Ethical Issue...Tarasoff

[Roxanita]

Q- A psychologist has been treating a 48y.o. man for 3 years and now is disturbed by what the man reveals to him in a therapy session. Under which circumstance is the mental health professional required to disregard doctor-patient confidentiality in most jurisdictions by reporting what the man said to the proper peacekeeping authorities?

[Roxanita]

The confidentiality of the doctor-patient relationship between mental health professionals and their patients has come under a great amount of scrutiny in recent years.

It is generally held, in most jurisdictions, that mental health professionals must report serious indications by mentally disturbed patients that they intend to cause harm to individuals or groups, other than themselves, to the proper peacekeeping authorities.

The problem for the mental health professional arises in distinguishing between idle comments and serious threats. Thus, the patient who says that he would like to see France bombed out of existence is unlikely to be making a serious threat unless he describes a specific plan of action.

Likewise, many people have, at one time or another, described the feeling of wanting to kill their boss, but this is also generally considered an idle threat in most cases, particularly if the individual interacts adequately with his boss and coworkers on most occasions.
While the patient who states that he secretly put arsenic in his brother’s food over a three-month period five years earlier may have committed a crime, the mental health professional may judge that this did not really happen, or that the patient does not currently represent a threat to his brother.

However, if a patient states that he is going to kill his girlfriend this coming weekend by shooting her at home, this may very well be a real threat, and should be reported to the proper peacekeeping authorities.