How to Deal With Risk Events in Therapy From an ACT Stance


Independent practice, Kate Morrison LLC, Sandy, Utah

Key Points

  1. When a client is putting someone else at risk due to their condition, the therapist has to address that immediately through validation, understanding, and genuine care.
  2. According to Dr. Morrison, practice of the acceptance and commitment therapy (ACT) tools and approaches in the therapist’s own life is a beneficial self-care activity.
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Risky Events and the Therapeutic Relationship

Jazmin: You described that if Anne were putting her child at actual risk, for example, making her take a bath with chlorine, you would have to call Child Services. How can you maintain the therapeutic relationship even though you have to report her to Child Services?

Dr. Morrison: That’s a tricky spot to be in and one that I don’t envy anyone having to be in that position, and I don’t enjoy it myself either.

In this situation, you express to your client that you’re on their side, validate them, and address immediately the safety concerns. For example, I would tell Anne, “I know you’re doing this because you’re trying to protect your child, and this is coming from a place of love and care. However, you’re putting your child at harm. We both know this is not okay.” So I’m coming strong with warmth and understanding, but I’m being direct about it.

Therefore, in those times when you will have to make that call and report it, pair it with understanding and genuine care. “I’m here to help you with this situation. Let’s address this as soon as possible, because I want you to not get in trouble, I want your child to be safe, and I want you to be able to keep your child. Let’s address this particular symptom of your OCD right now because it needs urgent attention.” And that can sometimes not go well, but I think we have a duty as providers to ensure that we keep children safe.

Self-Care Activities for Psychotherapists

Jazmin: This is a tricky spot to be as a therapist, and I’m assuming it might cause you distress. So which self-care activities do you practice to take care of yourself after an emotional session in this case scenario, where you might report Anne to Child Services?

Dr. Morrison: I try to practice the tools and approaches I share with my clients. The concepts we use with clients are not just for unwell people. It’s for all of us. If I have the time, I take a step away from my computer or office and get some fresh air. I like to step outside, practice being present, and don’t get caught up in my emotions. It is useful to recognize the type of content that hooks you as a provider, for example, the thoughts you get caught up in.

We don’t always have the luxury of having a lot of time between clients, so even if I’m sitting at my desk for a few moments, getting centered and focusing on my breath helps me. At the end of the day, I like to eat ice cream and watch the Great British Bake Off. I think it’s not always bad to have experiential avoidance in our lives. We have to maintain our mental health as we work with people. So, finding that balance of being present and reminding yourself of why we do the hard things that we do.

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How to Deal With Risk Events in Therapy From an ACT Stance