Tarasoff Case: Confidentiality and Informed Consent in Therapy

Introduction

Confidentiality has long been embedded as the foundation of professional social work values. This is primarily because social workers demonstrate honesty and respect by safeguarding the confidentiality of their clients. The significance of confidentiality in social work is reflected in the fact that it forms the basis of the ethical standards governing social work practice. Social workers must protect clients' confidentiality because the nature of their work involves receiving sensitive private information from those they serve.

One of the most influential events demonstrating the significance of confidentiality in social work is the decision in Tarasoff v. The Board of Regents of the University of California. The process of informed consent and refusal plays an important role in confidentiality within the therapist-client relationship.

Tarasoff v. The Board of Regents of the University of California

The California Supreme Court ruled in 1976 that psychotherapists have a responsibility to protect probable victims when their patients behave in a manner that presents significant danger to another person or make explicit threats (Vitelli, 2014). This ruling was made in the case of Tarasoff v. The Board of Regents of the University of California. In this lawsuit, the plaintiffs — Tatiana Tarasoff's parents — claimed that psychiatrists at Cowell Memorial Hospital had a responsibility to warn them of the potential danger posed by Prosenjit Poddar, their patient.

After the Superior Court of Alameda County, California rejected the plaintiffs' action, they appealed to the California Supreme Court. The dismissal had been based on the argument that the plaintiffs failed to provide a valid claim against the defendants — the Board of Regents of the University of California, the police, and the therapists ("Tarasoff v. Regents of University of California," n.d.).

The California Supreme Court made its ruling on the basis that it is more important for therapists to safeguard the public than to preserve confidentiality in the client-therapist relationship. The aftermath of this decision was the enactment of laws mandating all therapists to protect probable victims from potential harm or serious danger posed by their patients or clients. Therapists can fulfill this duty by warning victims directly, taking necessary measures to prevent harm or danger, and notifying law enforcement agencies directly. More background on the case can be found at Wikipedia's overview of the Tarasoff decision.

Link to the Therapist-Client Relationship

The decision in Tarasoff v. The Board of Regents of the University of California has considerable implications for the therapist-client relationship in relation to confidentiality. The connection between the ruling and this relationship is evident in the fact that the case focused on examining the degree to which psychotherapists have a duty to protect third persons facing safety threats from their patients or clients. In the therapist-client relationship, psychotherapists are required to warn third parties of potential dangers of physical harm arising from the therapist's patients (Nesbitt, 2013, p. 747).

Since the ruling is now followed by therapists in many jurisdictions, it has contributed to meaningful changes in the therapist-client relationship with respect to confidentiality. Specifically, the ruling introduced restrictions on confidentiality in that relationship. Therapists are required to advise patients regarding the limits of confidentiality before the commencement of the treatment process. Patients must then determine whether to continue with treatment despite the absence of assurances that information they provide will remain entirely private — disclosures may result in warnings to potential victims or the involvement of law enforcement.

Moreover, therapists have the duty to evaluate each threatening statement made during treatment to determine whether it represents a genuine threat. Consequently, the therapist-client relationship is characterized by a thin line between protecting a potential victim and preserving confidentiality in the treatment process. Many therapists conclude that the duty to protect a potential victim is sufficiently compelling to justify a breach of confidentiality. Professional guidance on navigating these obligations is addressed in the NASW Code of Ethics.

Conclusion

Confidentiality is one of the most important elements in the therapist-client relationship and the treatment process. The ruling in Tarasoff v. The Board of Regents of the University of California had considerable effects on confidentiality by creating a difficult balance for therapists between protecting confidentiality and safeguarding potential victims from harm by their clients. However, clients should be provided with a meaningful opportunity to make informed choices about whether to enter into or maintain their relationships with therapists.

References

Fisher, C. B., & Oransky, M. (n.d.). Informed consent to psychotherapy and the American Psychological Association's Ethics Code. Retrieved November 30, 2014, from http://e-psychologist.org/index.iml?mdl=exam/show_article.mdl&Material_ID=79

Fisher, M. A. (n.d.). Selected ethical standards about informed consent: Counselors (from ACA Code of Ethics). Retrieved November 30, 2014, from

Nesbitt, N. A. (2013). Tarasoff v. Regents of the University of California: Psychotherapist's obligation of confidentiality vs. the duty to warn. Tulsa Law Review, 12(4), 747–757.

"Tarasoff v. Regents of University of California." (n.d.). Case Briefs — The original, most comprehensive, digital legal content. Retrieved November 30, 2014, from http://www.casebriefs.com/blog/law/torts/torts-keyed-to-dobbs/the-duty-to-protect-from-third-persons/tarasoff-v-regents-of-university-of-california/

Vitelli, R. (2014, July 28). Revisiting Tarasoff. Retrieved November 30, 2014, from http://www.psychologytoday.com/blog/media-spotlight/201407/revisiting-tarasoff