What must a psychotherapist do if they determine that a patient poses a clear and present danger due to a history of violence?

In situations where a psychotherapist believes that a patient poses a clear and present danger due to a history of violence, the ethical and legal obligation is to take actions that protect potential victims. This commonly involves notifying both the potential victim and law enforcement authorities.

The reason this is the correct course of action is rooted in the concept of duty to warn, which emerges from the Tarasoff case that established that mental health professionals have the responsibility to protect individuals who may be at risk from a patient. By directly communicating the threat to the individuals or entities that can intervene, such as law enforcement or the potential victim, the psychotherapist acts to reduce imminent harm, thereby upholding their ethical duty to ensure safety.

Continuing therapy without interruption, while potentially beneficial in different circumstances, does not address the immediate threat and would go against the duty to protect others. Reporting the patient to the authorities alone might not ensure that the specific individuals at risk are informed. Documentation, while important for clinical records, does not help prevent potential harm if immediate action is necessary. Hence, notifying both the potential victim and law enforcement represents the most appropriate and responsible response in such critical situations.