Analogy

Risk can be thought of as a three-legged stool, or tripod - if any one leg breaks the whole will fall.

The three 'legs':

1. Risks for the client
2. Risk for other people
3. Risks for the worker

Risk and Mentalizing - an Assumption:

Risk is highest at those times when Mentalization fails:

1. Mentalization in the young person/family
2. Mentalization in the worker
3. Mentalization in the people (networks) around the Young Person

These are times when non-mentalizing interactions, particularly Teleological thinking, can easily and quickly erupt - common examples are violence, "dramatic" interventions (that may herald unwanted effects - such as absconding and increased vulnerability, direct side effects from medical interventions, or non-coordinated actions by agencies, etc).

Managing Risk, not Abolishing it

Working with impulsive young people, whose capacity to plan, predict risk, and consider the consequences of actions is often severely challenged, is always risky. This is one of the reasons why we stress the fact that one the KeyWorker's role is to manage their own anxiety. There are a variety of "positions" ("Abdication", "Fan Club" and "Persecutor" that can be adopted by any practitioner or service in relation to risk, which are helpful to consider. These are spread out in the territory between efforts to hold a balance between:

• CONTAINMENT (nurturance, safety, responsivity, sensitive attunement)
• CHALLENGE (promotion of concrete changes, termination of non-mentalized Pretend mode patterns of behaviour, etc).

The important point is to avoid an overly rigid position, but to maintain a thoughtful (Mentalizing) journey towards the territory of change. For further material on this, see the dynamic balances involved in Active Planning in the team culture, and the broader principle of Holding the Balance as part of the The Therapist's Mentalizing Stance.