Section 1: Crisis and Key Considerations

Sometimes, clients present to counselling in crisis situations; at other times, crises arise in the midst of the counselling process as client circumstances change. Whichever way they arise, crisis is associated with escalated levels of risk and a strong indicator of safety issues (Geldard, Geldard, & Yin Foo, 2017), thus must be addressed appropriately.

In the human services context, crises generally occur when a client’s ability to cope and the resources they have available to them are overwhelmed, or when there is a threat to the safety of a client or others in the client’s life. Crisis situations can be precipitated by sudden changes in the client’s external circumstance (e.g., relationship breakdown, job loss, accident or natural disaster) but they can also occur for other reasons, such as an episode of psychological disturbance, a developmental change, a serious physical health problem, or exposure to violence.

Crises can bring huge increases in stress and may significantly impact a person’s functioning, so they are an important consideration in counselling and in addressing safety concerns. People who are in crisis may be panicked, extremely distressed, overwhelmed, or immobilised. They often (temporarily) lack the capacity to identify, consider, and access the resources and options available to them. Moreover, clients in crisis often have other urgent needs, some of which can involve risks to safety. As such, some clients will require immediate referral to crisis intervention services or other relevant supports. While generalist counsellors do not usually provide crisis intervention, it is important for counsellors to be able to identify and assist clients in crisis so as to help meet immediate needs and facilitate access to appropriate services. Counsellors must also develop competency in supporting clients in crisis to reduce imminent risks and enhance their safety. This will naturally require counsellors to possess sufficient understanding of and competency in recognising a range of safety issues that are often associated with crisis situations, which is what we turn to now.

Risks from Others

Experiences of abuse and other forms of violence – direct or indirect – are associated with increased risk to clients (and others). Exposure to violence can also have significant impacts on the client’s functioning and affect their capacity to engage in counselling. Thus, checking for indicators of violence or abuse and responding appropriately is important when meeting with a potential client for the first time and throughout the period of contact. Some issues of abuse, such as child abuse, require reporting to particular authorities, and people who have experienced abuse may benefit from specialist support beyond counselling. Several types of abuse and violence that counsellors and other helping professionals need to be aware of are outlined in the following table (adapted from Queensland Government, 2017, 2020a, 2020b).

It is not uncommon for people subjected to the risks mentioned in the table to present in crisis or report threats from others. Imagine a client subjected to DFV, for example. The client may present in crisis after receiving threats for their attempt to leave or after escaping from an abusive relationship. The counsellor working with this particular client may also face threats from the partner using violence even though they are not a direct client. Conversely, a counsellor working with the person using violence will need to appropriately address situations in which the client threatens to harm others.

On the other hand, it is possible for clients to threaten or act aggressively towards their counsellor or other staff members if they are facing a crisis situation, experiencing a psychotic episode, are triggered by something said or done during the counselling process, or are under the influence of substances. In all cases, counsellors must carefully assess safety of the client, their own, and others in the location, and act in accordance with their organisational policies and procedures, which usually involves seeking immediate support and prioritising the safety of all persons involved.

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Risks to Self

In some cases, clients pose risks to their own safety, such as in situations of suicide or self-injury risk. Where suicidal risk is indicated, counsellors will need to ask directly if the person is considering suicide, followed by appropriate assessment and actions to increase the person’s safety. Whilst self-harm is often done without suicidal intent, it is an indicator of suicide risk, so clients who self-harm must be assessed for suicide risk, too. Additionally, it is important to note that clients who pose risks to themselves are not excluded from posing risks to others; in some cases, a suicidal person will kill others while taking their own lives. This is perhaps most common where men kill themselves and their partner or ex-partner, children, and/or partners’ or ex-partners’ children. Any client who is at imminent risk to themselves must be referred to emergency services.

Accepting Complexity

You may notice that some risk indicators overlap with those of multiple other issues; for instance, anxious and fearful responses, as well as physical injuries, are common indicators of multiple issues. Moreover, some indicators (e.g., confused thinking, and changes to behavioural patterns) also overlap with signs of potential developmental and mental health issues that may indicate a need for referral. Identifying these common indicators will help you to recognise the need to ask further questions, conduct a risk assessment, and determine appropriate responses and/or refer for specialist assessment.

It is also important to note that these are only potential indicators. Not every client experiencing these indicators is necessarily experiencing a risk situation. Similarly, the absence of these potential indicators does not necessarily indicate that the client is not at risk. Furthermore, everyone is different and not all clients will demonstrate the same indicators of risk and crisis. Imagine a client who comes into counselling in a state of agitation and tells you that they intend to end their life – this is an obvious sign that an assessment of suicide risk is required. In other cases, you may have identified potential risk issues based on a client’s responses to screening questions or because they avoid answering particular questions. For instance, a client who is self-harming or is experiencing DFV may not readily offer such information and may try to avoid or ‘brush off’ discussion on such topics. Occasionally, you may simply have a ‘hunch’ that things are not quite right and will have to explore carefully to confirm whether your hunch is correct. Whichever case it may be, it is important that you become familiar with potential indicators of safety issues and take the possibility of risk seriously.

Wherever issues of risk are identified, counsellors will need to ensure they respond in line with their organisational policies and procedures, as well as their professional and legal responsibilities. This typically involves carrying out a risk assessment and consulting with a supervisor or manager to determine the most appropriate responses. We will explore these processes in more detail in the next section. For now, let’s consider a range of legal and ethical considerations that underpin a counsellor’s responses to risk and crisis situations.

As a counsellor, you are obliged to work in accordance with legislation and regulations, including those that are general; those that relate to people in certain roles; and those that relate to certain risks (such as child safety). You also need to act in accordance with organisational policies and procedures applicable to your role and workplace. You have learned about these requirements generally throughout your diploma, so here we will take the opportunity to review a few specific legal and ethical requirements that are particularly relevant to issues of risk and crisis in the counselling context.

DFV and Child Protection Issues

Given the nature of client work, all helping professionals must understand and comply with legislation and ethical responsibilities relevant to DFV and child abuse. There is legislation in both federal and state/territory jurisdictions that sets out processes intended to protect people affected by such issues. While Commonwealth law (federal legislation) applies in all jurisdictions, the states and territories have variations in their definitions of and responses to aspects of DFV and child abuse, so it is important that you are familiar with the law in your state/territory, as well as with Commonwealth law. Key pieces of Commonwealth legislation relevant to DFV and child abuse are the Family Law Act 1975 (Cth) and the Australian Human Rights Commission Act 1986 (Cth). Pieces of state and territory legislation particularly relevant to each are listed in the following table.

Mandatory Reporting

In some jurisdictions, counsellors are regarded as mandatory reporters, which means they are legally required to report suspected cases of child abuse to a particular government authority. However, the types of abuse and neglect that must be reported can vary depending on the state or territory in which the counsellor practices.

A summary of contact details for the reporting authority in each jurisdiction is included in this article Reporting Child Abuse and Neglect: Information for Service Providers (Alternatively, search online using the name of the article). Remember that agency names and contact details may change over time and that it is your responsibility to make sure your information is up-to-date.

Even in jurisdictions where counsellors are not mandatory reporters, they have legal, ethical, and organisational responsibilities in relation to child abuse. Wherever there are concerns about possible child abuse, make sure that you bring this to the attention of your manager or supervisor, and follow organisational and professional procedures in responding and reporting as appropriate.

For instance, the responsibilities of counsellors (whether or not they are mandatory reporters) should be clearly set out in your organisational child protection policies and procedures, with details of the:

• staff’s responsibilities in monitoring for risks to children and duty of care
• staff’s obligation to inform clients about mandatory reporting duty and exception to confidentiality in relation to when a person discloses information that suggests a child may have been or is experiencing abuse
• reporting process of any suspected or identified child safety risk, e.g., must be reported to a manager, and to the relevant child welfare authority where appropriate
• information that needs to be documented where there has been suspicion of or identified child safety risk, e.g., identified issues and all actions taken.

Ethical Responsibilities

You have learned various ethical responsibilities that apply to counsellors throughout this diploma. Particularly in relation to working with clients at-risk, counsellors have a responsibility to protect client’s safety, as highlighted in the following extract of the ACA Code of Ethics and Practice.

As such, counsellors have a duty of care to the safety and well-being of their clients, and this duty includes any others who are involved with the client (e.g., the client’s children, carer, or significant others). Therefore, it is important that you continuously assess for safety concerns; remain vigilant for signs that indicate risks of harm; and, where necessary, work with the client to reduce risk and enhance safety. If you are unsure of whether a client is at risk but suspect they may be, even when it is just a ‘hunch’, take any concerns seriously and seek to clarify the situation.

On the other hand, counsellors are also required to support their client’s autonomy “by working in ways that respect and promote the client’s ability to make decisions in the light of his/her own beliefs, values and context” (ACA, 2019, p. 10), which is an important consideration when it comes to supporting clients in crisis. As mentioned before, clients may become temporarily ‘immobilised’ when they are in a state of crisis, which can impede their capacity for decision-making. This means that in situations of high or immediate risk where clients are unable or unwilling to access support, counsellors may need to take an active stance in reducing the client’s risk to themselves or others, such as through contacting emergency or crisis intervention services. Nevertheless, where safe and possible, counsellors are expected to support clients to make informed choices in these situations, such as referral services or actions to increase safety.

Other ethical principles that are particularly relevant to working with clients at risk include privacy, confidentiality and disclosure, record keeping and documentation, and work role boundaries.

Privacy, confidentiality and disclosure

Whilst counsellors are obliged to treat client information (including their engagement with the counselling service and all personal information held by the counsellor) as confidential, disclosure of confidential information may be required in exceptional circumstances, such as when a client discloses that they may harm themselves or another person, or when a child has been or is being abused. Typically, the decision to break confidentiality will be made in consultation with your supervisor/manager.

Record keeping and documentation

Counsellors are obliged to maintain appropriate records and documentation of client work, including any risks and any actions taken. For instance, when a counsellor has identified behavioural signs or client statements that require further assessment, it is important to record these and outline steps taken to clarify and/or respond to risks or issues suspected or identified. Similarly, risk assessment, reporting of incidents, notifications to authorities, and referrals must be documented. Where safety planning has taken place, a copy of the safety plan should be included on the client’s file for follow-up and review.

Work role boundaries

Counsellors are expected to work within their professional roles and responsibilities. In relation to working with clients at-risk or in crisis, for instance, a generalist counsellor has a duty of care to identify risk or crisis issues and support clients to reduce risk and enhance safety; however, it would be more appropriate for the client to be referred to a specialist service (e.g., crisis intervention service) for ongoing support. Offering services beyond professional competencies and boundaries can result in harm to clients as well as the counsellor. At the same time, counsellors must establish and maintain clear boundaries in the client-counsellor relationship to avoid unethical or over-involvement with clients.

Organisational Policy and Procedures

Typically, these legal and ethical responsibilities are readily incorporated into your organisation’s policies and procedures. These documents are established to help you maintain compliance with your legal and ethical responsibilities within your professional role or service context. In the following sections, you will learn more about the processes of assessing risks and responding to various risk issues where identified. You are likely to find the procedures for all of these processes in relevant organisational policies and procedures. A few generic examples include risk assessment, critical incident and referral policies.

Risk assessment policy

This policy outlines the type of risks and procedures to assess and manage these. In relation to client work, this may include when and how risk assessment should be conducted; the risk assessment tool that should be used; how to determine risk level and corresponding responses; whom you should consult; and so on.

Critical incident policy

Critical incidents can include a range of unexpected events in the workplace, including falls, injury, fire, bomb threats, suicidal clients, and aggressive behaviours. This policy should include definitions of critical incidents, delegation of staff responsibilities in the event of critical incidents, and procedures for managing and responding to these (e.g., list of support persons on-site, procedures for contacting emergency services; instructions for filling a critical incident report).

Referral policy

This may include both internal referral (i.e., referring to other professionals within the same service) and referring clients externally to other services or professionals. Depending on your role and the service context, the procedures for referral may range from providing referral services information to clients and contacting referral services in conjunction with clients, to attending referral services with a client as a support person. Typically, the procedures of referral will involve facilitating informed consent, gaining the client’s written consent, filling in a referral form with relevant details only, and recording all actions taken in the client’s file.

Note that each organisation and agency will have slightly different procedures as well as names for these policies, so you must ensure that you are familiar with them, and what they entail, and act accordingly. As such, you must refer to organisational, legal, and professional documents, and get guidance or clarification from your manager or supervisor when necessary, such as when deciding whether to report a risk or concern.

Apart from understanding the legal, ethical, and organisational requirements relevant to your professional role, it is also important to reflect upon personal values, beliefs and attitudes that may impact your capability to recognise and respond to clients in crisis.

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Counsellors have an ethical obligation to develop awareness of how their own values and beliefs may impact their capacity to work respectfully with clients (ACA, 2019). This is an important consideration when it comes to recognising and assessing risks clients may be facing because your capacity to recognise risk issues and immediate responses in these situations is heavily influenced by preconceived ideas and beliefs you hold, including those that are based on misconceptions. Therefore, it is important to examine your own attitudes, beliefs and values, before we proceed to strategies and processes that you can implement in response to situations of risk and crisis.

For instance, some counsellors may be concerned about the idea of asking directly about risk situations and think that they may offend the client or inadvertently escalate the situation (e.g., give the client the idea of suicide). However, this is not the case, and directly asking about safety issues is an important and necessary part of recognising and assessing potential safety issues. In fact, it will help to normalise stigmatised topics, such as suicide and DFV, and encourage clients to discuss relevant concerns.

Core Values - Your Inner Compass

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A Note on Terminology Used When Talking About Suicide

For a number of years now, there has been a strong push to change the terminology used to refer to suicide and related issues, with the aim of reducing stigma and misunderstanding.

For instance, the term ‘commit suicide’ should be avoided. It is stigmatising because it links suicide to crime (e.g., ‘committed burglary’ – harking back to the time when suicide was, indeed, a crime in Australia). It also invokes ideas of sin (e.g., ‘committed adultery’). Other inappropriate phrases include ‘completed suicide’, ‘successful suicide’, and ‘failed attempt at suicide’, all of which (unintentionally) associate death by suicide with positive connotations and non-fatal suicide attempts with negative connotations. Instead, we should replace these with objective terms, such as ‘died by suicide’, ‘suicided’, ‘took her/his/their own life’, and ‘suicide attempt’ or ‘non-fatal suicide attempt’.

Myths and Misconceptions

In the remainder of this section, we will explore some common misconceptions that people have about suicide and DFV, which are two common risk issues in the counselling context that often lead to crisis situations among clients. As you read each, consider the effects that holding such a belief could have on a counsellor’s capacity to recognise and respond to clients appropriately, and the barriers to help-seeking that such ideas could create for clients.

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Like suicide, there are many misconceptions about DFV, including myths and excuses that impact clients, as well as counsellors and professionals. These myths, excuses, attitudes, and ideas are – explicitly and implicitly – taught and acted upon in every area of our lives, through our families, schooling, community groups, workplaces, and media, as well as in our health, education and legal systems. Understanding these misconceptions and their effects will enable you to more clearly see and effectively respond to clients affected by DFV.

Excuses for DFV can overlap with myths, often shifting the blame to external factors (i.e., factors other than the responsibility of the person using DFV). People who use violence often use victim-blaming, such as claiming that they would not be violent if the victim did or did not do something. We also hear victim blaming in many discussions of violence against women, such as when a person asks why a woman who has been sexually assaulted was in a particular place or doing a particular thing.

In essence, providing appropriate support to clients in crisis will require you to critically examine your own values, beliefs, and attitudes, and identify those that may impede your work. This can be a difficult process, but it is not about criticising yourself if you have believed a myth or held an unhelpful belief. Rather, it is about recognising and addressing the problem and helping others to do the same. Remember, it takes a great deal of courage to face up to having been wrong and to actively work to improve yourself, so if you do this, well done!

At the same time, it is important to recognise and develop values, beliefs, and attitudes that are likely to facilitate appropriate responses to clients at risk. For instance, a counsellor who believes that every life is precious will likely work towards helping a suicidal client to identify reasons for living. Viewing clients as resourceful and competent, even in the face of crisis, is also likely to help counsellors work collaboratively with clients in decision-making and determining coping resources. Ultimately, counsellors must continuously reflect on and monitor the impacts of their values, beliefs, and attitudes in working with clients.

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In this section, we have explored key considerations in working with clients who may be at risk or in crisis. In particular, you acquired an understanding of how crises impact clients' capabilities, various indicators of risk issues, and the legal, ethical, and organisational considerations that form the basis for a counsellor's response to clients in crisis. Last but not least, you learned about the importance of examining your own values, beliefs, and attitudes towards clients in crisis which may impede or facilitate your capacity to recognise and respond to crisis situations. In the following section, we will take a closer look at how a counsellor might identify and assess risk issues, putting what they know about these key considerations into action in accordance with their legal and ethical responsibilities.

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