The risks that come with the therapy room

Mental health clinicians are trained to sit with distress, not to fear it, and most clients are far more likely to be harmed than to harm anyone. But the work itself carries real risk. When the Health and Community Services Union and researchers surveyed Victorian mental health services staff, including psychologists, nurses and social workers, 83 per cent reported exposure to at least one form of workplace violence in the previous 12 months. Verbal abuse was the most common at 80 per cent, followed by physical violence at 34 per cent.

Private practice is not immune. In a study of Australian psychologists published in 2005, 19.5 per cent of respondents had been stalked by a client for two weeks or more. Most changed the way they practised as a result, and 29 per cent considered leaving the profession. Across medicine more broadly, a national survey of 9,449 Australian doctors conducted in 2010 and 2011 found that 32.3 per cent had experienced physical aggression in the previous 12 months.

The risk comes from the shape of the work:

• One to one, behind a closed door. Confidentiality means soundproofed rooms and no one else present, which protects the client and isolates the clinician.
• People at their most unwell. Acute psychosis, mania, severe agitation, intoxication or withdrawal can change a person's behaviour quickly and unpredictably, through no fault of their own.
• Clients who did not choose to be there. Forensic, involuntary and court-ordered clients may see the clinician as part of the system working against them.
• You often deliver decisions people do not want. Treatment orders, court or parole reports, a refused prescription or ending therapy can all trigger anger.
• The boundary problem. For a small number of clients, the closeness of therapy turns into fixation, unwanted contact, turning up at the clinician's home, or online harassment.

When a session starts to turn

Violence in a therapy room rarely comes out of nowhere. There is usually a build up, and the clinician is best placed to notice it, if they are not too absorbed in the clinical task to see the room.

Picture a late afternoon appointment at a community mental health clinic after reception has gone home. A client who has been stable for months arrives smelling of alcohol, saying the treating team has been sharing their information with police. They take the chair nearest the door instead of their usual one. As you gently raise the possibility of a medication review, they stand, start pacing, and stop between you and the only exit, fists clenching and unclenching while they talk over you.

Nothing physical has happened, and the person is frightened, not malicious. But you are in a small room with no clear way out and the duress alarm on the far wall. What you do in the next minute shapes whether this ends with a call to the crisis team or with someone hurt.

Why policy and de-escalation training only go so far

Employers in Australia have a legal duty to manage the risk of workplace violence and aggression, including from clients and patients. Safe Work Australia describes it as incidents where a person is abused, threatened or assaulted while at work, and in Queensland the Managing the risk of psychosocial hazards at work Code of Practice 2022 (in force since 1 April 2023) names violence and aggression as hazards a business must identify and control.

Mental health services usually have good controls in place: risk assessment, duress alarms, seating plans, two-person reviews for high-risk clients and de-escalation training. Clinicians also work within strict limits on physical intervention. National principles aimed at eliminating mechanical and physical restraint in mental health services treat restraint as a last resort and put recovery-oriented, trauma-informed care first. That is exactly right for patients, and it is the reason clinicians need a different kind of preparation.

Most de-escalation training happens seated, in a classroom, at a calm heart rate. Under real threat, people freeze, talk too fast or forget the alarm entirely. And if de-escalation fails, policy is often silent on the seconds between someone grabbing your wrist and help arriving.

What protective self defence offers a clinician

For clinicians, self defence is never about controlling or hurting a client. It is about keeping yourself, and the person in front of you, as safe as possible until things settle or help arrives. Good training builds five practical capabilities:

• Earlier awareness. Recognising pacing, a changed voice, fixed staring, clenched hands or a shift in where someone stands, so you can respond while the situation is still verbal.
• Room layout and positioning. Choosing a seat with a clear route to the door, keeping a comfortable distance and moving calmly to a safer position early.
• De-escalation that holds under stress. A steady voice, open hands and respectful boundaries, practised with your heart rate up, plus knowing when to pause or end the session.
• Protective physical skills as a last resort. Simple, low-harm ways to protect your head, release a wrist or clothing grab, move past someone in a doorway and leave. Australian law generally allows force that is reasonable and necessary to protect yourself, and for clinicians the aim is escape and safe disengagement, not restraint.
• Composure. Clinicians who feel physically capable stay calmer, and that steadiness supports the therapeutic relationship rather than undermining it.

Awareness also extends beyond the room. Noticing when you are being followed and staying alert in car parks after a late session matters for clinicians dealing with boundary violations or stalking.

How Arakan supports mental health teams

Arakan Martial Art has been teaching for more than 30 years and has trained tens of thousands of people, from children to executives, professional athletes, law enforcement and military personnel. Our workplace workshops are trauma-aware and safety-first, which matters to a profession that understands trauma better than most.

A workshop for a private practice, community mental health team or hospital psychology and psychiatry department can focus on:

• reading early warning signs and responding while a conversation is still a conversation;
• setting up and moving around a consulting room so your exit stays open;
• staying calm and clear when adrenaline hits, so you can use your de-escalation skills and your alarm;
• protecting yourself and getting out if someone grabs you, blocks the door or comes towards you;
• personal safety outside the clinic, including car parks and being followed.

Sessions are led by full time professional instructors and are designed so that everyone can take part, whatever their age or fitness. Formats range from 90 to 120 minute intensives to half day and full day workshops, ongoing team programs and executive private coaching, and can be built into a team day, conference or wellness program.

Why Arakan suits clinicians better than a dojo or the ring

Competition and traditional martial arts have value, but neither was designed for a consulting room with two chairs and one door.

• Never a ring sport. Arakan is a Burmese martial art that has never been a ring or competition style. There is no winning in a therapy room, so we do not train as if there is.
• Built for small spaces. Training covers confined spaces, doorways, furniture, vehicles and situations with more than one person, because that is where clinicians actually work.
• Adaptable principles, not routines. Movement, balance, timing and positioning that work whether you are seated, standing or backed against a wall, not fixed sequences.
• Awareness and responsibility first. Avoidance, de-escalation and legal responsibility are central, which sits comfortably with a duty of care and professional codes of conduct.
• No egos, no aggression. Workshops challenge people without intimidating them, so clinicians leave more composed, not more combative.

This article is general information only and is not legal, clinical, safety or professional advice. Always follow your service's risk and safety procedures, your professional code of conduct and any restrictive practice requirements, and contact police on 000 in an emergency.