Understanding a Therapist’s Duty to Warn

Written by KKJ Intern Alyssa Choate and Katrina Kuzyszyn-Jones, Psy.D.

Part 1 of 2  |  Read Part 2 Here

One of the most complicated aspects of a psychologist’s job is understanding the fine line between patient confidentiality and the ethical duty to warn. The idea of a therapist’s duty to warn was first brought to light in the 1976 Tarasoff v. Regents of the University of California case.

Tarasoff began in 1968, when graduate student Prosenjit Poddar met fellow student Tatiana Tarasoff at the University of California, Berkeley. Poddar developed an unhealthy obsession with Tarasoff, and after hearing she was involved with other men, Poddar began to stalk her. In therapy sessions with Dr. Lawrence Moore, Poddar disclosed his plans to kill Tarasoff. Then, in 1969, Poddar attacked and murdered Tarasoff just as he had described to Dr. Moore in therapy. Dr. Moore did contact campus police, but he did not notify Ms. Tarasoff of the danger.

Tarasoff’s parents opened a civil suit against the university and Poddar’s treatment providers for their daughter’s death. The case was appealed to the California Supreme Court in 1976, where a landmark decision declared the state’s “duty to protect” possible victims. The majority opinion of the Court, delivered by Justice Mathew O. Tobriner, reads: “The protective privilege ends where the public peril begins” (Behnke, 2005; Tarasoff v. Regents of the University of California, 2022).

Tatiana Tarasoff’s preventable murder had lasting effects within the fields of psychology and law. The case brought forth questions regarding patient safety: when should a therapist breach confidentiality with their client, and what is a therapist’s ethical duty to warn?

Surprisingly, North Carolina does not currently hold any specific duty to warn laws like California; however, there are no laws prohibiting doctors from fulfilling a duty to warn (National Conference of State Legislatures, 2018; Licensed Professional Counselors’ Association of North Carolina, 2022). Although NC has no explicit duty to warn law, the American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct places an ethical requirement on psychologists to protect others from harm; they must also heed relevant state laws and psychology board regulations (APA, 2017).

In North Carolina, the legality and interpretation of a therapist’s duty to warn is ambiguous. Therapists in NC are told by their governing boards to use one’s ‘best judgment’ when deciding to breach patient confidentiality. The 'ethical requirement' imposed on psychologists by the APA’s Ethical Principles of Psychologists and Code of Conduct states that psychologists should take action to minimize harm where it is “foreseeable and unavoidable” (APA, 2017). In Section 4, the code states that breaching confidentiality without consent is permitted for various reasons, including to “protect the client/patient, psychologist, or others from harm” (APA, 2017).

Alongside the APA’s Ethical Principles and Code of Conduct (2017), psychologists should consider the American Counseling Association’s (ACA) Code of Ethics (2014). The ACA Code lists clear exceptions to breach confidentiality. The code states patient disclosure is required when needed to protect clients or others from “serious and foreseeable harm” or when legal requirements demand confidential information must be revealed. Counselors should consult with other professionals when they are uncertain about the best course of action. When disclosing information, counselors must also ensure that only essential information is revealed (ACA, 2014).

Therapists are permitted to breach confidentiality with the consent of an organizational client, an individual client, or a legally authorized person on behalf of the client. Even without consent, breaching confidentiality is still legally permitted for the purposes of: (1) providing needed professional services, (2) obtaining appropriate professional consultations, (3) protecting clients/psychologists/others from harm, or (4) to obtain payment for services from a client (ACA, 2014).

The 2021 North Carolina General Statutes describe other situations in which psychologists may breach confidentiality in Chapter 122C. Breaching confidentiality is permitted, for example, by psychologists who work in a North Carolina “facility” to protect others from danger or the act of a felony or violent misdemeanor (Mental Health, Developmental Disabilities, and Substance Abuse Act, 1985). Additionally, under HIPAA’s Privacy Rule, a “covered entity” is legally allowed to breach confidentiality to adhere to laws and ethical standards. Disclosure of protected health information through the Privacy Rule is allowed so long as the covered entity, in good faith, believes it is necessary to prevent or lessen a serious and imminent threat to patients and others (2022).

Again, when breaching confidentiality, therapists are advised to rely on their ethical and professional judgment. Although there is no explicit duty to warn for therapists in the state of North Carolina, therapists must balance their duties of maintaining confidentiality and protecting the public from harm. When navigating the legality of psychologists’ duty to warn in NC, it's imperative to understand how a patient’s danger is defined and to examine relevant court cases within NC, which are both addressed in Part 2.

Spread the love

You may also like

We know it's not always easy to ask for help.
But sometimes talking with a compassionate, insightful professional can provide answers and clarity.

We know it's not always easy to ask for help. But sometimes talking with a compassionate, insightful professional can provide answers and clarity.