Staying thoughtful when responsibility and uncertainty meet
Working with risk is one of the quieter pressures of clinical work.
It rarely announces itself clearly. More often, it sits in the background of sessions as a low-level tension. A sense of responsibility that can be difficult to name, but hard to ignore.
I remember the first time I had to act on a client presenting with high risk. It was a complex situation. Risk was not clear-cut, and there were many social factors and barriers involved. On the outside, I remained calm. Internally, I was convinced my heart was beating so hard it might jump out of my chest.
There was an extended period of trying to calm my client, organise emergency supports, and coordinate a careful handover of care. Eventually, it was done. The person willingly went to the hospital and received the immediate help they needed.
Exhausted, I left work that day thinking, I never want to do this again.
For many clinicians, a moment like this becomes a turning point away from working with higher-risk clients. I have heard colleagues speak about similar experiences and how the intensity made them less willing to take on this type of work again.
For me, something different happened.
After time to reflect, to debrief with a senior colleague, and with the support of good supervision, I had a realisation. I could actually be the support someone needed in that moment. I could stay calm and collected enough to hold the situation, even if internally I felt shaken.
More importantly, I learned that without that support and encouragement, I may very well have gone the same way as many others. Stepping back from complexity. Moving away from risk. Choosing work that felt more predictable.
Instead, my work increasingly focused on supporting individuals with extensive trauma, complex life circumstances, and presentations where risk was often present due to diagnosis, history, or personality features.
That is not to say it has been easy. There have been moments in the therapy room that were deeply challenging. But many of those moments have also been some of the most meaningful and rewarding after the fact.
Risk work does not become comfortable. What changes is our capacity to hold it.
Over time, I have noticed that overreacting to risk often comes from the same place as underreacting. A desire to manage our own discomfort. For some clinicians, that discomfort leads to avoidance. For others, it leads to hypervigilance and a pull toward doing more than is clinically indicated.
Neither extreme is particularly helpful.
Clinical responsibility does not mean eliminating risk. It means holding it thoughtfully and proportionately, within the context of relationship, history, and presentation. It means recognising when escalation is protective, and when containment and monitoring are more appropriate.
This capacity develops slowly. It is shaped by experience, reflection, and supervision, not by rigid rules or checklists alone.
The aim is not to feel calm all the time. The aim is to remain thoughtful rather than reactive.
To Sit With This Week
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Notice what happens in you when risk enters the room, both emotionally and physically.
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Reflect on whether your response to risk is shaped more by the client’s presentation or by your own need for certainty.
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Consider the difference between risk that requires immediate action and risk that requires careful holding over time.
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Gently remind yourself that working with risk is about proportionate care, not perfect certainty.
Thank you for sitting with me in the clinical space this week.
Warmly,
Psychologist and Principal, My Thriving Mind