Counseling Skills – Tarasoff case implications on therapist-patient relationship

SUBMITTED BY: B. Vasanth Kumar ROLL NO: F09060

The key implication of the verdict in the Tarasoff case has redefined the conventional
idea of ‘right to privacy’ in the relationship between a patient and a therapist. The verdict is
based on the premise that, ’the right to privacy ends where public peril begins’. The real
challenge of saving a life has been transferred to the therapist who must now reflect on how best
to assess and document potential violence to the third parties while maintaining ‘trust’ with the
patient. This legal duty has laid the onus upon therapists who must now consider how to warn or
protect within the confines of sound clinical judgment. Failure to attend to this issue with greater
sensitivity and detail will lead to penalty for the therapist. This verdict has also modified the
dynamics of out-patient and in-patient management that was followed conventionally.

Though several lessons were learnt after the Tarasoff case, the verdict did not mark the
end of Psychotherapy. There is no proof to substantiate that patients have been discouraged from
coming to therapy, or discouraged from speaking freely once there, for fear that their
confidentiality will be breached. Patients accept the limits of confidentiality in their use of
psychotherapy. Absolute confidentiality is not a prerequisite for a trusting therapy relationship,
so long as the limits of confidentiality are discussed with the patient. Although confidentiality is
an integral part of therapy, patients accept therapists' legal and ethical obligations to society.
‘Trust’ (and not absolute confidentiality) is the cornerstone of psychotherapy. Talking about a
patient or writing about him without his knowledge or consent would be a breach of trust. But
imposing control where self-control breaks down is not a breach of trust when it is not deceptive.
And it is not necessary to be deceptive.

The main setback for therapists after the verdict is that they have lost their unquestionable
right of confidentiality that they held prior to the judgment. This could work negatively for the
therapists because of the double bind in which therapists would find themselves, when there was
potential of harm to a third party, believing that the therapist would be vulnerable to litigation no
matter what course of action was chosen. So, in a sense this verdict is rather ironic in nature and
does not serve to protect the therapist who takes genuine efforts from his side to protect the third
party when things go wrong. So, the Tarasoff case is a study in contradiction by itself!