Assessing Risk

By Cindy Kuzma

September 2026

Counselors are trained to assess and recognize risk, as well as to understand what might be beneath the surface when someone displays aggressive or violent behavior.

Yet this skill set and the empathy involved in the work can lead counselors to minimize their own odds of facing danger, says Krystyne Mendoza, PhD, LPC, NCC, who practices in Texas and Colorado. “We know the risk and we see the risk, but we can develop tolerance to it in a way that can be blindsiding,” she says.

Following the murder of licensed mental health counselor Rebecca White by a former client at her Orlando, Florida, office in January, many in the profession are examining their own safety protocols and asking questions about systems and supports, especially in higher-risk settings.

Reducing counselor risk isn’t about stereotyping or stigmatizing clients or diagnoses. People living with mental health concerns are far more likely to be victims of violence than perpetrators, says Jessica Meléndez Tyler, PhD, LPC-S, NCC, an associate professor of the practice and program director at Vanderbilt University, as well as a private practitioner.

However, counselors work with people carrying significant trauma, distress and hopelessness, which are factors that may increase the potential for impulsive or aggressive behavior. Knowledge of the risk is an important first step, says Janet Kempf, PhD, LPC, ATR-BC, assistant professor and clinical internship coordinator at Old Dominion University. Kempf is the first author of a 2023 study in the Journal of Counseling & Development that found about three-fourths of counselors nationwide had experienced psychological or physical violence initiated by clients.

From there, the goal is to plan and create a safe space protecting both clinicians and clients. “I encourage counselors to think about safety the same way we think about informed consent, confidentiality or suicide assessment, not because we expect something bad to happen, but because it is part of competent, ethical practice,” Tyler says.

Understanding the Risk

Some diagnoses, such as antisocial personality disorder, are associated with an increased risk for violence, says Wendy Eckenrod-Green, PhD, NCC, professor at Radford University. Circumstances and risk factors that can contribute to elevated risk include intoxication, substance withdrawal, active homicidal ideation, forensic involvement, involuntary treatment or acute crisis.

Settings where these situations occur frequently include emergency departments, inpatient units, crisis stabilization programs, correctional settings, mobile crisis teams and community-based services. Private practitioners may face an elevated risk if they’re working alone or with clients who are court-involved, part of a high-conflict family situation or experiencing significant crises, Tyler says.

Kempf’s study results confirm the widespread nature of risk. About half of counselors working in a community mental health clinic, outpatient behavioral health agency or vocational rehabilitation center experienced client-initiated violence, as did 47% of those in a private mental health or employee assistance program office. That compares to 29% in a behavioral health unit in a hospital or inpatient unit, 33% on a residential unit of a behavioral health facility and 21% in a forensic setting.

Across settings, exploring the risk of violence during intake should be as standard as taking a family medical history, says Julia Hoge, EdS, LPC-MHSP, NCC, co-founder of The Village Well Counseling & Psychotherapy in Nashville and an adjunct professor at Vanderbilt University. Counselors should directly ask about topics such as past violence, hospitalizations and coping skills. Formal risk assessments such as the Historical-Clinical-Risk Management-20, Classification of Violence Risk and Broset Violence Checklist can establish baselines and open conversations — but they don’t replace clinical judgment.

Risk assessment isn’t a one-time task, either. Tyler, who has experienced harassment and threatening behavior from former clients, learned that concerns often appear gradually.

“Looking back, there were moments that seemed small at the time: repeated boundary testing, attempts to access personal information, escalating contact outside of sessions and difficulty accepting limits,” she says. “Most of these situations never become dangerous, but they can provide important information.”

When concerns arise, consultation is essential. In some cases, the most ethical decision is to refer a client elsewhere, with continuity planning and clear communication. “The goal is never to reject a client. The goal is to connect them with the safest and most appropriate care possible,” Tyler says. Developing networks of counselors and other professionals in your area can facilitate the process, Eckenrod-Green says.

In these processes, counselors should be aware of countertransference and bias. Countertransference may lead counselors to either become more restrictive or risk-averse than necessary or to minimize concerns, Tyler says. In consultation and supervision, counselors can examine bias related to race or other demographic characteristics and also recognize and learn from countertransference, Hoge says.

Preventing and Managing Threats and Violence

All agencies, hospitals and organizations that provide clinical care should have safety protocols to prevent workplace violence and take action when it happens, says Kempf, who began researching and speaking about the topic after her own experience of being hurt by a client.

Counselors — including those who are part-time or contract — should receive site-specific training, with verbal and physical de-escalation components. Those in private practice may have to seek training and create safety protocols for themselves if none are in place on-site. (Read more about workplace safety.)

Informed consent documents can specify the consequences of aggression or violence, says Logan Bell, LMHC, clinical director and owner of Sigma Centrum Counseling LLC and the Florida Therapist Network, of which White was a member. His office, for instance, has a zero-tolerance policy: If a client becomes threatening, they’re discharged and referred.

When aggression emerges during a session, counselors must first regulate themselves. Staying calm can have an impact on your client, allowing them to “borrow your nervous system,” Hoge says.

When boundaries are violated, counselors can enforce them by activating protocols and ending the session, with appropriate follow-up and documentation. It’s also helpful to know your organization’s policies for contacting law enforcement — or if you’re in private practice, your threshold for doing so. “If a client is in a state where they can’t make decisions for themselves, calling the police for help [to keep] both the counselor and the client safe is supportive to their system,” Hoge says. Request a crisis intervention team (CIT) or CIT officer, if available in your area, as they are trained for mental health crises.

Staying Safe Outside the Office

Safety considerations extend to other locations where counselors provide treatment, including in homes and outdoors. In Kempf’s study, 32% of counselors experienced violence in a home setting.

Security measures for counselors conducting in-home or outdoor counseling include identifying the nearest emergency services, telling someone where you’re going and for how long, and carrying a silent alarm or a safety item such as pepper spray. De-escalation and other crisis counseling skills — along with clear boundaries — are critical in these settings, as well.

Consider taking someone with you to in-home visits, especially the first time, Hoge says. When Bell does these sessions, he wears loose-fitting clothing that won’t restrict movement and puts his identification badge on a breakaway lanyard. When he arrives, he surveys the room, noting the exits.

You may also consider parking farther away and dressing in a non-descript manner, as well as staying alert for curiosity from clients or others that might push boundaries, such as asking to follow you on social media, Hoge suggests.

Counselors can also learn from related professionals, including social workers and child protective services, Mendoza says. For example, the National Association of Social Workers’ safety guidelines recommend a thorough risk assessment before every home visit that considers factors such as neighborhood crime, other people and pets in the home, and firearms in the home.

Training the Next Generation

Educators and supervisors play a key role in preparing new counselors to practice safely, including in higher-risk environments. Kempf’s research underscores that importance: More than half of violent incidents took place during training or within the first four years of licensure.

Mendoza is also a clinical associate professor and director of the online counselor education program at Marquette University. Before her counseling students see clients, she asks them to think through what they would do if someone threatened their safety or presented with suicidality or homicidality. “I don’t want to teach them to catastrophize,” she says. “But it’s going to be scary if it happens, and it’s much more difficult to think clearly as to what you need to do in the moment.”

At every practicum or internship site, students should learn protocols for preventing and managing threats. Supervisors can support this education. “Following trauma-informed supervision protocols is important,” Kempf says. “Check in with the wellness of interns or supervisees, make sure you know how they feel about their own safety, and advocate for them to have the same kind of systems in place that everyone else at the site does.”

As counselors progress in their practice, this guidance can continue. When Bell supervises post-graduate counselors, he ensures they receive appropriate training, shares safety protocols and oversees their treatment planning for higher-risk clients to confirm that homicidality, suicidality and violence are addressed in counseling.

Building awareness and planning into counselor training can establish a foundation of safety and a recognition that doing so supports compassionate care rather than being at odds with it.

“I can’t imagine the kind of work counselors could do — even more beautifully than they’re already doing — if every clinician in every space really felt safe and knew exactly what to do when they didn’t feel safe,” Hoge says.