Honoring Rebecca White: Implementing Therapist Safety Protocols Now

Rebecca White, LMHC, was brutally murdered in Orlando, Florida, last Monday, in her office, in front of her client. She was 44 years old.

We don’t have to have known Rebecca personally to be deeply affected by the heartbreak of this violent act. She died doing the work she loved, offering hope, and healing to those fortunate enough to have found her. Even if we didn’t know her personally, we all knew her heart, her commitment and her passion. We grieve with her family, friends, and clients. We hope the client who was injured while trying to defend Rebecca gets the help he needs to process and recover from losing his therapist in such a targeted act of violence. 

Piercing the Veil of Safety

We also grieve for the breach in our own denial. How can we not be affected by Rebecca’s tragic death? The unacknowledged but unavoidable truth is that any one of us could be this statistic.

Fifteen years ago, I supervised three clinicians subjected to workplace violence. One was attacked while getting into her car after she left a home visit. Another supervisee witnessed a murder. The first therapist had bruises. Both were deeply shaken. The third therapist was threatened by a client in the clinic. She was able to walk out and tell the receptionist to summon me to the room. Each one of these incidents required my critical debriefing and deescalation skills. I was lucky to learn them as an EAP intern 28 years ago!

Three acts of violence in one year were a big wakeup call. Management dove into developing protocols and provided workplace safety training as a requirement for employment. But imagine if the clinic had invested the time to develop and train its clinicians on safety protocols before they were subjected to violent acts of aggression.

Rebecca is not the first psychotherapist to be murdered by a client, and she will not be the last. If Rebecca’s memory is going to be a blessing, may it catapult us into implementing systems for protecting ourselves on the street, in our own offices, perhaps even in our own home offices.

Safety Protocols

Both the NASW and the APA recognize that mental health workers need training to better recognize workplace risk, to create a secure environment, and to protect themselves from violence.

The following protocols represent a balance between maintaining therapeutic rapport and ensuring safety. The specific measures do not apply to all situations. They should be tailored to your practice setting, client population, and an individual risk assessment you perform with each client.

Environmental Design & Physical Safety

• Office layout: Position your seat closest to the door so you can exit quickly if needed. Avoid having clients between you and the exit.
• Panic buttons: Install an alarm system that alerts security, front desk staff, or emergency services.
• Visibility: Use offices with windows in doors. Use video monitoring in waiting areas.
• Waiting area safety: Ensure reception areas have clear sight lines and that administrative staff know emergency protocols.
• Remove potential weapons: Remove or hide heavy objects, letter openers, or anything that could be used as a weapon.
• Provide lockers: Have clients store their belongings inside a locker in the waiting area and give them a key. If the client carries a weapon, it goes in this locker.

Screening & Assessment

• Thorough intake assessments: Conduct an initial assessment to determine every client’s potential for violence. Screen for a history of violence, substance abuse, impulse control issues, and active psychosis.
• Ongoing risk assessment: Regularly reassess clients for changes in threat level, especially during times of stress or decompensation.
• Trust your instincts: If something feels unsafe, it probably is. Don’t dismiss your gut feelings.

Administrative Protocols

• Inform others of your schedule: Ensure colleagues or staff know who you’re seeing and when. If you live with others, let them know when they should expect you home and discuss what to do if you’re not home on time.
• Stagger appointments: Avoid scheduling high-risk clients back-to-back or when you’re alone in the building.
• Emergency contacts: Keep updated emergency contact information for all clients.
• Consultation: Regularly consult with colleagues about high-risk cases.

Professional Boundaries & Communication

• Clear boundaries: Maintain consistent, professional boundaries to prevent misunderstandings or entitlement.
• Document concerning behavior: Keep detailed notes about threats, concerning statements, or aggressive behavior.
• Report threats: Confidentiality does not pertain to a threatening situation. It activates the “duty to warn” requiring the therapist to breach confidentiality and protect the potential victim, in this case, themselves.
• Allow colleagues to interrupt: A knock on the door and the presence of another person sometimes helps to calm things down.

Training & Preparedness

• De-escalation training: Learn verbal de-escalation techniques and crisis intervention skills. Training should cover early recognition of escalating behavior or recognition of warning signs or situations that may lead to assaults; ways to recognize, prevent or diffuse volatile situations or aggressive behavior.
• Get out of the room: if you suspect the client is getting violent, say you need to use the bathroom or that you forgot to give a staff member a message, or a family member if working from home.
• Self-defense training: Though the priority is always to escape and not confront, it’s important to know basic self-defense technique to prevent physical harm, avoid a lunge, and break free from a violent person’s grip.
• Emergency plan: Have a clear, practiced plan for various scenarios (active threat, medical emergency, etc.). Include a “safe room” to hide in case someone goes on the rampage. Make sure you have an evacuation plan.

High-Risk Situations

• Consider alternative settings: For clients with significant violence history, consider seeing them in settings with more security (hospital, clinic with security staff).
• Consultation before acceptance: For high-risk referrals, consult with colleagues or supervisors before agreeing to treat.
• Know when to refer: Recognize when a client’s needs or risk level exceeds your setting’s safety capabilities.

After-Hours & Telehealth Considerations

• Limit after-hours appointments: Arrange your appointments so you’re not working alone in the building at night. If working with a potentially violent client, make sure someone is around and knows your schedule.
• Telehealth for high-risk clients: Consider virtual sessions when safety is a concern.
• Secure personal information: Keep home addresses and personal contact information private. This may not be possible if you work from home. (This is when a thorough pre-screening is crucial.)

Therapists in small private practices face additional potential hazards because many do not have the staff or other practitioners working in the same office. Students receive virtually no training. Maybe because we see ourselves as “good people who understand and help others,” we don’t see ourselves as potential targets. I encourage you to think again.

Document Everything

I wouldn’t be the Documentation Wizard if I didn’t remind you to keep detailed notes about threats, concerning statements, aggressive behavior and consultations you may get. Include all documentation in the client’s chart.

Personal Safety First

According to the US Bureau of Labor Statistics, health care and social service workers are five times more likely to suffer a workplace violence injury than workers overall. That was in 2018. Incidents are on the rise.

Rebecca’s attacker had served nineteen years for kidnapping, burglary, and two counts of sexual assault. Rebecca was specially trained to work with sex offenders and believed passionately in the power of relationship and redemption. This devastating tragedy proves that even expert therapists working with high-risk populations can become victims of workplace violence. There are no guarantees.

Most clients are not violent, and most assaults do not result in serious injury. But when they do happen, they can be physically and emotionally devestating. Being trained and prepared can still save your life.

Please, please, please do not postpone doing an assessment with each client, discussing this issue with colleagues, landlords, office mates, and employers, and taking the steps to protect yourself. Despite our best intentions, every incidence of violence or abuse cannot be anticipated or avoided. Yet, it is still up to us to develop and implement protocols. We owe it to ourselves to do it.

Our compassionate understanding of a client’s behavior may not be enough to calm down an aggressvie and violent client. My advice – get training, implement protocols, err on the side of personal safety, and enourage your colleagues to do the same. This is how we honor the memory of Rebecca White, LMHC.