Guidance for Therapists on Online Therapy Appropriateness and Risk Management
My Therapist Online is committed to offering supportive, online therapeutic services. It is crucial for therapists to recognise that online services may not be appropriate for all clients, particularly those who are at a greater risk of harm or are in need of urgent care. MTO uses a screening process at registration designed to identify clients who may require more intensive, local support than can be provided through remote therapy.
Online therapy services may not be suitable for a therapist's client if:
The client has thoughts of self-harm or harming others.
The client is in the midst of an urgent crisis or emergency.
The client has been diagnosed with a severe mental illness that necessitates a multidisciplinary team approach.
The client is legally required to undergo therapy through a court order or by another authority.
The client does not have access to a reliable internet connection or the necessary device to engage in online therapy.
Therapists should be aware that a client’s risk level can change, and presentations that initially seem low risk may escalate. It is important for therapists to continually assess and manage risk, always prioritising the client’s safety and well-being.
If a therapist believes their client is in danger or at risk of self-harm or harming others, it is imperative to direct them to contact emergency services immediately by phoning 999 or going to the nearest Accident & Emergency department.
Therapists should also be aware of additional crisis support services, such as the Samaritans, for immediate assistance.
Guidance for Online Therapy Risk Management
In line with NICE guidelines NG225, My Therapist Online presents this document as a guide to support independent practitioners in their clinical decision-making. This is not an instructional manual on managing risk but rather a supportive framework to complement the rigorous standards set forth by your clinical governing body.
Approach to Risk Assessment and Management
Independent practitioners are encouraged to consider the individual's immediate and long-term needs for psychological and physical safety during assessments.
It is suggested that risk formulation be integrated into each psychosocial assessment, adhering to the clinician's own professional judgment.
Managing Presentations of Suicidal Ideation
It is recommended that therapists, guided by their discretion and training, engage in a timely risk assessment if a client exhibits suicidal ideation.
The development or revision of a safety plan, tailored to the client's situation and incorporating proven coping strategies, may be beneficial.
Should a high-risk scenario be identified, practitioners might consider advising clients on the importance of a safe and supervised environment.
Sharing crisis resources and facilitating referrals to local emergency services could be considered as part of the response plan, depending on the assessed need.
Involving a client’s support network, with their permission, can sometimes provide an additional layer of support.
Documentation and Follow-Up
Scheduling follow-up sessions to reassess client welfare and maintaining detailed records of consultations are practices that align with professional accountability.
Documentation should be thorough, reflecting adherence to ethical standards and the nuances of the individual case.
Therapist Self-Care and Professional Consultation
Seeking peer consultation or supervision can be an invaluable part of maintaining professional competence and personal well-being.
We encourage you to inform MTO where risk has been assessed and managed.
Adherence to Professional Standards
Practitioners are reminded of the importance of following their own professional training and the ethical guidelines established by their respective professional organisations.
Privacy and Security
Maintaining confidentiality through secure communication channels is paramount, and having emergency contact information for clients is a prudent practice.
Respect for Clinical Decision-Making and Expertise
My Therapist Online holds in high regard the clinical decision-making and risk assessment expertise of each independent practitioner. We understand that therapists are the experts in their field and possess the deepest insight into their clients and their presentations. As such, we fully support the clinical decisions made by therapists regarding the most appropriate course of action for the provision of therapy following a comprehensive assessment and management of risk.
We trust in the professional acumen and discretion of practitioners to navigate the complexities of each unique clinical situation. Your expertise is the cornerstone of effective and compassionate therapy.
This document is intended to offer guidance, recognising the autonomy of therapists in applying their professional knowledge and judgment. It is understood that the specifics of each client case and clinical professional regulatory requirements (such as BACP, EMDR UK, BABCP, HCPC and BPS) will inform individual management plans. The primary concern is always the safety and well-being of the client, balanced with compassionate care.