A comparison study of the psychologist' duty to protect third parties from the potential violence of their patients

Results indicate that therapists appear willing to discuss the possibility of having to breach confidentiality at the outset of therapy and do so again when patients perceived as dangerous threaten harm. Some therapists noted a change in practice in implementing written forms to ensure that patients have informed consent about the possibility of breaches in confidentiality when they undertake treatment.; As to knowledge of the law, most psychologists regardless of state believe they are bound by a legal duty to protect identifiable third parties from their patient's potential physical violence. Therefore, Tarasoff v. Regents of University of California was thought to apply universally, even in states that have not codified it into law.; Regarding therapists' experiences with potentially violent patients, many therapists had seen such a patient in therapy over the past 15 years. This study determined that a majority of therapists had warned a potential victim. A major motivating factor behind therapists' decisions to warn is concern for the potential victim, with fear of legal liability a strong alternative factor for many therapists. There was a sex difference in that female therapists were more likely than males to avoid seeing potentially dangerous patients, and this was mainly due to fear of personal safety. Females were also more likely than males to prematurely terminate such patients. However, when seeing such patients in therapy, female therapists were more likely to believe they could "very accurately" predict the potential dangerousness of their patients than male therapists. There was a difference in therapists' orientation, in that psychodynamic therapists were less likely to notify the police or to initiate involuntary hospitalization of potentially dangerous patients.; As to experiences with hospitalizing potentially violent patients, many therapists have initiated commitment, specifically because of their fear of legal liability. However it appears that female therapists are less likely than male therapists to hospitalize potentially dangerous patients.; An almost equal number of therapists stated that warning or taking other actions with potentially violent patients had had an adverse impact on the therapeutic bond as felt there had been no impact. Yet a specific question about the impact of the duty to protect on patients yielded positive responses, in that one-third of the therapists felt it had encouraged patients to take more responsibility for controlling violent impulses. One-quarter of the therapists reported that it encouraged patients to apply a verbal solution to a potentially violent situation.; Many therapists incorrectly believed that they have a legal duty to protect a sexual partner of their AIDS patient, where the patient discloses to the therapist that he is engaging in unprotected sexual relations and the partner is unaware of the patient's disease. Therapists are evenly split on what the law specifically requires in such a case, with one-half of the respondents believing they must continue in therapy to discuss the potential for harm, and one-half of the therapists stating that the law requires them to terminate treatment. A much smaller number would actually notify the potential victim.; The results indicate that most therapists believe incorrectly they have a Tarasoff-type legal duty to protect the patient from harming himself; specifically, a majority thought the law requires initiating hospitalization of a suicidal patient.