Duty to Warn: Don’t Get Distracted

Course excerpt from Therapy Tidbits – May/June 2017

Duty to WarnSome years ago, a psychologist in Wausau, WI, found himself worrying about the increasingly angry talk by a client. He was distracted as he tried to remember the “duty to warn” standard, which is a specific case and not a statute in Wisconsin, and suddenly found himself fighting for his life. He survived the 37 stab wounds from a letter opener. The lesson he wants people to know: Forget about dangers to third parties – you are the person at risk until the client is out of your office.

During the last two years, there have been “duty to warn” cases that have ended up causing anxiety, but more important, being a distraction. Neither case challenged the notion as to what the essential “duty to warn” is – basically, if you think your client is about to go out and seriously harm someone, you should try to prevent it. Typically, a call to law enforcement, or in some circumstances the intended victim, is all you can do to prevent immediate violence.

It is important to recognize that case law continues to evolve and that cases are typically very much tied to the past decisions as well as any statutes in a given venue. Furthermore, unless it is a U.S. Supreme Court decision, there can always be a higher court that overturns a decision. In Washington State the decision in Peterson v. State (100 Wn.2d 421) ruled that a psychiatrist could have liability in a case where, absent a specific threat of harm, the psychiatrist should have reasonably known that people were at risk of harm. In this instance, there was no connection between the victim and the person who harmed her.

Relying on the Peterson standard, the Court of Appeals, Division Three, in the case of Volk v. DeMeerlear, ruled that a psychiatrist might have had a duty to protect persons who were not the subject of any threat from the patient. In this case, the patient, who had been in treatment for nine years, without warning attacked and murdered two people and injured a third.

There was no evidence that the psychiatrist could have known that those people would become targets. In its 50-page opinion filed Nov. 13, 2014, the court relied on expert testimony by an expert employed by the plaintiffs, James L. Knoll, IV, MD, the editor of Psychiatric Times. He opined that the psychiatrist failed to properly assess the dangerousness and other clinical matters, and that had he done so the degree of risk might have been clear. He also opined that the intervention by the psychiatrist was not sufficient.

It now goes back to the trial court to see if the jury determines the psychiatrist could have done better.

The issues as to coverage for persons under the supervision of a licensed person became the focus of attention after the findings of the State of Minnesota Court of Appeals in the case of Jerry Expose Jr. vs. Thad Wilderson and Associates, P.A. and Nina Mattson filed May 4, 2015 in Ramsey County District Court. (File No. 62-CV-13-5229). The Minnesota Supreme Court agreed with the court of appeals in a decision filed Nov. 30, 2016.

Meanwhile several licensing boards changed their laws so that trainees are covered. The other findings – that duty to warn does not allow you to discuss the client’s treatment without consent, and that a client handout is not permission to disclose, were no surprise.

In short, despite all of the anxiety created by these two cases, they were really tempests in a teapot. Secondly, a well-constructed statute in the area of duty to warn is always a good idea. Case law is not a good way to go.

Therapy Tidbits – May/June 2017 is a 1-hour online continuing education (CE) course that covers a variety of therapy topics in a succinct and reader-friendly format. This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more.

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).


Ethics in Therapy: Quick Tips I

Ethics in Therapy

Click on image to view course webpage

This new online CE course addresses a variety of ethics topics in the form of seven archived articles from The National Psychologist and is intended to provide psychotherapists of all specialties with a set of brief, practical tips for dealing with ethical dilemmas that present themselves in everyday practice.

Topics Include:

Office ‘Bookstore’ Should Not be for Profit
By Jeffrey E. Barnett, PsyD, ABPP

Psychologists frequently make recommendations to clients for books to read, workbooks and CDs to use, and even movies or television shows to view. In fact, bibliotherapy, the integration of such media into ongoing psychotherapy is a widely used and often highly effective addition to psychotherapy. Learn the issues involved to avoid crossing any boundaries.

Ethical, Effective Marketing for Your Private Practice
By Susan Giurleo, PhD

Many psychologists are cautious, confused and unsure of how to market their work. Many worry that marketing is unethical and something that we should not consider as we pursue a private practice career. Learn effective, ethical marketing techniques you can use to market your practice.

Law Impacts Psychology
By Richard Lawlor, PhD, JD

Over the past several years many articles have appeared in this newspaper for practitioners dealing with various aspects of psychology and the law. Some dealt with a substantive area of psychology and its impact on the law, for example research on children’s memories and the implications for interviewing children and using them as witnesses. Discover the areas of law that psychologists need to be aware of, and understand.

Duty to Warn is Now Duty to Protect
Review by Milton F. Shore, PhD, ABPP

Book review of: The Duty to Protect: Ethical, Legal and Professional Considerations for Mental Health Professionals by Werth, J.L., Welfel, E. and Benjamin, G.A.H. (Eds.) 2009. Washington, D.C. American Psychological Association.

Test Givers Must be Qualified
By Jeffrey E. Barnett, PsyD, ABPP

As a busy professional, it makes great sense to utilize others when it is appropriate to do so. This can be a much more efficient way to work than doing everything yourself. But, the situation is more complex when clinical activities are involved. Learn the ethical issues, laws and regulations for use of non-licensed subordinates in the provision of clinical services.

To Collect or Not to Collect?
By Ofer Zur, PhD

In today’s economy and financial difficulties the questions regarding fees and debt collection from clients seem to be more frequent and more relevant. In times of economic crisis, many people who have lost their homes or jobs understandably seek psychotherapy to better cope with stress due to mounting debt and loss. Explore the relevant professional, relational, clinical, ethical, legal and unintentional consequences aspects of this issue.

Duty to Warn, Protect Differs in HIV Cases
By Jeffrey E. Barnett, PsyD, ABPP

The situation where a client who is HIV-positive or who has AIDS reports having unprotected sex with another person or having done so in the past raises a number of ethical challenges. Explore the relevant issues of informed consent, confidentiality and exceptions to confidentiality, laws concerning the duty to warn and protect when threats of dangerous behavior are made and case law that may impact these areas.

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