Discussion About Confidentiality, Tarasoff, and Ethical / Legal Issues

[DrClinPsyAdvice]

*MOD NOTE: This was a question from another thread that I thought would be worth discussing. Tarasoff, legal, and ethical considerations are important topics for clinicians to discuss, particularly those that work with high-risk populations. -t4c*

question 3: In an answer to a previous question, you mentioned that a Clinical Psychologist is only 'posed to disclose for a few reasons, you listed 3 - risk of self-harm being one of them.
Now since this is a public forum, I just want to clarify...isn't self-harm (cutting for e.g.) confidential, and only risk of suicide trumps confidentiality rules, or does it vary by state?

I'm just curious...because I really did think self-harming behaviour was confidential...

3. The rule typically states imminent risk of severe self harm. Some self-injury suggests impending suicide attempts. Some does not. The clinician's judgment of suicide risk will determine whether they report or not.

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[Therapist4Chnge]

question 3: In an answer to a previous question, you mentioned that a Clinical Psychologist is only 'posed to disclose for a few reasons, you listed 3 - risk of self-harm being one of them.
Now since this is a public forum, I just want to clarify...isn't self-harm (cutting for e.g.) confidential, and only risk of suicide trumps confidentiality rules, or does it vary by state?

Confidentially should be broken if the person is a threat to themselves or others. Tarasoff implications vary by state, so it is important to understand the ethical and legal ramifications of confidentially.....as you may be liable if you do not probably inform the right people.

There are also implications if the patient is a minor v. an adult. If a minor is self-harming, that is something that needs to be disclosed to the parent, as they are responsible for the child's well being. Although the child is your patient, the parent's legal right trumps confidentiality between the clinician and the patient.

If your patient is an adult (not under the supervision of a 3rd party), it is a bit more complicated and is not an automatic report, but the patient's overall health needs to be considered as self-harm can lead to a suicide attempt. People who self-harm are at a greater risk to make an attempt compared to those that don't, so even if there is not a history of attempts, that does not preclude the person from following through during an instance of self-harm.

 

[Therapist4Chnge]

*edit to merge and do other mod-like things to make this thread.*