MONAHAN 1993

TARASOFF LIABILITY

Would a reasonable therapist, applying the professional standards that existed at the time of treatment, have assessed the patient’s risk of violence as sufficient to justify preventative intervention, and if so, was an appropriate intervention chosen?

1. A reasonable effort to gain information about violence prediction:

- What is the most violent thing you have ever done?

- What is the closest you ever came to being violent?

- Do you ever worry that you might hurt someone physically?

*Records of past and current treatment and when appropriate, interview significant others.

*Document a record of your acting responsibly. (Ex. In charts) Claims no violent (or suicidal) thoughts, actions.

*Document phone contacts:

a. Content of info

b. Date

c. Party called

d. Any action taken

2. Interventions:

1. Incapacitation- voluntary or involuntary hospitalization

2. Target Hardening- warn potential victims and others

3. Intensified Treatment- more frequent sessions, contracts, joint sessions with the significant other and perhaps the potential victim.

***Get second opinions!!!

Suicide Risk:

Low: Threats with no plan; no previous attempts; no drug-alcohol problems

Moderate: Low lethal plan; history of low lethal attempts; drug use for stress relief ; Ambivalence (re. Life/death)

High: High lethal plan, available means; previous attempts; drinking problems; depressed; wanting to die

Very High: High (above) plus impending loss or social crisis, alcohol to excess; history of high lethal attempts

STEPS:

1. Suicide contract, call hotline/clinic if impulses become strong - implies 24 hour coverage

2. Increased sessions and telephone contacts between sessions

3. Adequate staff supervision and medications in limited quantities

4. Accurate information (re. Anniversary/holiday reactions)

5. Permission to contact clients friends or relatives for support

6. Consultations with colleagues

7. Hospitalization - voluntary or involuntary

8. Document your evaluation of risk and steps taken

Schachter, 1999: The seven sins of memory

Omissions:

1. Transience—forgetting what we have learned over time, either quickly or gradually

2. Absent-mindedness—insufficient attention devoted at the time of encoding, “Where did I put my glasses”

3. Blocking—temporary inaccessibility of well-encoded material

Commissions:

1. Misattribution—a) correctly remembering an item or fact, but attributing it to an incorrect source. b) Misattributing an idea as the spontaneous product of one’s current thoughts when it is really the product of previous experiences, e.g., unintentional plagiarism. c) False recall or recognition of items or events that never happened.

2. Suggestibility—a tendency in memory to incorporate information (possibly incorrect information) provided by others, such as misleading questions.

3. Bias—the distorting influences of present knowledge, beliefs, and feelings on the encoding and recollection of experiences.

4. Persistence—remembering and embellishing a fact or event that one would prefer to forget.

Hill, Gelso, & Mohr, 2000: Client concealment and self presentation—a comment on Kelly, 2000

Main point to remember: Despite the awareness of most clients that therapists expect complete disclosure from them in psychotherapy, research shows that 40-60% of clients keep secrets from their therapists. This percentage is probably an underestimate.