Unit 3 Crisis Case Handling CJ 440

Any articles or /current issues regarding Crisis Intervention to share?

Confidentiality What is it? Privileged communication? Why so important?

Relationship client/counselor Trust issues Is confidentially crucial to develop that relationship?

3 Principles Legal Ethical Moral

Legal Principles Certain professions have the right of confidentiality thru privileged communication. Who?

Ethical Principles General guiding Code of Conduct for a profession Violation may result in censure or loss of license by Ethics Board Not the same “weight” of law

Moral Principles Does the therapist’s morals “belong” in therapy? Can they be “ignored” ? Should they be “ignored” ?

Moral Principles Common decency Consequences Examples of possible conflicts??

Intent to Harm and Duty to Warn When the client provides info about intent to do harm to him/herself or another, rule of confidentiality changes Counselor must decide whether to inform authorities, significant other or the potential victim(s) and taking action to ensure client does not carry out the threat

Tarasoff v Board or Regents of U of California 1976 Changed rules of confidentiality Duty to warn a potential victim

Facts of Case Male client told therapist on campus that he intended to murder a young woman Specific name of victim not stated but therapist able to determine who it was Therapist took no steps to warn the intended victim of client’s threats Therapist did write a letter to campus police about client’s homicidal ideation

Client immediately taken into custody for observation After evaluation, client was found rational and after promising to stay away from woman, was released Therapist’s supervisor requested police return the original letter and all copies and notes about the incident be destroyed

Two months later, the client killed the woman Parents of woman sued university On appeal to the CA State Supreme Court, ruled for plaintiff Precedent setting case

Ruling “When a psychotherapist ascertains a threat is neither remote nor idle in its content, the public good demands that disclosure of the threat to a third party outweighs the benefits of preserving confidentially”

3 conditions mandated by Tarasoff 1.Must be a special relationship ie therapist to client 2.Must be a reasonable prediction of conduct that constitutes a danger 3.And, there must be a foreseeable victim

1.It is a good practice to clearly convey to client at beginning what you can and cannot hold in confidence 2.Plan ahead with supervisors, police, attorneys, etc so you know how to handle 3.Often, split second decision; need to know what to do; who to call, etc

4.Develop contingency plans 5.Role play is helpful 6.If not sure, consult with another professional or supervisor for advice. Keep documentation of conversation. Especially if threat not clear.

General Rule for determining a clear and present danger is that such a danger is present if client –Specifies victim “my husband” –Motive “revenge” –Means “gun” –Plan “I’ll wait for him to come home”

Danger present if: –Client unable to understand what he/she is contemplating –Is incapable of exercising self-control –Is incapable of collaborating with the worker If at least 2 of the elements present, therapist has Duty to Warn.

If client specifically states a threat, therapist is morally, legally and ethically bound to act Duty to warn the victim if known unless state statue clearly indicates otherwise Let your client know & attempt to calm & get to place of safety. Explain why Be supportive

Get client to participate if possible Get client to give up weapons if any Inform those that need to know ie police, supervisor, attorney, psychiatric hospital, victim

If client acting out or vehement, avoid a confrontation. Leave it up to police or security If not available, get a coworker or someone close to contain/calm the client until help arrives Remember, in a crisis intervention setting, no worker should ever be alone

If client threatening to sue or other legal resources, it’s not an excuse not to report Law supports the therapist Ensure documentation is complete