The Guidelines by Which a Psychologist Determines the Danger Level of a Patient

Confidentiality is a huge part of a patient's rights when undergoing therapy. In fact therapist-client confidentiality is so protected that only very specific circumstances allow for its being broken. One of these circumstances is the case of the client posing a threat to either themselves or those around them. The condition of this circumstance is that the threat is identifiable, meaning the therapist can direct the proper authorities to the exact person at risk, the general public doesn't count as a means for breaking confidentiality. However, predicting the dangerousness of one's client can be difficult. A therapist must be careful not to over-predict, nor look over a threat that may cost a life.

In addition to predicting dangerousness of client during therapy sessions, a clinician may also be asked to predict acts of child abuse, sexual abuse or violence, and suicidal or homicidal behavior in prison inmates and defendants in legal cases.* These sort of predictions are often used to determine the bail status of defendants, and determining the work and living status of individuals who are up for release from mental institutions (Trull, 2005). So, with such important circumstances at weighing against the psychologist, there is a lot of pressure to properly and safely predict the dangerousness associated with a particular patient or client. Because of this, a clinician must guide their decision using a set of criteria. According to Wrightsman, et al., (1998)** predictions are more accurate when the predictions are made for the near and/or short-term future; predictions are made for settings which have already been recorded by the clinician; predictions are based on the clinician's knowledge of the client's past violent or otherwise dangerous behavior; and predictions are made for individuals who come from groups with high rates of violent behavior.

Using these aforementioned criteria aid the clinician in more accurately assessing the danger posed by a patient or client. Additionally, assessing a patient or client based on a set of criteria gives the clinician some backing by which to make their decision. Basing predictions on client histories can also allow for physical evidence should legal issues arise with the breaking of confidentiality. This isn't to say that a therapist would easily assess a client as dangerous, nor would they easily break confidentiality. In fact, clinicians are very careful to choose the correct prediction, as well as correct and very limited times in which confidentiality should be broken.

*From the legal side of things, a forensic psychologist might be called in. Forensic psychologists connect the psychological world with the legal, while a clinical psychologist would be responsible for the counseling side of things.

**Found in Trull (2005)

References:

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

Trull, T., J. (2005). Clinical Psychology, 7^th Ed. Belmont, Ca. Thomson Wadsworth.

Wrightsman, L. S, Nietzel, M. T., Fortune, W. H. (1998). Psychology and the legal system, 4^th Ed. Pacific Grove, Ca; Brooks/Cole.