OBJECTIVE: The Tarasoff case and subsequent court decisions and
legislation in many jurisdictions established a duty to protect the
intended victims of patients who pose a serious threat of violence. An
approach that has been legally sanctioned is to warn the intended victim.
This study examined the effects of such warnings on the warned persons and
on the therapeutic relationship. METHODS: All second-, third-, and
fourth-year psychiatric residents (N = 46) in a university- based
psychiatric residency program in San Francisco were interviewed about their
experiences related to issuing Tarasoff warnings. RESULTS: Almost half of
the residents (N = 22) reported having issued a Tarasoff warning. Most
warnings were issued for patients seen in inpatient units and emergency
rooms. In almost half of the cases, the resident was unable to contact the
intended victim but did report the threat to a law enforcement agency. In
almost three-fourths of the cases in which the intended victim was
contacted, the individual already knew of the threat. The most common
reaction among those warned was anxiety mixed with thankfulness; most
expressed an intent to modify their behavior to increase safety. The second
most common reaction was denial that the patient would ever hurt them.
Clinicians reported that in most cases issuing the warning had a minimal or
a positive effect on the psychotherapeutic relationship. CONCLUSIONS: Many
of the anticipated negative effects of the Tarasoff decision have not
materialized.
Abstract Teaser