在治疗中警告职位和义务的职务和宗旨

警告的责任是指责任counselor要么治疗师to inform third parties or authorities if a client poses a threat to themselves or another identifiable individual.它只是治疗师可以违反客户机密性的几个情况之一。通常情况下，道德指南要求治疗师保留在此期间显示的信息治疗strictly private.

What Is Duty to Warn?

The美国心理协会的“心理学家的道德原则和行为准则”指定如何以及何时可以披露机密信息。这些ethical guidelines建议只能在个人或法律允许的情况下披露私人信息。

Legal instances where such information can be revealed include when it is necessary to provide professional services, when obtaining consultations from other professionals, to obtain payment for services, and to protect the client and other parties from potential harm.

建立法律责任的案件

如果他们认为客户对自己或他人构成风险，两个地标法律案件建立了治疗师的法律义务，以违反机密性。

Tarasoff v。加利福尼亚大学的居民（1976年）

警告的法律义务是首次制定的Tarasoff v. Regents of the University of California（1976年）治疗师未能通知一名年轻女性和她的父母，并通过客户提出的特定死亡威胁。

Tatiana Tarasoff and Prosenjit Poddar met in 1968 as students at the University of California, Berkeley. Poddar came to believe that the two were in a serious relationship, a view that was not shared by Tarasoff. When she expressed that she was not interested in a romantic relationship, Poddar began to stalk her and experienced a serious emotional breakdown.

1969年，Poddar成为了一个患者psychologist在UC Berkeley的Cowell Memorial Hospital医院命名为Lawrence Moore博士。在向他的治疗师杀死他的治疗师的意图后，摩尔警告校园警察并宣布了他认为Poddar所需的住院治疗，并且他对自己和他人构成了危险。

Poddar was detained briefly but appeared rational and stable, leading police to release him with a promise that he would stay away from Tarasoff. Soon afterward, the director of the psychiatry department at Cowell Memorial Hospital ordered the written letter and治疗笔记destroyed.

警察和帕多尔的治疗师都没有警告Tatiana Tarasoff或她的威胁。帕多尔继续追踪年轻女子，1969年10月27日，他谋杀了她。

Poddar went to the Tarasoff home armed with a kitchen knife and a pellet gun. After a confrontation, Tarasoff screamed for help, at which point Poddar shot her with the pellet gun. She fled into the yard, but Poddar caught her and proceeded to stab her to death with the kitchen knife. He then entered the Tarasoff home and alerted the police. After his arrest, Poddar was diagnosed withparanoid schizophrenia，相同的诊断摩尔最初是制造的。

Her parents filed a lawsuit against the therapists and the University of California, Berkeley. They contended that their daughter should have been warned of the danger, while the defendants held that their responsibility was to maintain the confidentiality of their client.

The lower courts agreed with the defendants and the case was initially dismissed. The Tarasoff’s appealed the case to the California Supreme Court. While the case was eventually settled out of court for a significant sum, the higher court's 1976 ruling specified that confidentiality was secondary to the public's safety.

jablonski by Pahls v。美国（1983）

Jablonski的案例由Pahls v。美国进一步延长了责任警告，包括审查以前的记录，这些记录可能包括暴力行为的历史。

The ruling originated from a case in which a doctor conducted a risk assessment of a client, Mr. Jablonski, but did not review Jablonski's history of violence. As a result, the client's girlfriend, Ms. Kimball, was not warned about Jablonski's history of violent behavior. When Jablonski was released, he then killed Kimball.

警告例子

值得注意的是，警告责任仅义务向个人和当局提供任何具体威胁的人。他们不应该讨论他们患者的护理或治疗的细节。任何与直接威胁无关的信息都应保持保密。

仍然是一个争论什么constitutes a credible threat. Direct, specific plots to harm to kill another individual would clearly trigger a duty to warn, but in other cases, a therapist must use their best judgment to determine if a less-clear threat presents a serious danger.

当治疗师需要考虑他们的道德和法律义务时，少数时间包括：

• 客户指出，他们想要杀死同事，但不要说出特定的个人
• 一名病人说他们幻想杀死一个特定的人，但是说他们永远不会实际做到这一点
• 客户有造成伤害的手段，例如拥有枪支，对特定个人表达极度愤怒，但从未做出了特定的威胁

对潜在威胁的评估通常以与治疗师评估自杀风险的方式相同。治疗师可能会考虑威胁本身的严重性和特异性，客户的过去的暴力或侵略行为史以及最近的症状进展。

Opposing Views

虽然已经是第一次建立法律义务以来已经几十年来，但它仍然是辩论的话题。2013年，APA Donald N. Bersoff的当时总裁建议，Tarasoff Ruling决定是一个糟糕的决定。他提出的客户机密性是至关重要的，违反它削弱了客户在心理健康提供者中的信任。万博手机客户端Bersoff认为，突破这种机密性只会作为最后的手段，博尔斯夫相信。

Some suggest that had Moore not reported the threats, Poddar may have remained in treatment. Had he continued to receive treatment, perhaps he might have recovered from his obsession and Tarasoff might not have been killed. However, there is simply no way to know if the situation may have played out in this way.

A Word From Verywell

Psychologists often face ethical dilemmas and are required to use their best judgment to determine the right course of action. Duty to warn presents a challenge in many instances, but it is one that therapists are legally obligated to surmount.