The Ethics of Therapy with Potentially Dangerous People

As more information becomes available about Elliot Rodgers, the man who allegedly killed six people in California, the media continues to focus on what his therapist did or did not do right. Therapy can and does help people who struggle with challenges such as isolation and anger, but therapists face serious ethical challenges when faced with potentially dangerous clients.

The Importance of Confidentiality

Confidentiality is the bedrock of healthy and productive therapy. Many people have fleeting angry thoughts, and it’s common to speak in hyperbole, such as in the instance that a teenager tells her therapist that she wishes her mother were dead. Mandating that any violent thought or feeling be immediately reported, then, could be an overreaction that lands nonviolent people in trouble.

Some therapists are concerned that more stringent reporting requirements could undermine good therapy. People who desperately need help may opt not to seek therapy if they are worried that doing so will land them in jail or a psychiatric hospital. People who are currently in therapy may not be fully honest with their therapists if they sense that one wrong word will cause them to be reported to the authorities. Further, targeting people with mental health issues cannot fully solve the problem, since not all spree killers experience mental health issues. In fact, people with mental health issues are more likely to be crime victims than crime perpetrators.

The Consequences of Reporting

Despite therapists’ best efforts to maintain confidentiality and offer extraordinary care, they have an ethical duty to protect general public and report clients who make clear and specific threats of violence. The decision to report isn’t always an easy one, though. State reporting requirements vary, and therapists must determine the appropriate person or authority to report the threat to.

The consequences to a client’s life of such a report can be powerful and long-lasting. Most police officers don’t get mental health training. Calling a client’s family or spouse is not always helpful, particularly if the family is unsupportive of the client’s attempts to get better in therapy. A client who is in serious distress may make police officers feel threatened. Several people who have had suicidal thoughts or tendencies have been shot by police in the last year.

Given the risks to which clients are exposed when their therapists report them, some therapists avoid reporting until they know a threat is imminent, and by then it may be too late. There’s only so much that law enforcement can do to stop a crime, and even the best therapist can’t talk someone out of a spree killing.

Improving Care for People with Anger Issues

Joshua Nash, a GoodTherapy.org anger Topic Expert, emphasizes that people who are at risk of harming others need better care and that mental health training could begin to improve outcomes for troubled therapy clients. He explained to GoodTherapy.org,

“If we continue to view these incidents as ‘anger management‘ concerns, we fail to see the underlying issues at play. All too often anger results from unexpressed emotions and the unacknowledged irrational beliefs that spawned them. Carrying around a core belief of one’s worthlessness and powerlessness can certainly serve as a powder keg for future explosions. A direction I would love to see the mental health field move towards is an increased focus on psychoeducation for all personnel that come into contact with high risk individuals. Learning to differentiate genuine peace and calm from a forced, affected ‘okayness’ might just prevent further tragedies from occurring.”

References:

1. Experts fear proposed N.Y. gun law might hinder therapy. (2013, January 15). Retrieved from http://www.usatoday.com/story/news/nation/2013/01/15/ny-gun-law-therapy/1836323/
2. Fact sheets. (n.d.). Retrieved from http://depts.washington.edu/mhreport/facts_violence.php
3. Goldberg, J. (2014, May 25). Christian Alberto Sierra, Purcellville teenager threatening suicide, shot, killed by police. Retrieved from http://www.wjla.com/articles/2014/05/christian-alberto-sierra-purcellville-teenager-threatening-suicide-shot-killed-by-police-103465.html
4. Palmer, B. (n.d.). Elliot Rodger was seeing multiple therapists. Why couldn’t they stop him? Retrieved from http://www.slate.com/articles/health_and_science/medical_examiner/2014/05/elliot_rodger_therapists_why_did_they_and_law_enforcement_fail_to_recognize.html

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.