Is clinical practice safe?

[jollyrancher7]

Wondering if any clinical psychologists or students could speak about the dangers of training or clinical practice? Is this a career where you have to be on guard during the job and after work?

As a woman who plans to start a family during training , I am mainly referring to aggressive/unstable patients.

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[WisNeuro]

The mentally ill are not more dangerous than the general population. If you don't work in prisons or doing forensics/benefits work, no different than other service occupations.

 

[FreudianSlippers]

Wondering if any clinical psychologists or students could speak about the dangers of training or clinical practice? Is this a career where you have to be on guard during the job and after work?

As a woman who plans to start a family during training , I am mainly referring to aggressive/unstable patients.

5th year doctoral student (going on internship this year) here. It really depends on where you work. Overall, my experience (and the experience of my cohort) has generally been that we feel very safe at all sites, with some being inherently more risky overall than others. For instance, I have worked at a counseling center, community mental health clinic, and a locked psychiatric inpatient unit. I think that what makes me feel the most safe is simply knowing certain protocols are in place. For instance, always having an emergency plan (emergency button or some way to contact somebody), making sure you are always closest to a door in a room with nothing blocking you, and not seeing clients if there is nobody else around in the clinic. Also, conflict de-escalation should be a core skill for all MH professionals. It goes hell of a long way, and I wish other professions (i.e. law enforcement) were trained more specifically in this area.

Also, boundaries are an essential skill in reducing the likelihood of stalking or inappropriate behavior. While there are many ways to limit the likelihood of seeing aggressive/unstable patients, you never know what will happen in somebody's life to trigger these behaviors. You have to be prepared no matter where you are, but hopefully you are going to a legit program that will teach you how to prepare and deal with these situations in an ethical way.

 

[jmiah717]

Army Vet, male, LCSW with a variety of practice experience....I can say without a doubt that outpatient CBOC work at a rural VA doing general MH therapy is probably the LEAST safe I've felt in my career. I've been to court due to threats (vague general gun threats, not toward me specifically). I still think we are generally safe and statistics are on our side.

That said, this is easily the most acutely ill outpatient population I've ever worked with and I've worked in some interesting settings. I agree with the above..control what you can and try not to worry so much about the rest. I've always felt, even with the most unstable cases, that my rapport building ability goes a long way if any of them ever snap. Hate to think like that but it does make me feel a little more at ease knowing that I provide them with something that the overwhelming majority appreciate and benefit from. Best of luck. Side note: Because people with PTSD often think about such scenarios, I've had group members tell me that they would protect me if anyone ever came in the building to cause harm. It was a good moment to reflect on the actual unlikelihood of that and how that is certainly part of the PTSD pathology, but nonetheless slightly comforting in an odd way.

 

[Justanothergrad]

As WisNeuro said, the statistics support that mental illness and violence do not relate to each other in any different way than violence and 'normal' populations. If you look for dangerous spots, you can find them- substance users have increased impulsivity, forensic settings, etc Or, take for instance child custody cases with the 'normal' people.

I've found the VA to be completely safe across inpatient units I've worked on (Acute and four different residential) to outpatient. As a woman you're likely more safe, particularly in groups. If you're pregnant, that increases substantially based on my experiences in a few VAs in the midwest. Vets are protective, as Jmiah mentions. Other settings (homebased intensive outpatient for acute psychiatric, hospital transition teams, independent practice, community mental health in office, etc.) are like I described above and not increasingly dangerous... because the statistics show that the relationship between mental illness and violence is just not different.

 

[Therapist4Chnge]

There are faaaar more dangerous jobs out there. Our pts are more likely to hurt themselves than us. Taking proper precautions, setting boundaries, and a bit of common sense goes a long way.

 

[PsyDr]

Eh, I get threats pretty regularly of varying likelihood. One personal injury guy waited for me in the parking lot after hours to threaten. Been assaulted a few times. Only once was semi bad (few broken bones, some cuts and bruises).

But I work in forensics for both criminal and civil matters.

 

[smalltownpsych]

Take reasonable precautions and be good at your job. Part of our skill set is to be good at deescalating. Every training that I have been to on violent patients emphasized deescalation first and foremost and as psychologists, we tended to rock that part of the course. Another part of our skill set is paying attention to interpersonal cues which is important, just need to add situational awareness to that. My last call, I had an intoxicated man who wanted to leave and go home that I was going to place on a hold. I typically tell patients this myself for a number of reasons, but since patient was very large and closer to the door, I decided to let staff with assistance of the law enforcement who had brought patient in to break the news.

 

[Ollie123]

For 99% of psychologists, it is so extremely safe that I was a little confused when reading your question why anyone would even be asking. Some folks select into areas that are higher-risk (see PSYDRs post), but that is not the norm. There are probably a handful of other exceptions (custody evals, some forensic settings). I prac'd in a VA, an inpatient addiction unit, did outpatient forensic drug treatment on internship. Is it possible a patient would end up stalking you? Sure. Unless you start a dedicated clinic for former therapist-stalkers, I don't think its going to be an issue. These make great stories for the news and ethics classes, but are incredibly low base-rate events. More likely is you bump into a client in a public place, have an awkward interaction and then have a conversation with them at the next session about why you didn't introduce them to your partner. Its really not any more dangerous than any other field that involves interacting with the public (e.g. accountant, teacher, etc.) and probably safer than many. Far safer than many blue collar jobs.

The old adage about air travel likely applies to psychology too. The most dangerous part of the job is driving to/from work.

 

[WisNeuro]

Yeah, much more dangerous jobs than ours. You could be a reporter asking questions about healthcare...

 

[blakjak12]

Yeah, much more dangerous jobs than ours. You could be a reporter asking questions about healthcare...

And hey, just to make your job more difficult as a reporter, the person who assaults you still gets elected!

 

[BuckeyeLove]

civil matters.

this is where I start to get worried. criminal defendants, psychopathic or not, usually could care less. you start talking about people with means losing either money or their kids???? #dangerzone

 

[Therapist4Chnge]

this is where I start to get worried. criminal defendants, psychopathic or not, usually could care less. you start talking about people with means losing either money or their kids???? #dangerzone

I avoid civil stuff like the plague. Every once in awhile I'll get a stealth referral I need to vet, but I typically limit my chances by limiting my referral sources. Child custody is by far the worst scenario for me.

 

[erg923]

I have gone to court twice for Aetna. And that was just because of/for file review work.