Abstract
The duty of therapists to warn or protect third parties when a patient expresses a threat was established by the court in the Tarasoff decision. Confidentiality, disclosure, and prediction of violence are clinical, ethical, and legal issues that the therapist must address in the context of a therapeutic relationship. Clinical case material from the literature, as well as cases from the authors' experiences, indicate that when confidentiality is breached and a potential victim is warned, the therapeutic results may be positive, especially if the patient participated in the process. Other methods of protection, such as commitment, use of medications, police involvement, and confiscation of a weapon, may be necessary. Each case deserves individual consideration as to what appropriate and necessary steps should be taken. Through careful assessment of a patient's threats, concern for the patient and victim, adherence to ethical standards of care, and knowledge of the law, one can often protect a victim as well as engage the patient in an ongoing therapeutic relationship.
Footnotes
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Dr. Carlson is assistant professor of psychiatry, community and social psychiatry programs, Baylor College of Medicine, Houston, Texas, and clinical director, Southside Mental Health Clinic. Dr. Friedman is assistant professor of psychology, Baylor College of Medicine, Houston, Texas, and chief psychologist, Ben Taub General Hospital. Dr. Riggert is postdoctoral fellow, Department of Pediatric Oncology, M. D. Anderson Hospital and Tumor Institute, Houston, Texas. Address reprint requests to Dr. Carlson, Department of Psychiatry, Baylor College of Medicine, Texas Medical Center, Houston, TX 77030.
- Copyright © 1986, The American Academy of Psychiatry and the Law
