Why You Shouldn’t Be Afraid of Managing Risk in Private Practice

Risk exists, but I know you can handle it. Resource - Client Risk Assessment, Checklist & Support Plan Template below

Are you worried about managing risk in your private practice? You’re not alone. In a 2019 survey by Therapy Today, 45% of therapists in private practice said managing risk alone was one of their top three concerns. I get it.

• Resource Below - Copy and paste the Risk Assessment & Support Plan Template I use in my private practice

Without the organisational framework of the NHS, managing clinical risk can feel daunting. What do you do if a client is suicidal or in crisis, especially without the immediate support of a team? You fear ‘getting it wrong’ and feel uncertain about what policies or procedures to follow. Risk feels like a liability rather than part of your therapeutic work.

What I Want You to Know About Managing Risk

The vast majority of therapists in private practice do not encounter high-risk or emergency situations regularly. Research and professional experience suggest serious incidents like suicide or violence are extremely rare in private practice, particularly when therapists are well-trained and follow ethical guidelines.

This is reassuring, but risk exists. The good news is you already have the skills you need. Assessing, holding risk in mind, and managing collaboratively is part of your core training.

In private practice, it’s not about having all the answers. It’s about having a plan. You may work independently, but this doesn’t mean you have to go it alone. You still have access to GPs and the NHS. You can also create systems of support and consultation around you through supervision and communities like Therapists Corner.

Finally, managing risk transparently and collaboratively builds trust and resilience in clients. Let’s dive into what this looks like. Paid members will also find a copy-and-paste Client Risk Assessment & Support Plan Template below the paywall.

5 Tips for Managing Clinical Risk in Private Practice

1. Ask About Risk Early On

Gather key safety details from the beginning. Your initial risk assessment should cover things like the client’s GP, next of kin, and any current medications. You should also ask about their past mental health history including suicide and self-harm.

Talk openly about how you manage risk, confidentiality, and limits to privacy. Be clear about how and when you will review the things you’ve covered and the clinical measures you’ll use to support them.

Finally, tell clients what to do in an emergency, listing phone numbers and resources they can use if they are ever in crisis or feel unsafe at any point.

2. Make Risk Assessment an Ongoing Process, Not a One-Off

Risk fluctuates, so it’s important you revisit the topic regularly in therapy, updating your written risk assessment and support plan as needed. You should also use supervision to reflect and review how you’re managing client risk on an ongoing basis.

3. Create Clear Clinical Policies for Emergencies

It’s important you know what you’ll do if a client is in crisis. Hopefully, it’s a plan you’ll never have to put into action. If you do, you’ll be glad you prepared in advance.

Make sure you are up to date with training around safeguarding and plan for different clinical scenarios. For example, suicidal ideation, disclosures of abuse, risk to others, significant deterioration in mental health, clients with unclear or fluctuating capacity, and inappropriate referrals that fall outside your scope.

4. Know When to Refer or Collaborate

Sometimes the best risk management is recognising when therapy isn’t the right fit and helping your client get the support they need. Build a network of therapists around you who you can refer on to or contact for specialist supervision. Curate a list of referral options and crisis support services and create template letters for GPs or professionals you might need to contact.

5. Document Clearly and Professionally

It’s vital you keep detailed records of risk assessments and actions taken. Write notes with the assumption they may be read by others. Be factual, balanced, and clear. Explain your rationale for decisions, especially if you choose not to act.

Feel the Fear and Do It Anyway

The secret to managing client risk in private practice is clarity, compassion and clinical skill.

Most therapists are already well-equipped to assess and manage risk clinically. The biggest challenge in private practice is having the right systems in place. Think documentation, emergency contacts, supervision, and lone working protocols.

In other words, you don’t need to be afraid. You just need a plan, a supportive supervisor in place and a steady commitment to your own development. Risk exists, but with planning and regular review, it’s very manageable. You’ve got this!

---

Resource below - Client Risk Assessment, Checklist & Support Plan Template

Below is a copy-and-paste template you can use to assess risk and agree a support plan with clients. It should be completed together during your first few sessions and updated as needed.

Upgrade here to access the template.