Key Protocols and Strategies for High-Risk Online Therapy:
Crisis Protocols:
Always have clear and well-communicated crisis protocols in place.
Prioritize having a safety plan in place for each high-risk client, ensuring that the plan is regularly updated.
Make clients aware of the limitations of telehealth—especially regarding immediate intervention in emergency situations.
Clinical Tip: Start each session with a quick safety check:
“Before we start, I want to check in—do you have any immediate safety concerns we should address today?”
Local Emergency Contacts on File:
Maintain an updated list of local emergency contacts for each client, including emergency responders (911), mental health crisis lines, and support organizations.
Obtain consent from the client to contact emergency services if necessary.
Build relationships with local resources—if possible, connect with organizations that specialize in suicide prevention or domestic violence in your client’s area.
Example:
“In case of an emergency, I want you to know I have your local crisis hotline on file. If you feel unsafe or in distress during a session, we can call them together.”
Safety Planning and Check-Ins:
Conduct regular safety check-ins throughout the course of treatment, especially with clients who are at elevated risk.
Safety plans should include specific steps clients can take during a crisis, such as calling a family member, reaching out to a friend, or engaging in grounding techniques.
Review and update the safety plan regularly to ensure it remains relevant and effective.
Key Questions for Safety Planning:
“What has worked for you in past crises?”
“Who can you reach out to in your immediate network for support?”
“What is your backup plan if you feel unsafe at home?”