrath of the other patients. Squires (2017) narrated a case where a patient opened fire on his therapist and his family and injuring them. It is not common for patients to harm the people trying to help them, but in the same vein, it is not known why those who do attack them. However, this is a possibility that therapists face, and they need to be insured against the chances of them suffering losses from such incidents. Anderson and West. (2011) emphasised that violence against healthcare professionals is not uncommon, and sometimes, assaults can result in injuries and other medical expenses. Though it is said to be less common, in the event a psychiatric patient attacks and sometimes stalks their therapists can affect emotional and physical health. There is a need for psychiatrists and other therapists to stay safe, avoid working alone with mentally unstable patients. Homlitas (2011) noted that cases of patients attacking care providers, including nurses, are common, and in the majority of cases, therapists did not believe they would be attacked. There is often less concern for training for such eventualities, and as a result, they are least prepared and likely to bear losses from patients. Kaptan (2008) observed that the nature of the work environment for psychiatrists, as their clients sometimes make good of their threats and kill or attempt to kill them. Each case is unique and needs to be assessed individually. To be safe, psychologists are advised to do background studies of clients on issues of past arrests, antisocial behaviour, evidence of drug abuse, past violence, among others.

9.0      Conclusion

The essay discussed the nature of the work of psychotherapists and the implications of various risks posed by it. Therapists are involved in a highly volatile and litigious environment due nature of the clients they handle and the unpredictability of the outcome of their work. These imply various costs that therapists may suffer in losses if they are not insured. Therapists can be sued for disclosing client information, failing to meet the expectations of clients, sometimes several years after treatment was rendered, or the client pulling out and demanding compensation. Cases of burnout and possible stress affecting themselves were explained, and insurance cover was justified to minimise costs likely to impact therapists owing to their professional duty. Training and caution were noted as possible prevention techniques to avoid losses, especially those resulting from physical attacks by clients.

10.0  References

Anderson, A., & West, S. G. (2011). Violence Against Mental Health Professionals: When the Treater Becomes the Victim. Innov Clin Neurosci, 8(3), Innov Clin Neurosci34-39.

APA. (2017). Will the things I discuss in therapy be kept private? 

Blackfriars Group. (2017). Psychotherapists’ Professional Indemnity Insurance.

Gil, E., & Crenshaw, D. A. (2016). Termination Challenges in Child Psychotherapy. New York: Guilford Publications.

Hiscock, J., & Lovett, F. (2008). Level 2 Beauty Therapy. Oxford: Heinemann.

Homlitas, M. M. (2011). Client-perpetrated violence against student clinicians: A survey of directors of clinical training at APA-accredited clinical, counseling, and school.

Jenkins, P. (Ed.). (2002). Legal Issues in Counselling & Psychotherapy. London: SAGE.

Kaplan, A. (2008, October 1). Violent Attacks by Patients: Prevention and Self-Protection. Retrieved from Psychiatric Times.

Koocher, G. P., & Keith-Spiegel, P. (2008). Ethics in Psychology and the Mental Health Professions: Standards and Cases. Oxford: Oxford University Press.

Luck, A. (2014). Struck off and shamed… so why is ga roping psychotherapist still free to treat women today?: Victims said they were asked to undress, but a lack of regulation means firms found to be ‘abusing trust’ keep operating.

Madden, R. G. (1988). Legal Issues in Social Work, Counseling, and Mental Health: Guidelines for. London: SAGE.

Reeves, A. (2010). Working with Risk in Counselling and Psychotherapy. London: SAGE.

Savill, R. (2009). Former client sues psychologist after he ended their two-year affair.

Squires, S. (2017, September 23). When Patients Turn on Their Therapists : Violence: Attacks against those in the health professions alarm the industry. Psychiatrists have formed a task force to deal with the problem. 

Tribe, R., & Morrissey, J. (Eds.). (2015). Handbook of Professional and Ethical Practice for Psychologists, Counsellors. New York: Routledge.

Walfish, S., Barnett, J. E., & Zimmerman, J. (2017). Handbook of Private Practice: Keys to Success for Mental Health Practitioners. Oxford: Oxford University Press.

Willer, J. (2013). The Beginning Psychotherapist’s Companion. OUP: Oxford.