Safety is a Myth so Know That Your Patients May Kill You at Any Moment

When a client arrives at the office suite I share with a few other clinicians, there is a buzzer to press which notifies the therapist of his or her presence. The therapist presses a button next to his chair, which unlocks the door so the client can enter the waiting room suite. Per the request of one of the Psychologists, anyone who is within arm’s reach of the button should buzz in whoever is at the door. This is in case one therapist has stepped out to pick up some coffee or use the restroom and therefore doesn’t force the client to stand in the hallway until he or she returns.

For at least the third time in the past month, the mechanism that unlocks the door broke. It’s annoying because every clinician who is expecting someone now has to get up, walk out into the waiting room and open the door, possibly interrupting a session. One of the therapists in my suite – the same one who turned into a screaming ball of anger at the loud clients a few months ago – made what some might consider a bold move: released the dead bolt on the door so that it is always unlocked and put a handwritten note on the door that said, “Buzzer is broken, please come in.”

Apparently, this angered and worried the managing company of the building. That pleased me tremendously because, as discussed, management and I don’t like each other. So to see them up in arms over something ridiculous as an unlocked door in a massive office building is sweet revenge for their besmirching of my name.

When I saw one of the custodial people he asked if I was ‘worried’ about the buzzer.

“Why would I be worried?”

“You know, safety. Anyone can get in there now and stab you to death. Announcing that your buzz is broken is just an invitation for trouble.”

After Dr. Kathryn Faughey was killed last year by a client, the mental health community went up in arms about protecting the providers. Doormen were added to previously unattended lobbies, video cameras got installed into office suites and, of course, buzzers were bought up like iPods to place in every shrink’s place of work. Some therapists went so far as to add an intercom system so they could communicate with whoever was at the door. This helped to create the illusion of safety. And that’s exactly what true safety is, an illusion. Complete and total safety is a myth.

I’ve said this before but it bears repeating. If a client (or anyone else for that matter) wants to kill you, he will. No buzzer will change that. All that does is make it slightly less convenient for him to do it, because he’ll have to wait for you to let him in the office, rather than bursting through in a more dramatic fashion. If you put a doorman out front, he’d have to strip search each client for anything that could be construed as a weapon. And if this killer is paying even the slightest bit of attention to this office environment, he’ll wait for you to leave work for the day and kill you outside. It’s just that simple. But the buzzer gave some of the therapists that illusion that the office was protected from toxic forces. It wasn’t and never will be.

One of the hallmarks of self-medicating for anxiety is the erroneous mindset that one can guarantee a lack of self-harm, that “everything will definitely be alright.” Hypochondriacs go to the doctor incessantly to hear the magic words, “you’re fine.” This is only an educated guess. The actual answer that a physician should give is “you are probably fine. I can’t possibly run you through every possible test for every single disease or condition and I have no clue if you have the smallest tumor growing somewhere that we can’t see, but from what I can tell, you seem okay to me.” That’s the best anyone can hope for.

This would be an unsatisfactory answer for the patient, however. Even though we know that routine physicals simply rule out the usual suspects that can harm us, we love to think that we are completely safe and healthy. The doctor said so, so it must be a guarantee. It is not. And even if it were, what about tomorrow? Are you sure that even though you’ve been guaranteed picture perfect health today, you’ll be in the exact same condition tomorrow?

When clients are struggling in their relationships, they need to make a change. For some this involves acting in new ways toward their partners. And when the clients say, “but that might not work,” or “but he might leave me if I do that,” the answer from me is invariably the same:

You are 100% right. It may not work. He may leave. If you make this change, it could very well make you immeasurably more happy. But make no mistake: nothing is risk free.

For someone with anxiety this can be a crippling message. They are so used to concocting ways to cover all the bases. The clients with OCD believe that washing just enough will eliminate the germs, rendering them uncontaminated (i.e., “safe”). Dr. Gail is a trembling, neurotic mess when it comes to addressing the interface of being a Psychologist with being a member of the community. She goes to great lengths to make sure her clients have no idea where she lives, at what gym she works out, or where she shops. The reality is that if a client wants to know any of that stuff, he’ll just follow you home after work. But she simply refuses to believe that there is no escape from this fact.

However, the good news surrounding this sobering message is two-fold. First, the idea that real safety is an illusion can be quite liberating. The pressure to engage in the grueling mental calculations to create this bogus Utopia can be jettisoned. Second, by replacing multiple regression designed to account for every factor of life with more calculated risks, you can live a happier life. No one can say that it’s a great idea to ignore violent chest pains or to walk down the dark alleys of dangerous city streets simply because there are no guarantees in life. Reasonable calculation of risk isn’t frowned upon; in fact, it’s encouraged in the psychological world. But it’s at that moment of delusion, where you think you can account for every variable, that you believe you can become “completely safe,” that you’ve set yourself up to be miserable. Because you’ll eventually see the truth: anything other than relative safety is a myth.

So while management freaks out at the fact that a homicidal maniac can no longer be deterred by the $3.99 plastic buzzer sitting next to my therapist’s chair, we know differently. And by not obsessing over what we cannot control, we can simply be happier than them. Without question, I’d love that.

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15 Responses to “Safety is a Myth so Know That Your Patients May Kill You at Any Moment”

  1. Patrick says:

    Great post Dr. Rob.

  2. sandyphd says:

    Reminds me of the controls put into place in our public schools post Columbine shootings. As if the sign that says, “all visitors must stop by the front office ands sign in” will deter someone carrying an AK-47. A killer will be even less hindered because those of us in the building who might spot gun toter and call the police are too busy filling in the check boxes at the front office.

  3. Dorothy says:

    This is why I love mindfulness-based methods. It trains the mind to be with the fear and the anxiety rather than cover it up. It’s not for everyone but it’s powerful. I wonder if they have tried it with OCD populations. I know the research has been pretty well funded since 2005, thanks to John Kabat Zinn.

  4. Amber says:

    I wish it were as easy as just letting it go to find an ounce of peace…but I’m a mom…and it’s my son’s safety that I worry about, nearly obssess over. I think it’s part of being a mom though…not being able to let it go.

  5. Clindos says:

    We humans love the illusion of saftey. People just don’t relize that if someone wants to harm you, they ca neasily accomplish their goals. All this hypped up security everywhere, yet I can still get through airport security with a 1″ blade on my keychain/bottle opener. Hell, you can kill people with a pencile, and yet others will think a little plastic buzzer will keep them safe. You are totally right Dr. Rob. To me a life filled with a false since of security is worse then a life filled with the fear of harm. But, thats just my opinion. Part of the reason I like living in Texas is that I know if a shooting happns at my local gathering place, everyone around me is also packing heat. The only security you have is what you provide yourself.

  6. My false sense of security went out the window on 9/11. I was actually lamenting about it the other day on my blog. Small world.
    As for work….”reasonable precautions” is what I shoot for, since we can’t account for everything. If anyone wants to really freak about their safety, talk to a prison worker about what prisoners have used to kill people. The average person in society has access to far more deadly options.
    Sleep well!

  7. Wayland says:

    Why don’t they install a small monitor with the buzzer. The monitor would be wired to a camera near the door. That would be “safer” right? Good stuff man. Hope things are going pretty well for you.

  8. Anonymous says:

    Right now, the US Military won’t take you if you’re taking psychoactive drugs. It’s an instant disqualification.
    What do you make of that?
    Dr. Rob: Depending on the drug, it’s an idiotic position. If you feel NOT depressed on Celexa, isn’t that a better situation than being depressed/not functioning and not on anything? If Xyprexa stops the voices, isn’t that more fortunate than being not medicated and having your thoughts disrupted? Each of the first two candidates seem like they would make better soldiers.
    That being said, if someone could show me that any form of relapse for certain conditions would compromise the requirements of military service, I’d have to consider that data. Meds don’t necessarily eliminate the disorders, whether that be temporary or permanently.
    In other words, a case-by-case basis should be the approach.

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  15. copysquirl says:

    Reminds me of a big client I work for that has a security check point form they ask you to sign asking if you are (1) a felon or (2) dangerous or (3) carrying any weapons concealed. Because no dangerous felon would LIE would they? I mean, hey, that’ll stop them from getting in the door.