The Ethics of Therapy with Potentially Dangerous People

man on smart phoneAs more information becomes available about Elliot Rodgers, the man who allegedly killed six people in California, the media continues to focus on what his therapist did or did not do right. Therapy can and does help people who struggle with challenges such as isolation and anger, but therapists face serious ethical challenges when faced with potentially dangerous clients.

The Importance of Confidentiality

Confidentiality is the bedrock of healthy and productive therapy. Many people have fleeting angry thoughts, and it’s common to speak in hyperbole, such as in the instance that a teenager tells her therapist that she wishes her mother were dead. Mandating that any violent thought or feeling be immediately reported, then, could be an overreaction that lands nonviolent people in trouble.

Some therapists are concerned that more stringent reporting requirements could undermine good therapy. People who desperately need help may opt not to seek therapy if they are worried that doing so will land them in jail or a psychiatric hospital. People who are currently in therapy may not be fully honest with their therapists if they sense that one wrong word will cause them to be reported to the authorities. Further, targeting people with mental health issues cannot fully solve the problem, since not all spree killers experience mental health issues. In fact, people with mental health issues are more likely to be crime victims than crime perpetrators.

The Consequences of Reporting

Despite therapists’ best efforts to maintain confidentiality and offer extraordinary care, they have an ethical duty to protect general public and report clients who make clear and specific threats of violence. The decision to report isn’t always an easy one, though. State reporting requirements vary, and therapists must determine the appropriate person or authority to report the threat to.

The consequences to a client’s life of such a report can be powerful and long-lasting. Most police officers don’t get mental health training. Calling a client’s family or spouse is not always helpful, particularly if the family is unsupportive of the client’s attempts to get better in therapy. A client who is in serious distress may make police officers feel threatened. Several people who have had suicidal thoughts or tendencies have been shot by police in the last year.

Given the risks to which clients are exposed when their therapists report them, some therapists avoid reporting until they know a threat is imminent, and by then it may be too late. There’s only so much that law enforcement can do to stop a crime, and even the best therapist can’t talk someone out of a spree killing.

Improving Care for People with Anger Issues

Joshua Nash, a GoodTherapy.org anger Topic Expert, emphasizes that people who are at risk of harming others need better care and that mental health training could begin to improve outcomes for troubled therapy clients. He explained to GoodTherapy.org,

“If we continue to view these incidents as ‘anger management‘ concerns, we fail to see the underlying issues at play. All too often anger results from unexpressed emotions and the unacknowledged irrational beliefs that spawned them. Carrying around a core belief of one’s worthlessness and powerlessness can certainly serve as a powder keg for future explosions. A direction I would love to see the mental health field move towards is an increased focus on psychoeducation for all personnel that come into contact with high risk individuals. Learning to differentiate genuine peace and calm from a forced, affected ‘okayness’ might just prevent further tragedies from occurring.”

References:

  1. Experts fear proposed N.Y. gun law might hinder therapy. (2013, January 15). Retrieved from http://www.usatoday.com/story/news/nation/2013/01/15/ny-gun-law-therapy/1836323/
  2. Fact sheets. (n.d.). Retrieved from http://depts.washington.edu/mhreport/facts_violence.php
  3. Goldberg, J. (2014, May 25). Christian Alberto Sierra, Purcellville teenager threatening suicide, shot, killed by police. Retrieved from http://www.wjla.com/articles/2014/05/christian-alberto-sierra-purcellville-teenager-threatening-suicide-shot-killed-by-police-103465.html
  4. Palmer, B. (n.d.). Elliot Rodger was seeing multiple therapists. Why couldn’t they stop him? Retrieved from http://www.slate.com/articles/health_and_science/medical_examiner/2014/05/elliot_rodger_therapists_why_did_they_and_law_enforcement_fail_to_recognize.html

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  • Dannie

    Dannie

    June 2nd, 2014 at 3:16 PM

    There really is a very fine line when it come sto protecting the confidentiality of a client and protecting the general public. Knowing what is the right thing to do and when… that has to be some kind of terrible dilemma that a therapist has to face.

  • Verna

    Verna

    June 3rd, 2014 at 3:53 AM

    Ok so this is another job that I could not do because I would have to tell if I thought that someone I was working with was going to hurt someone. We have had so many incidents in the recent past where someone was working with a therapist and then still went on to injure and kill many others that it would be difficult to make that judgement call. I would ahve to tell, therefore I know that this wouldn’t be my calling. Sometimes protecting the lives of many others would simply be too much greater than protecting the confidentiality of one person.

  • jay

    jay

    February 23rd, 2018 at 4:16 PM

    Excellent post! Confidentiality is put above protecting society. You hit it right on the head

  • Tabby

    Tabby

    June 3rd, 2014 at 4:48 PM

    We have to realize that their hands are tied in many situations, and if there isn’t something specific to go on, even if they went to law enforcement they couldn’t do anything without any concrete evidence. This is designed to protect us but sadly it can also let us down.

  • thad c.

    thad c.

    June 4th, 2014 at 1:48 PM

    It would have to be something really bad for a therapist to violate that code of confidentialtiy that I think most of us would expect that we would get from this relationship.

  • Margot

    Margot

    June 6th, 2014 at 8:43 PM

    I suppose that you can choose which clients with whom you wish to work and those you do not.

    If you don’t feel like you can handle this person as a patient then make a recommendation for them to see someone else and dismiss them as a ptient. That way you are still trying to get help for them but you can wash your own hands clean of feeling any sort of responsibility toward them.

    Hopefully you can help them find another therapist who has a better grasp of the problems that they have and who could perhaps have a clearer take on how to best help. them.

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