Background and Objective: The high prevalence of adolescent self-harm
within mental health services presents considerable management concerns, exacerbated
by a lack of clear evidence regarding therapeutically effective approaches. This shortfall
perpetuates traditional risk-averse practice, despite likely inadequacies in mitigating
self-harm through failing to address underlying psychological mechanisms. Therapeutic
risk, defined as an approach whereby clinicians support individual risk-taking,
may be an alternative that yields improved recovery outcomes. However, related research
is adult-focused and provides limited detail on its features, practical delivery
and impact on recovery. Consequently, the current study explored the experiences of
professionals delivering a therapeutic risk ethos, including their conceptualisation of it
and its impact on young people.
Methods: Semi-structured interviews were conducted with seven mental health support
workers employed by a residential healthcare provider, which promotes a therapeutic
risk approach. The provider supported service users aged 15 - 20 experiencing complex
psychopathology who, following inpatient discharge, presented a high risk of self-harm
and suicidality. Interview data was thematically analysed.
Discussion and Conclusion: Staff participants provided their understanding of a therapeutic
risk approach, suggesting risk is viewed as positive and beneficial to recovery,
alongside the promotion of service user freedom and flexible therapeutic risk management.
The perceived therapeutic risk incorporates both permission and support, which facilitate
the exploration of underlying feelings and alternative actions. Additionally, therapeutic
risk promotes positive recovery outcomes due to empowered service users having
increased control over their lives. They argued this can reduce psychological distress, encouraging
the development of emotional regulation and adaptive coping strategies.