How Circe Manages Clinical Risk in Group Therapy: A Guide for Health Professionals
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Published by Circe Practice Room | Clinical Governance | Professional Resources
Clinical governance is not a secondary consideration in therapeutic practice. It is the foundation on which safe, effective care is built. For health professionals considering referring a client to Circe, or for those who simply want to understand how clinical risk is managed within a group therapy model, this article sets out our framework in full.
Group therapy carries specific governance considerations that differ from individual therapy. Circe's clinical risk protocol is designed to address each of these considerations directly.
Before a Client Joins: Assessment and Inclusion
The first layer of risk management happens before a client attends a single session.
Every client who applies to join a Circe group completes a structured clinical assessment at intake. This assessment covers current symptoms, mental health history, risk indicators, and suitability for a group therapy format. It is not a formality. It is a clinical gatekeeping function that protects both the individual client and the integrity of the group.
Where the assessment identifies risk indicators that fall within a manageable range, the therapist initiates a private discussion with the client to explore further, determines whether the group remains the appropriate treatment, and considers whether individual support is needed alongside group participation. In these cases the therapist may encourage GP contact for medical assessment, offer referral to individual counselling or psychological support where indicated, including Mind, NHS Talking Therapies, and the BACP directory, and document the discussion and agreed next steps in clinical notes.
Where the assessment identifies risk at a level that places the client outside the scope of what group therapy can safely provide, the client will not be accepted into the group. She will be directed clearly toward more appropriate clinical support with referral information provided. Depending on the nature and urgency of the risk identified, this may include her GP for immediate clinical review, NHS Talking Therapies via self-referral, specialist mental health services via GP referral, NHS 111 for urgent support, or 999 and emergency services where there is immediate risk to life. This decision is made on clinical grounds and is communicated with care.
Risk Monitoring During the Programme
Clinical risk is not assessed once at intake and then set aside. It is monitored at all stages of the programme: at assessment, within sessions, and at agreed review points throughout.
The therapist maintains ongoing awareness of each client's presentation across the course of the group, noting changes in mood, engagement, disclosure content, and behaviour that may indicate elevated risk. Where concern arises between formal review points, the therapist acts on clinical judgment rather than waiting for a scheduled review.
All risk assessments, decisions, and referrals are documented clearly and in a timely manner in clinical notes, in line with professional, ethical, and legal obligations.
Risk Expressed During a Group Session
Disclosures of significant distress or risk can arise within a group session. Circe's protocol for managing this is structured and specific.
Where a client expresses thoughts of harming herself or others during a session, the therapist will contain the group by respectfully acknowledging the disclosure and managing the group dynamic to maintain the safety and stability of all members present. The therapist will then arrange a private conversation with the disclosing client as soon as possible outside the group session.
In that private conversation, a structured risk assessment is conducted covering intent, plan, means, timeframe, and protective factors. Where the risk assessment indicates that additional support is needed, options are discussed collaboratively with the client. These may include GP referral, crisis line signposting, or referral to individual therapy.
Where imminent risk is identified, the therapist will act in line with safeguarding responsibilities. This may require breaking confidentiality to contact relevant emergency services, the client's GP, or next of kin. This decision is made in accordance with professional, ethical, and legal obligations and is documented fully in clinical notes.
Risk Arising Between Sessions
Clients are informed explicitly at the outset, in both the initial client agreement and the group introduction, that Circe's group therapy is not an emergency service. This is a clinical and ethical necessity. It ensures that clients have accurate expectations of the service and are equipped with the appropriate crisis pathways before they need them.
All clients are provided with the following crisis resources at the start of the programme:
Contact your GP for non-emergency support and clinical guidance. Call NHS 111 for urgent medical support that does not require emergency services. Dial 999 if in immediate danger of harming yourself or others. Contact Samaritans on 116 123, free and available 24 hours a day, seven days a week.
These resources are provided in writing and reinforced verbally within the group where clinically appropriate.
Domestic Violence and Safeguarding
Domestic violence and abuse disclosures require a specific clinical response that sits within Circe's broader safeguarding framework.
Where a client discloses experiences of domestic violence or abuse, the therapist will offer a private and confidential space to explore the disclosure safely, separate from the group context where necessary. The client is provided with information on specialist domestic violence services and support networks, including the National Domestic Abuse Helpline on 0808 2000 247, free and available 24 hours a day, seven days a week.
The therapist encourages the client to consider contacting her GP or relevant safeguarding agencies and assesses any immediate safety concerns for the client and any dependents, including children and vulnerable adults.
Where there is an immediate or serious risk of harm to the client or others, the therapist may be required to share information with safeguarding services or emergency services in line with legal and professional responsibilities. All disclosures and actions are documented clearly in clinical notes.
Therapist Responsibilities
Circe's clinical risk protocol places explicit responsibilities on the therapist delivering the programme.
The therapist monitors clinical risk at all stages of therapy including assessment, sessions, and reviews. Clear and timely documentation of risk assessments, decisions, and referrals is maintained throughout the programme. Clients are provided with information about crisis resources at the outset and this is reinforced where clinically appropriate.
All practice is conducted in line with professional, ethical, and legal obligations, including duty of care and safeguarding responsibilities. Where clinical decisions involve significant risk, the reasoning behind those decisions is documented to a standard that meets professional requirements.
Client Responsibilities
Circe's risk protocol operates as a shared clinical framework. Alongside the therapist's obligations, clients are asked to engage honestly in assessments and discussions about their wellbeing, to inform the therapist promptly if experiencing thoughts of self-harm or harm to others, and to use appropriate crisis resources outside of therapy sessions if at risk.
This shared framework is communicated clearly at intake and reinforced at the start of the group programme. It is presented as a collaborative clinical agreement that supports the safety of every member of the group.
Termination of Therapy and Step-Up Pathways
Circe reserves the right to withdraw a client from the group where it is deemed clinically unsafe for her to continue in a group setting, or where she requires a higher level of care than the group format can provide.
This decision is not taken unilaterally or without clinical justification. Where termination is indicated, the therapist discusses the decision with the client, provides referral recommendations, and supplies information on appropriate alternative services. The aim is a safe and supported transition to the right level of care.
Step-up pathways may include GP referral for medication review or onward referral, NHS Talking Therapies for individual psychological therapy, specialist mental health team involvement, or in acute cases emergency services or inpatient care.
Where a referring professional has been involved in a client's care, they can be informed of a step-up transition with the client's consent.
What This Means for Referring Professionals
For health professionals referring a client to Circe, the clinical governance framework described in this article means the following in practice.
Your client will be assessed before she joins the group. If she is not appropriate for the group format at this point in time, she will be told clearly and directed toward more appropriate support. She will not be placed in a group that is not clinically right for her.
If risk emerges during the programme, it will be managed within a structured protocol by a qualified therapist. If your client requires a higher level of care than the group can provide, Circe will manage that transition and can inform you with her consent.
If you have clinical concerns about a referred client at any point, the appropriate route is direct communication with the Circe team rather than an assumption that the group is managing it. Get in touch here.
Circe welcomes clinical dialogue with referring professionals. If you have questions about any aspect of the risk protocol that are not addressed here, we encourage you to reach out directly.
Circe offers clinically facilitated group therapy for women. To discuss a referral or request a copy of the full clinical risk protocol document, contact the Circe team here.
Frequently Asked Questions
How does Circe assess whether a client is appropriate for group therapy before she joins?
Every client completes a structured clinical assessment at intake covering current symptoms, mental health history, risk indicators, and suitability for group therapy. Where the assessment identifies presentations outside the scope of the group, the client is directed to more appropriate support rather than being accepted into the programme.
What happens if the intake assessment identifies elevated risk?
Where risk indicators fall within a manageable range, the therapist initiates a private discussion, encourages GP contact, considers whether individual support is needed alongside the group, and documents the discussion and agreed next steps. Where risk is at a level that places the client outside the scope of group therapy, she is not accepted into the group and is directed to more appropriate clinical support.
How is risk managed if a client discloses distress during a group session?
The therapist contains the group, acknowledges the disclosure, and arranges a private conversation with the client as soon as possible. A structured risk assessment is conducted covering intent, plan, means, timeframe, and protective factors. Where imminent risk is identified, the therapist acts in line with safeguarding responsibilities, which may include contacting emergency services, the client's GP, or next of kin.
What crisis support is available to clients between sessions?
Clients are informed at the outset that the group is not an emergency service and are provided with clear crisis pathways: GP for non-emergency support, NHS 111 for urgent medical support, 999 in an immediate emergency, and Samaritans on 116 123, free and available 24 hours a day.
How does Circe handle domestic violence disclosures?
The therapist provides a private and confidential space to explore the disclosure, supplies information on specialist services including the National Domestic Abuse Helpline (0808 2000 247, free, 24/7), assesses immediate safety concerns for the client and any dependents, and where there is serious risk of harm will share information with safeguarding or emergency services in line with legal and professional obligations.
What documentation standards does Circe maintain?
All risk assessments, decisions, referrals, and significant clinical conversations are documented in clinical notes clearly and in a timely manner, in line with professional, ethical, and legal obligations.
Can Circe remove a client from the group if her needs exceed what the group can provide?
Yes. Circe reserves the right to withdraw a client where it is deemed clinically unsafe for her to continue in a group setting or where she requires a higher level of care. Referral recommendations and information on appropriate alternative services are provided and the transition is managed with clinical care.
Will I be informed if my referred client is stepped up to a higher level of care?
Yes, with the client's consent. Where a client is transitioned out of the group to a higher level of care, the referring professional can be informed.
How can I raise a clinical concern about a referred client?
Contact the Circe team directly. Direct communication between Circe and referring professionals is encouraged at any stage of the referral process or programme. Get in touch here.
Can I request a copy of Circe's full clinical risk protocol?
Yes. Referring professionals who want to review the full protocol document can request it directly from the Circe team.
This article is intended as a professional resource for health professionals and does not constitute legal or regulatory advice. Circe operates within standard clinical, ethical, and legal frameworks applicable to psychological therapy services in the UK.