The History and Purpose of Duty to Warn in Therapy

The History and Purpose of Duty to Warn in Therapy Basics Print The History and Purpose of Duty to Warn in Therapy By Kendra Cherry facebook twitter Kendra Cherry, MS, is an author, educational consultant, and speaker focused on helping students learn about psychology. Learn about our editorial policy Kendra Cherry Reviewed by Reviewed by Amy Morin, LCSW on November 27, 2019 facebook twitter instagram Amy Morin, LCSW, is a psychotherapist, author of the bestselling book 13 Things Mentally Strong People Dont Do, and a highly sought-after speaker. Learn about our Wellness Board Amy Morin, LCSW on November 27, 2019 BSIP / UIG / Getty Images More in Psychology Basics Psychotherapy Student Resources History and Biographies Theories Phobias Emotions Sleep and Dreaming Duty to warn refers to the responsibility of a counselor or therapist to inform third parties or authorities if a client poses a threat to himself or herself or another identifiable individual.?? It is one of just a few instances where a therapist can breach client confidentiality. Normally, ethical guidelines require that therapists keep information revealed during therapy strictly private. What Is Duty to Warn? The American Psychological Associations Ethical Principles of Psychologists and Code of Conduct specify how and when confidential information can be disclosed. These ethical guidelines suggest that private information can only be disclosed with the permission of the individual or as permitted by the law.?? Legal instances where such information can be revealed include when it is necessary to provide professional services, when obtaining consultations from other professionals, to obtain payment for services, and to protect the client and other parties from potential harm. The specifics of a legal duty to warn vary by state. In most cases:A therapist is required to breach confidentiality if clients pose an imminent threat to either themselves, the therapist, or a third party.The necessary information must be divulged to someone who is capable of taking action to reduce the threat.In most cases, the person who is in danger and law enforcement would be notified. Cases That Established Legal Duty to Warn Two landmark legal cases established therapists legal obligations to breach confidentiality if they believe a client poses a risk to himself or others. Tarasoff v. Regents of the University of California (1976) Legal duty to warn was first established in the case of Tarasoff v. Regents of the University of California (1976) where a therapist failed to inform a young woman and her parents of specific death threats made by a client.?? Tatiana Tarasoff and Prosenjit Poddar met in 1968 as students at the University of California, Berkeley. Poddar came to believe that the two were in a serious relationship, a view that was not shared by Tarasoff. When she expressed that she was not interested in a romantic relationship, Poddar began to stalk her and experienced a serious emotional breakdown. In 1969, Poddar became a patient of a psychologist named Dr. Lawrence Moore at UC Berkeleys Cowell Memorial Hospital. After expressing his intentions to kill Tarasoff to his therapist, Moore alerted campus police and gave his opinion that Poddar required hospitalization and that he posed a danger to himself and others. Poddar was detained briefly but appeared rational and stable, leading police to release him with a promise that he would stay away from Tarasoff. Soon afterward, the director of the psychiatry department at Cowell Memorial Hospital ordered the written letter and therapy notes destroyed. Neither the police nor Poddars therapists warned Tatiana Tarasoff or her family of the threats. Poddar continued to stalk the young woman and on October 27, 1969, he murdered her. Poddar went to the Tarasoff home armed with a kitchen knife and a pellet gun. After a confrontation, Tarasoff screamed for help, at which point Poddar shot her with the pellet gun. She fled into the yard, but Poddar caught her and proceeded to stab her to death with the kitchen knife. He then entered the Tarasoff home and alerted the police. After his arrest, Poddar was ?diagnosed with paranoid schizophrenia, the same diagnosis Moore had initially made. Her parents filed a lawsuit against the therapists and the University of California, Berkeley. They contended that their daughter should have been warned of the danger, while the defendants held that their responsibility was to maintain the confidentiality of their client. The lower courts agreed with the defendants and the case was initially dismissed. The Tarasoff’s appealed the case to the California Supreme Court. While the case was eventually settled out of court for a significant sum, the higher courts 1976 ruling specified that confidentiality was secondary to the publics safety. Jablonski by Pahls v. United States (1983) The case of Jablonski by Pahls v. the United States further extended the responsibilities of duty to warn by including the review of previous records that might include a history of violent behavior.?? The ruling originated from a case in which a doctor conducted a risk assessment of a client, Mr. Jablonski, but did not review Jablonskis history of violence. As a result, the clients girlfriend, Ms. Kimball, was not warned about Jablonskis history of violent behavior. When  Jablonski was released, he then killed Kimball. Duty to warn gives counselors and therapists the right and obligation to breach confidentiality if they believe a client poses a risk to another person. It also protects clinicians from prosecution for breach of confidentiality if they have reasonable suspicion that the client might be a danger to himself or others. Duty to Warn Examples It is important to note that duty to warn only obligates therapists to inform individuals and authorities of any specific threats. They should not discuss the details of their patients care or treatment. Any information that is not relevant to the immediate threat should remain confidential. There continues to be a debate about what exactly constitutes a credible threat. Direct, specific plots to harm to kill another individual would clearly trigger a duty to warn, but in other cases, a therapist must use their best judgment to determine if a less-clear threat presents a serious danger. A few examples of times when a therapist would need to consider their ethical and legal obligations include: A client states that they want to kill a colleague, but do not name a specific individualA patient says that they fantasize about killing a specific person, but then state that they would never actually do itA client as the means to commit harm, such as owning firearms, and expresses extreme anger toward a specific individual but never makes a specific threat An assessment of a potential threat is often considered in the same way that a therapist would assess suicide risk. The therapist might consider the seriousness and specificity of the threat itself, the clients past history of violent or aggressive behavior, and recent symptom progression. Opposing Views While it has been decades since the legal duty to warn was first established, it remains a topic of debate. In 2013, the then-president of the APA Donald N. Bersoff suggested that the Tarasoff ruling was a poor decision. Client confidentiality, he proposed, was paramount and breaching it undercuts the trust that clients place in their mental health providers. Breaking this confidentiality should only happen as a last resort, Bersoff believes.?? Some suggest that had Moore not reported the threats, Poddar may have remained in treatment. Had he continued to receive treatment, perhaps he might have recovered from his obsession and  Tarasoff might not have been killed. However, there is simply no way to know if the situation may have played out in this way. A Word From Verywell Psychologists often face ethical dilemmas and are required to use their best judgment to determine the right course of action. Duty to warn presents a challenge in many instances, but it is one that therapists are legally obligated to surmount. What Ethical Guidelines Do Psychologists Follow?