This article provides tips and practical safety suggestions for therapists while conducting in-person appointments.
Benefits of In-Person Therapy Sessions
With proper planning, therapists can enhance the safety of in-person appointments. There are also some advantages, such as being able to control the environment and conduct more thorough risk assessments.
Controlling the Environment
- You control the entire therapeutic environment: Lighting, seating arrangement, room temperature, noise levels.
- Physical presence enhances de-escalation: Body language, tone, and therapeutic presence can be more impactful.
- Clients can feel more at-ease: Many clients actually feel safer in a controlled, professional environment.
- You have access to immediate crisis resources: Ability to call 911, contact emergency contacts, or involve security without technology barriers.
More Comprehensive Risk Assessments
- You can observe the full picture: Gait, hygiene, physical presentation, medication compliance indicators.
- You can check for real-time behavioral cues: Fidgeting, agitation, or escalation patterns are more visible.
- You have access to immediate safety interventions: Physically guide clients to safer spaces or positions.
Practical Safety Protocols
There are practical ways therapists can make in-person appointments safer, especially for higher-risk sessions or when a patient is showing signs of crisis.
Safety Protocols Before Each Session
- Quick environmental scan: Take 30 seconds to ensure clear pathways to exits and remove any potential objects of concern.
- Set your phone to emergency speed dial: Have 911 and building security on quick access.
- Remove or secure potential weapons (letter openers, heavy objects, sharp items).
- Inform someone of your schedule: Let a colleague or supervisor know your high-risk appointment times.
During Sessions with Elevated Risk
- The "therapeutic triangle": Position yourself between the client and the door, but not cornering them.
- Use grounding techniques actively.
- Avoid arguing, challenging delusions directly, or making promises you can't keep.
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Here are some verbal de-escalation phrases:
- "I can see you're really struggling right now."
- "Let's slow this down together."
- "Your safety and mine are both important to me."
Crisis Escalation Protocol
- Stay calm and use a low, steady voice.
- Create physical space while maintaining therapeutic connection.
- Offer choices: "Would you like to sit down or would standing feel better right now?"
- Use their name frequently—it's grounding and personalizing.
- If escalation continues: "I'm going to call for some additional support to help us both feel safer."
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You can consult with Rula’s Patient Safety Clinical Risk team for patient safety concerns or managing clinical risk.
- Remember, higher acuity clients are where you can potentially make the biggest difference.
Confidence-Building Strategies
Therapists can participate in professional development opportunities and try out practice scenarios to help build confidence for safer in-person sessions.
Professional Development
- Participate in crisis intervention training.
- Learn and use standardized risk assessment tools to improve prediction of violent behavior in clinical settings.
- Consider de-escalation technique workshops.
- Connect with other providers doing in-person work for peer consultation.
Practice Scenarios
- Role-play de-escalation with colleagues.
- Use informed consent to set safety expectations.
- Walk through your crisis protocol with your office space in mind.
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Identify your local emergency resources and know mental health crisis response teams and procedures.
- Practice emergency procedures regularly (similar to fire drills).
Key takeaways
Your clinical skills translate directly to in-person work. With proper preparation, environmental setup, and crisis protocols, in-person sessions often provide both you and your clients with enhanced safety and effective treatment outcomes.
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