What Does The Tarasoff Ruling Mean For Modern Therapy?
By: Nicole Beasley
Updated March 06, 2020
Medically Reviewed By: Kelly Kampf
In 1976, a California court ruling determined that it was the duty of the psychiatric profession to protect an individual who was being threatened with bodily harm by a patient. Since then, the duty to warn or protect has been codified in the legislative statutes of 23 states. While a statute does not codify the duty, it is present in the common law supported by precedent in ten states. Eleven states have a permissive duty, and six states are described as having no statutes or state laws offering guidance.
Background Of Tarasoff Law
The Tarasoff law is based on the 1969 murder of a young college student named Tatiana Tarasoff. After meeting Indian graduate student, Prosenjit Poddar, at a folk dancing class, Tatiana agreed to go on several dates with him but soon called it off after getting into a disagreement over the seriousness of their relationship. The obsessed Poddar began stalking her on the Berkeley University campus. He had reached an emotional crisis and sought to counsel.
During his sessions, he began talking about how he wanted to kill Tatiana. His therapist, Dr. Lawrence Moore, became concerned over his patient's confessed intentions, and finally told him if he did not cease fantasizing murder, the doctor had no choice but to hospitalize him for his own good. Poddar quit showing up for the sessions.
Concerned, Dr. Moore consulted his psychiatric supervisor, Dr. Harvey Powelson, who advised notifying the police. A letter was sent to the campus authorities, and Poddar was questioned but denied stating he wanted to kill his ex-girlfriend and assured the police he would stay away from her. On October 27, 1969, Poddar confronted Tatiana in her home and murdered her.
Poddar served five years of a second- degree murder charge before his lawyer overturned it.
Shortly after his release, the Tarasoff family filed a civil suit against the therapists and the University of Berkeley. The suit claimed Tatiana should have been warned directly and that the warning could have saved her life. Moore and Powelson defended their case because it was their duty to their patient over a third party and the courts agreed. After the plaintiffs appealed this decision, the California Supreme Court reviewed the case and in 1976, handed down what was to be a landmark decision, in favor of Tarasoff's family.
Widening The Definition Of The Tarasoff Ruling
On June 21, 2001, Geno Collelo asked his father to loan him his gun. Despondent over the break-up with his long-term girlfriend, the young man had been seeing a therapist. He now expressed a desire to kill Keith Ewing, "the kid" who had been visiting his ex-girlfriend. His father refused, instead notifying Geno's psychiatrist, who urged Geno to commit himself to the Northridge Hospital Medical Center.
Collelo was admitted as a voluntary patient, but discharged the next day, even though Geno's father had told the evaluator about the threat. The following day, Geno Collelo shot and killed Ewing, then killed himself. Ewing's parents then sued the hospital and Dr. Goldstein, stating Collelo had posed a foreseeable danger to their son and that Goldstein and the hospital were both aware of that threat but had failed to discharge their duty by either warning Ewing or a law enforcement agency.
Goldstein claimed he was not liable for failure to warn as Collelo had never expressed to him a desire to harm Ewing seriously. The hospital claimed that expert testimony was required to prove a psychotherapist's liability for failure to warn and noted that the plaintiffs had no plans to present such testimony. The courts summarily agreed with the defendants.
However, the 2004 Court of Appeals upheld the plaintiff's right to trial. The court decided there was no difference between threats relayed by the patient and those relayed by an immediate family member of the patient. The court took the precedent a step further by stating jurors may rely on "common knowledge" to determine whether a psychotherapist believed or predicted that a patient posed a risk to an identifiable victim.
The Ethical Mandate
The Tarasoff versus Regents of University of California decision has continued to change and develop its definition of the duties of the psychiatric profession. Even in states where it's not mandatory, therapists will explain the limits of their confidentiality with their patients, notifying them that they will notify the authorities if the patient is expressing the desire to harm others. The psychiatric profession, including state social workers, has determined it is not only the duty of therapists to warn potential victims of actions that may be taken against them, but they also must protect victims.
Breaching confidentiality isn't always an easy decision. A therapist can't always predict when a patient is seriously considering a violent act and when they're just venting frustrations that will come to nothing, yet a police report is still filed when expressions turn violent. Police reports are often followed up by a home visit, which may or may not have positive consequences.
Modern psychiatrists agree that their duty to warn and their duty to protect the public is greater than their patient/ client privileges. However, there is an Achilles' Heel embedded in the policy. When Dr. Moore urged Poddar to sign in to a psychiatric hospital, he quit coming to sessions. The police were notified and did show up at Poddar's home. He denied violent intentions.
Collelo also denied violent intentions when he voluntarily showed up for a psychiatric evaluation. Psychiatrists who diligently adhere to the codified Tarasoff law are protected from liability charges in cases where they have notified police and potential victims of the possibility of harm from their clients. However, the law also handicaps therapists who seek an open and honest relationship with their clients.
Among the most difficult are among domestic violence offenders. The transparency in relationships falters as victimized women withdraw from the help they might otherwise receive in fear of a police investigation or the consequences of one. In many cases, the perpetrator becomes angrier, even if no charges have been filed, escalating a situation the therapist has hoped to defuse.
The Lurking Criminal
Killers are not easy to detect. They can be some of the nicest people in the world. They can appear normal in every way except that they were able to premeditate and take a human life. This concept chills the social senses that can understand accidental death, self-defense and momentary insanity but that cringes at the image of someone who will stalk and murder.
Killers adapt to laws as quickly and easily as any other criminal element. A law that breaches confidentiality in psychiatric treatment teaches potential killers to circumvent any dialogue that might reveal their violent tendencies. Psychiatrists do not have access to police reports and other private information that might reveal more of their patients' past. They must rely on what their patient and family members tell them. Although some families are very candid, others may be hesitant to reveal their observation of their loved one's behavior. They may minimize it or give excuses that include stress, isolation, and depression.
The Tarasoff law served a very useful purpose. It forced the issue of patient/ client privileges where there was a clear and present danger to a potential victim, ruling it was the duty of the psychiatric profession to place the well-being of the public first. Its broad interpretation, however, may have become a stumbling block for therapists who need an honest exchange to help evaluate the client's mental health.
The Critical Beyond
The first objective of the therapist is the healthy mental state of the client. The Tarasoff ruling handicaps the ability of the therapist to find full candidacy in the client. Private records are inaccessible to non-forensic psychiatrists without prior permission. Police intervention may or may not defuse a potentially violent situation. At best, it establishes a record of pre-meditative behavior.
It is the goal of a therapist to uncover the causes of a patient's abnormal behavior and treat the symptoms before they translate into harmful actions. To do this, there must be an underlying trust between the therapist and the patient. With the duty to protect, not only the psychiatric profession, but the public must begin to analyze our rights to privacy painfully.
There is no clear-cut profile of anyone who is apt to commit a violent crime. The most common psychiatric disorders are a sociopathic personality disorder, schizophrenic personality disorder, paranoia and various major depressions, but none can be defined as precursors. Circumstances vary, stress levels change, and coping levels are subject to the person's abilities for handling disappointments and setbacks.
The North Alabama Conference of the United Methodist Church suggested examples of the best deterrents to violent crime would be:
- to have mental health treatment available to all citizens
- to have healthy communities which create a sense of real safety and community concern for all its citizens
- to have a law enforcement component that is well trained in mental health, high-risk factors for violence and in creating a safe environment
- to have churches and other organizations reach out to include those whom others would exclude due to being perceived as defective, inferior or unwanted
- to foster the development of families that are close and who demonstrate caring toward their members with a sense of connectedness and affirmation.
Each time there is a violent crime, it shocks us with its lack of empathy for others. As a society, we demand answers. We want to know what the warning signs were, and how the violence could have been prevented. We make demands of the professionals in education, counseling, law enforcement, legal and social services to make us safer from potential predators, but part of the ongoing process must come from each one of us.
We must warn if we hear a friend or family member speak of committing a violent act. We must protect the potential victim. We must speak frankly about behavioral problems when we attend family counseling. Family counseling can be uncomfortable. Statistics confirm that the largest number of domestic violence offenders came from abusive homes. The largest number of women who accept violent partners came from homes where abuse was routine. Before effective treatment can be realized, families must recognize their abuses and learn more supportive mechanisms for relating to each other.
The Tarasoff versus Regents of the University of California ruling has awakened the Psychiatric profession to its obligations to the public as well as its commitment to the patient. This has changed in the way it presents its confidentiality agreement, alerting the patient to possible dangers in confessing to violent urges. It is possible that the Tarasoff law will make it more difficult for therapists to determine real threats to identifiable victims, but the ruling has also created an awareness within society of its duties to create happy harmonious communities.
Under the guidelines suggested by the Methodist Church Conference, mental health care would be easily available and affordable for all income brackets. Law enforcement agencies would receive training for handling mental health issues constructively, without escalating the situation. Communities would reach out to isolated members and maintain a healthy relationship of concern and safety for each other's well-being. This would help therapists in their efforts to interconnect their patients with a balanced view of their workplace, family life, and relationships with others.
Remember, it's the goal of every professional and educated therapist to help you improve so that you are functioning and contributing member of society. We cannot have one without the other. A therapist will always help you and keep matters confidential so as long as it doesn't immediately endanger you or someone else.
Virtual chat, offered by services such as https://www.betterhelp.com/start/, now allow you to confess many of your feelings that you might never be able to tell someone in person. You don't have to fear being judged. You can speak your mind and receive some helpful advice on how to productively address these issues so that you can feel better and advance in life!
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