Therapists Are Bound to Protect the Confidentiality

¶ … Therapists are bound to protect the confidentiality of patients, except when the patient poses a risk to him or herself or to others.

Identify the potential issues involved.

The therapist is bound to report if a client has made credibly threatening gestures. The therapist must evaluate the client's words and actions to see if they are genuinely fall under the guidelines of breaking confidentiality.

Review the relevant ethics codes.

Counselors have a duty to warn the authorities when patients pose a potential risk to themselves and to others.

Know the applicable laws and regulations.

All states have 'duty to warn' laws, but they may vary slightly in wording.

Step 5: Obtain consultation.

In this particular instance, obtaining legal advice would be advisable.

Step 6: Consider possible and probable courses of action.

The counselor could report the threats to the authorities or remain silent.

Step 7: Enumerate the consequences of various decisions.

If the threats are not credible, the relationship between client and therapist is likely to be broken, based upon the client's loss of trust; the client could also face legal difficulties that could impact his fragile state of mental health. He could also lose shared custody of his children. However, if the therapist does nothing, the client's wife and children could meet with real harm, and the therapist would be held liable for remaining silent if the client's threats came to light.

Step 8: Decide on what appears to be the best course of action.

Informing upon the client to the authorities is the best course of action.

Vignette 2

Step 1: Identify the problem or dilemma.

The client is expressing suicidal ideation.

Step 2: Identify the potential issues involved.

Suicidal ideation is common, particularly in patients undergoing the type of extreme stress experienced by this client.

Step 3: Review the relevant ethics codes.

Duty to warn also applies to patients which are imminent dangers to themselves and others.

Step 4: Know the applicable laws and regulations.

Duty to warn laws regarding suicide vary from state to state, in terms of how imminent danger to self is defined.

Step 5: Obtain a consultation

Asking a professional colleague or lawyer to define what is meant by immanent is essential, given that simply talking of suicide does not automatically constitute a legally immanent threat of suicide.

Step 6: Consider possible and probable courses of action.

The therapist could report the client as being at risk of suicide to the authorities or continue with the client's treatment and discuss the client's suicidal ideation at the next session (or beforehand, if the therapist believes it is sufficiently urgent).

Step 7: Enumerate the consequences of various decisions.