Which of the following is an exception to privileged communication between a patient and a psychotherapist?

The correct choice highlights an important aspect of privileged communication within the therapist-patient relationship: the duty to protect. When a patient poses an imminently dangerous threat to themselves or to others, the therapist may be legally obligated to disclose information that would ordinarily be protected under privilege. This exception arises from a balance between maintaining confidentiality and the ethical and legal duty to prevent harm. In such situations, the therapist is not only justified but required to breach confidentiality to ensure the safety of the patient or others who might be at risk.

The other options do not typically qualify as exceptions to privileged communication under the law. For instance, disclosing a substance abuse history does not necessarily indicate an immediate threat of harm, and confidentiality still applies. Similarly, the presence of a family member in therapy does not impact the privilege directly and does not constitute a threat. Lastly, a patient's desire to change therapists does not create an urgent situation that would warrant breaking confidentiality, as this is a normal part of the therapeutic process that does not involve imminent danger.