The "Duty to Protect" in Psychology: Breaking Therapist-Client Confidentiality

When one thinks about psychology and other mental health fields, ethics may not be the first thing that comes to mind. Then again, with the controversy that surrounds psychiatry, perhaps it is. Either way, the fact of the matter is, that like other fields that deal with guiding the lives of others (i.e. medicine and law) the practice of mental health is also guided by a strong and strict set of ethics. Psychologists in particular are guided by the American Psychological Association, perhaps better known as the APA. That being said, it's also important to remember that each branch of the mental health system has its own set or "code of ethics."

One purpose for the American Psychological Association's code of ethics is to ensure effective and appropriate care without relying excessively on the legal system. This is not to say that psychologists would easily and intentionally overstep the boundaries of patient's rights should this code not be in place; however, it does protect and give legal backing to both psychologist and patient.

One of the most currently discussed issues in the therapist's office is the duty to protect. When is it okay to break confidentiality with the patient? It is the therapist's job, after all, to protect their client, isn't it? According to California courts the duty to protects allows for the breaking of confidentiality. A 1976 case entitled Tarasoff v. Regents of the University of California came to the conclusion that "...the protective privilege ends where the public peril begins" (Comer, 2005). More specifically it specified a necessity for a therapist to disclose confidential information with or without the permission of the client if the client is a danger to themselves or those around them. The ruling was provoked by a therapist who, after hearing that his client wanted to hurt his ex-girlfriend, kept confidentiality. Days later, that same client murdered his ex-girlfriend. The parents of Ms. Tarasoff, the murdered women sued asserting that the therapist should have released the information in order to protect their daughter. As aforementioned, the courts sided with the Tarasoff family, and thus founded the duty to protect.

Since the duty to protect has come into being it has been amended by California courts to include the duty to protect those close to the client and/or close to the intended victim, such as children or spouses (Comer, 2005). These amendments have also included a clause stating that the victim must be identifiable, meaning the public in general is not a reason to break confidentiality. Instead, a specific threat to self or identifiable individual must be at hand in order to ethically break therapist-client confidentiality under the duty to protect code.

While confidentiality might be broken for other extenuating circumstances, these must also be discussed. For example, a student therapist will be discussing cases with their teacher, and police officers is allowed to collect confidential information so long as a court order is obtained (this may be done in criminal cases, and the like). However, the duty to protect is the most important to understand as it can be done without the knowledge of the client. Whereas a student therapist will tell the client when they are discussing their case with a teacher, confidentiality under the duty to protect can be done without informing the client.

*It is important to note here that each states has to weigh in on their own duty to protect rule. Information on your particular state can be found at the APA site, or a local law site. You can also consult your therapist about it, although it is common practice to give clients a flyer discussing the issue. Additionally, a therapist will generally discuss it verbally before the session begins.

References:

Comer, R., J. (2005). Fundamentals of Abnormal Psychology, 4^th Ed. New York. Worth Publishers.

Gostin, L., O. (2002). Public Health Law and Ethics: A Reader. Retrieved December 15, 2007, from http://www.publichealthlaw.net/Reader/docs/Tarasoff.pdf