Carlson R J, Friedman L C, Riggert S C
Department of Psychiatry, Baylor College of Medicine, Houston, TX 77030.
Bull Am Acad Psychiatry Law. 1987;15(2):179-86.
The duty of therapists to warn or protect third parties when a patient expresses a threat was established by the court in the Tarasoff decision. Confidentiality, disclosure, and prediction of violence are clinical, ethical, and legal issues that the therapist must address in the context of a therapeutic relationship. Clinical case material from the literature, as well as cases from the authors' experiences, indicate that when confidentiality is breached and a potential victim is warned, the therapeutic results may be positive, especially if the patient participated in the process. Other methods of protection, such as commitment, use of medications, police involvement, and confiscation of a weapon, may be necessary. Each case deserves individual consideration as to what appropriate and necessary steps should be taken. Through careful assessment of a patient's threats, concern for the patient and victim, adherence to ethical standards of care, and knowledge of the law, one can often protect a victim as well as engage the patient in an ongoing therapeutic relationship.
治疗师在患者表达威胁时向第三方发出警告或提供保护的职责是由法院在塔拉索夫案判决中确立的。保密、信息披露以及暴力行为预测是治疗师在治疗关系背景下必须处理的临床、伦理和法律问题。文献中的临床案例材料以及作者经验中的案例表明，当保密义务被打破并向潜在受害者发出警告时，治疗效果可能是积极的，尤其是在患者参与这一过程的情况下。其他保护方法，如强制住院、使用药物、警方介入以及没收武器，可能是必要的。对于应采取哪些适当和必要的措施，每个案例都值得单独考虑。通过仔细评估患者的威胁、对患者和受害者的关注、遵守护理伦理标准以及了解法律，人们通常可以保护受害者，同时使患者维持持续的治疗关系。
