Client safety is an important priority for counselors. An all-too-common source of physical danger for clients comes from domestic violence (DV) or intimate partner violence (IPV). A counselor cannot guarantee a client’s protection outside of the therapy office, and this is where a safety plan may be vital.
We spoke with Jennifer Toof, PhD, NCC, LPC, about the importance of safety plans and some common challenges that counselors and clients face when creating these tools.
What should the process look like for establishing a safety plan for IPV/DV?
A safety plan for IPV/DV is a personalized set of actions that a survivor can use to protect themselves (and children, if applicable) from harm. Each client’s IPV/DV safety plan will be different based on their own unique situation, but, generally, establishing such a safety plan includes:
- identifying (and communicating with children, if applicable) a safe place to go inside the home during altercations (e.g., a room that locks from the inside, away from rooms/areas with possible weapons).
- identifying (and communicating with children, if applicable) a safe place to go outside of the home during altercations (e.g., a supportive neighbor’s home).
- having a “to-go” bag packed with some clothes, written phone numbers of safe contacts, some cash, prescription medications, and ID or other important documents.
- knowing phone numbers or addresses for supportive friends/family members.
- knowing phone numbers or locations for crisis centers.
Unlike a suicide safety plan, survivors of IPV/DV usually cannot display their safety plans openly in their homes for fear that the abusive partner may see it. The clinician should therefore ensure the client is either able to remember the components of their plans or place them in a safe space that the abusive partner will not be able to access. I’d also add that, to effectively address the safety needs of diverse, marginalized survivors of IPV/DV, the clinician must examine the impact of marginalized identities on survivors’ access to services and ensure that the safety plan appropriately addresses cultural considerations.
Does safety planning for IPV/DV look different with the presence of suicidal ideation?
Intimate partner violence or domestic violence and suicide risk are two deeply challenging issues for both survivors and clinicians. In clinical practice, IPV/DV and suicide risk are often evaluated and addressed separately, yet many survivors of IPV/DV also experience suicidal thoughts and behaviors, so it is important to address the problems jointly when they co-occur. If a client is experiencing both IPV/DV and suicidal ideation, the clinician should work with the client to develop safety plans for both concerns that are suitable to the client’s circumstances. The clinician should help the client identify coping strategies that are safe and feasible given the presence of an abusive partner, supportive contacts that are appropriate for both plans, and professional resources for both suicide-specific and IPV/DV-specific support.
Does the use of telehealth pose additional challenges for making a safety plan?
Counselors should remember that the use of telehealth may be essential for clients who feel unable to physically go to an office, such as if the abusive partner limits their access to transportation or tracks the client’s location. However, telehealth certainly poses its own challenges for safety planning. There is always a possibility that the abusive partner could install spyware on the client’s devices or hidden cameras in the home. Discussing IPV/DV over telehealth may require ensuring that the client is always in a safe location and on a device that is not monitored by the abusive partner. The client and counselor may also need to establish code words or signals for if the client needs to abruptly stop discussing the abuse, end the session, or have the counselor contact the authorities.
Do the limitations of a telehealth modality pose ethical concerns when the client is under threat of violence?
Informed consent, confidentiality, and issues related to a client's children are additional ethical issues that should always be considered in issues of IPV/DV. Counselors need to obtain informed consent from their clients about the limitations to confidentiality, such as the counselor's responsibility to prevent clear and imminent danger to the client or others. Counselors must also be aware of the legal aspects of the duty to protect because there are differences by state.
When utilizing telehealth, counselors should also establish a technology failure plan that describes the steps that will be taken in case of technology failure during session (i.e., a secondary method of contacting the client). The counselor should also document the physical location of the client at the start of each session in case an emergency occurs.
Are there situations in which a counselor may be unable to ethically provide services to a client experiencing IPV/DV due to safety concerns? What is the counselor’s responsibility in such a case?
A counselor may need to stop working with a client experiencing IPV/DV for various reasons, such as if there is a conflict of interest, if dealing with IPV/DV falls outside the counselor's area of expertise, if the client is not benefiting from therapy, if the counselor is experiencing personal issues that could impair their judgment and ability to provide proper care, or if the counselor feels physically threatened themself. The latter reason may be particularly relevant in cases of IPV/DV. In such situations, the counselor should discuss the reason for termination with the client in a respectful and transparent manner, provide a referral to another suitable professional who is competent in IPV/DV cases, and ensure they engage in proper documentation, maintaining detailed records of the termination process. If possible, the counselor should allow for a planned transition process to another provider to help the client adjust. The counselor should never leave a client who is in danger without any appropriate resources for help.
Jennifer Toof, PhD, NCC, LPC, is the owner of Trauma Informed Counseling & Consulting. She holds a doctoral degree in international psychology with a concentration in trauma services. She is a certified trauma therapist and works with clients of all ages with a variety of mental health concerns. She also provides trauma and mental health–related consultation services to organizations around the world. Dr. Toof is highly active in a number of local, national, and international advocacy efforts.
