Confidentiality and Duty to Warn

You are a psychologist treating a 22-year-old man with a history of depression and generalized anxiety who works in retail. He is despondent because he has learned a young woman, Susan, who works the counter with him, is dating another man. In the past he referred to Susan as his girlfriend. However, when you queried him about that he described her friendliness at work, not situations you would consider dating. He says her new relationship is “not right.” He shares a fantasy of stalking Susan and her new boyfriend on a date and suddenly appearing in order to “catch” them and give them a “good scare.” When you ask if he ever desires to hurt them, he says no, just to scare them.

• What should you do? between duties to respect your patient’s confidentiality and to protect Susan and her boyfriend, if you worry that your client’s fantasy indicates any potential for violence?
• Do you continue to counsel your client, trying to assess whether he intends to act on his fantasy and encouraging him to think about what the negative consequences of doing that will do?
• Do you warn Susan that your client has an obsession with her and her boyfriend, and has threatened to “scare” them on a date?
• Other?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)

Source – Santa Clara University, Markkula Center for Applied Ethics