In the U.S. healthcare system, mental healthcare professionals have a legal obligation called a “duty to warn.” This means that healthcare providers, including therapists and social workers, may be required to warn an identifiable victim if their client makes it clear that they intend to harm someone.
Understandably, clients might worry about their privacy and potential breaches of confidentiality. However, it’s important to know that therapists can only break confidentiality in specific cases when someone’s life or physical well-being is at stake.
Our goal is to clear up any confusion about the duty to warn, and explain when and why therapists might have to share information.
What is a Duty to Warn Decision?
Mental health therapists must maintain a delicate balance between protecting client confidentiality and maintaining the patient relationship and ensuring safety. While therapists uphold a code of ethics that protects the privacy of information shared during therapy sessions, certain circumstances might make it necessary to breach this confidentiality. The duty to warn comes into play when a client poses a potential threat of harm to a third party.
The duty to warn obligates therapists to reveal confidential patient information when there is a serious threat to the safety of others. This concept is recognized in the majority of states, where mental health professionals face a legal duty to warn, mandating them to break confidentiality if they have reason to believe a client may become violent. Although there is a duty to warn obligation in most US states, some states merely permit but do not require disclosure, and a few have either no duty to warn or allow it only in extremely limited circumstances.
The American Psychological Association (APA) offers ethical guidance through its “Ethical Principles of Psychologists and Code of Conduct.” Under these principles, therapists can disclose information without client consent if deemed necessary to protect the client or others from harm. This authorization for disclosure also extends to situations where the client has given permission, or when required by law, such as when providing professional services, seeking consultation from other professionals, or obtaining payment for services.
While the duty to warn is in place to protect individuals from potential harm, understandably, some clients may have concerns about the impact of breaching client confidentiality on the therapist-client relationship. Striking a balance between ethical considerations and legal obligations is nuanced, and clients should be encouraged to speak with their therapist about their concerns if they have any.
The duty to warn not only grants professionals the right to disclose but in most states, imposes an obligation to breach confidentiality when there is a credible belief that a client poses a risk to others.
Tarasoff Rule and the History of Duty to Warn
The duty to warn steps from the landmark case, Tarasoff v. Regents of the University of California (1976). The case is rooted in the tragic 1969 murder of university student Tatiana Tarasoff, and it laid the foundation for a significant legal precedent.
The perpetrator, Prosenjit Poddar, a graduate student at the University of California, Berkeley, became obsessed with Tarasoff after a disagreement over the seriousness of their relationship. This ultimately led to stalking, prompting Poddar to undergo psychological counseling at the university medical center. While he was in therapy with the school counselor, Poddar made several threats about harming and killing Tarasoff, which he eventually followed through on.
Guided by the court decision that followed, the California Supreme Court enacted a law requiring all clinicians to protect potential victims. The duty to warn involves warning intended victims directly, notifying a law enforcement agency, or taking necessary steps to prevent harm. Despite ongoing controversy over breaching confidentiality, Tarasoff laws have gained adoption in numerous U.S. states and have influenced similar legislation worldwide.
Legislation varies between states, with some states adopting a duty to protect laws.
The duty to warn and duty to protect laws are a poignant reminder of the delicate balance therapists face between safeguarding potential victims and respecting client confidentiality.
Professional Discernment in Duty to Warn
Therapists navigate a delicate balance when it comes to discerning between expressions of normal anger and credible threats that pose a risk of harm to others. Therapists are trained to distinguish between typical emotional expressions and imminent threats of potential danger. Anger is a normal human emotion, and clients often discuss feelings of frustration, resentment, or annoyance towards others within the therapeutic setting. Therapists are trained to recognize and validate these emotions, giving clients space to explore and understand them in a safe and confidential space.
Breaking confidentiality is a serious matter that can negatively impact the therapeutic relationship. The practitioner must assess the potential threat to either the client and /or the community.
- Nancy Arnovits, social worker
However, the critical distinction arises when anger escalates to the level of posing a credible and specific threat of harm to others. Expressing anger alone does not trigger the duty to warn or duty to protect; but when the anger is accompanied by a clear and imminent risk of harm, therapists may be required to disclose.
“Breaking confidentiality is a serious matter that can negatively impact the therapeutic relationship. The practitioner must assess the potential threat to either the client and /or the community. Such things might include the specificity of the threat, whether or not there is an identified victim, a plan, and a history of violent and aggressive behavior,” explains Nancy Arnovits, a social worker who provides therapy with Grow Therapy.
Clinicians rely on their training, and their clinical expertise to explore the depth and nature of a client’s emotional expressions to differentiate between common expressions of anger and indications of a genuine threat. This process involves open communication, active listening, and careful assessment of the client’s intentions.
Let’s Assess this Example
Sarah, a licensed therapist, has been working with Alex, a 30-year-old client, for several months. During a therapy session, Alex discloses that he is experiencing intense anger and frustration towards his former business partner, Mark. Alex reveals specific plans to harm Mark physically, describing a detailed and imminent threat of harm to his former partner.
Recognizing the gravity of the situation and the potential bodily harm to Mark, Sarah is faced with a duty to warn. Because there is a credible and immediate threat to Mark’s safety, Sarah takes prompt action to disclose the information to the appropriate authorities, such as notifying law enforcement or providing a warning to Mark directly.
By invoking the duty to warn in this hypothetical scenario, Sarah prioritizes the safety of the potential victim, Mark, and takes necessary steps to prevent bodily harm.
On the other hand, if Alex comes to therapy and expresses his anger and resentment towards Mark, that would not trigger a duty to warn obligation on the part of his therapist.
Do All States Have A Duty to Warn the Law?
In the United States, most jurisdictions have enacted laws that either mandate or allow mental health providers to disclose information when patients pose a potential threat of violence. However, it’s important to note that not all states have duty to warn protections in place.
Currently, only four states — Maine, North Carolina, North Dakota, and Nevada — do not have specific legal provisions regarding the duty to warn. In these states, mental health professionals may not have a legal obligation to disclose information about a patient’s potential for violence to third parties, even if they have reasonable grounds to suspect such a threat.
Clients who are unclear about the duty to warn laws in their state should discuss state laws with their therapist. The legal obligations of mental health professionals can vary, and therapists are there to provide information and guidance to their clients.
Final Thoughts
The Duty to Warn stands as a critical ethical and legal obligation for mental health professionals in the United States. Therapists must delicately balance confidential information with the responsibility to protect potential victims from harm. The Tarasoff case, rooted in a tragic event, has shaped not only U.S. mental health practices but has also influenced legislation globally.
For individuals entering therapy, establishing an open dialogue with their therapist about the boundaries of patient confidentiality is important for building trust and ensuring a safe therapeutic space. Taking the initiative to discuss the limitations of confidentiality can be a good step in building a therapeutic relationship.
Having this conversation allows both the client and the therapist to foster transparency in the therapeutic relationship. This creates a supportive environment where trust can flourish, and clients feel safe to process their emotions.
