Psychotherapist Patient Confidentiality And The Threat Of Harm

Those who provide psychiatric treatment are obliged to keep confidential the things their patients tell them.  This confidentiality is considered necessary for effective treatment.  Patients should be free to tell their therapists their most troubling thoughts without worrying that they will be revealed to others. 

For many years, this obligation was absolute.  No matter what was revealed – even if it was a declared commitment to murder a particular person – the confidentiality rule remained.

But in 1976, a very sad case changed that rule.  The case is Tarasoff v. Regents of the University of California.  It involved two students who attended the University of California at Berkeley, Mr. Podder and Ms. Tarasoff.  They met during folk dancing classes and saw each other weekly for a while.  On New Year's Eve Ms. Tarasoff kissed Mr. Poddar, which he interpreted as recognition of a deep and meaningful relationship. Ms.Tarasoff did not share this view; she told Mr. Podder she was not interested in dating him.

After this rebuff, Mr. Poddar became depressed.  He neglected his appearance, his health, and his studies. This condition persisted until Ms. Tarasoff traveled to South America.  After her departure Mr. Poddar began to improve, and at the suggestion of a friend, he sought psychological treatment.  He became a patient of Dr. Lawrence Moore, a campus psychologist.  During one session with Dr. Moore, Mr. Podder stated that he intended to kill Ms. Tarasoff. 

Dr. Moore was very concerned by this disclosure. He had the campus police detain Mr. Poddar with the goal of committing him to a psychiatric facility.  Mr. Poddar was indeed detained, but was then released, as he appeared rational.  Dr. Moore's supervisor intervened, ordering that Mr. Poddar not be subject to further detention. 

Ms. Tarasoff then returned to campus.  On October 27, 1969, Mr. Poddar got her alone, and murdered her.

The investigation that followed revealed that Mr. Poddar had told his psychologist that he intended to kill Ms. Tarasoff.  Her parents sued, claiming that Ms. Tarasoff should have been warned of this threat to her life. 

The California Supreme Court eventually got the case.  It found that a mental health professional has a duty not only to the patient, but also to those particular individuals who are specifically being threatened by the patient. 

The case changed medical reporting obligations in California.  Other states, including Illinois, then enacted “Tarasoff Laws” that permit or require reporting when there is a serious, credible threat to a specific, targeted individual.  The Illinois law permits disclosure when a therapist, in their sole discretion, determines that it is necessary to “protect the recipient or other person against a clear, imminent risk of serious physical or mental injury or disease or death being inflicted … by the recipient on himself or another…”

Tarasoff laws are not without critics.  Psychiatric professionals note that when Mr. Podder knew his threats had been reported to the police, he terminated treatment, leaving him more isolated than ever.  If the police had not been involved, would he have stayed in therapy, and not committed murder?  Other therapists point out that determining what may or may not be a credible threat can be very difficult, and require information a therapist may not have, such as police or court records. 

President John F. Kennedy once said, “The human mind is our fundamental resource.”  Channeling that resource away from destructive endeavors is the most critical and worthy goal of every therapist.  Tarasoff laws seek to balance that important goal with the need to keep preventable tragedies from occurring.