Consider this scenario: A client tells their therapist that they wish someone was dead. How does a therapist ethically and legally handle this situation? Therapists have legal and ethical responsibilities to both their clients and the greater society. Many mental health professionals face challenges determining the best course of action when clients make threats toward others. This training will present a history of duty to warn laws and an examination of the Tarasoff Rule. Case vignettes will illustrate various situations that therapists may encounter when clients are expressing threats, violence, or harm to others. Learners will be provided with concrete and ethically sound practices to increase their confidence in managing duty to warn dilemmas.
Upon completion of this training, participants will be able to:
- Identify relevant state law and professional ethics regarding duty to warn responsibilities.
- Discover methods of assessing and intervening with potential duty to warn concerns and client potential for violence.
- Demonstrate increased confidence in mitigating client violence and following ethical and legal mandates regarding the duty to warn.
Syllabus:
Objective #1: Historical Context and the Tarasoff Case
- Review the facts and outcomes of the Tarasoff case
- Explain the court’s ruling on therapist responsibility
- Differentiate between the 1974 and 1976 rulings: duty to warn versus duty to protect
- Understand the legacy and influence on state-level laws
Objective #2: Homicidality and Clinical Risk Assessment
- Conduct thorough assessments of homicidal ideation, plans, means, and history
- Evaluate level of imminent risk and develop collaborative intervention plans
- Recognize red flags and use structured clinical judgment
Objective #3: Legal and Ethical Frameworks
- Summarize key rulings in subsequent court cases (e.g., David v. Lhim, Chrite v. U.S.)
- Understand variations in state laws regarding duty to warn and protect
- Review NASW Code of Ethics 1.07(c) on disclosure to prevent serious harm
Objective #4: Guidelines for Assessing Duty to Warn
- Examine client behavior, affect, interpersonal relationships, and cognitive patterns
- Use ACT-ION framework to evaluate justification, capacity, and intent
- Determine level of threat: low, medium, or high based on specificity and plausibility
Objective #5: Clinical Decision-Making and Intervention Strategies
- Utilize informed consent at the start of treatment to explain duty to warn obligations
- Intervene with de-escalation techniques, safety planning, and involuntary commitment if necessary
- Consult supervisors when possible and document decisions and actions thoroughly
Objective #6: Reamer’s Four Considerations and Ethical Criteria
- Presence of a threat
- Imminence of the act
- Foreseeability of harm
- Identification of a specific victim
Objective #7: Case Studies and Practice Examples
- Analyze scenarios with varying degrees of risk and legal obligation
- Discuss clinical decision-making and potential consequences of action or inaction
- Address threats made in front of intended victims and clinician response protocol
Objective #8: Communication and Documentation
- Communicate with intended victims and law enforcement as necessary
- Clearly document rationale, actions, consultations, and client responses
- Use nonjudgmental and behavioral language in clinical notes
Resources and Continuing Education
- Reference national guidelines and interactive legal maps
- Access homicide risk assessment tools and ethical decision-making handouts
- Explore professional literature, case law summaries, and video training materials
Social workers completing this course receive 3 Ethics asynchronous continuing education credits.
For other board approvals, this course qualifies for 3 Ethics continuing education training.
Instructor: Diane Bigler, LCSW, LSCSW
Recording Date: 1/20/2024
CEUS On-Demand, LLC, provider #2274, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/7/2026 - 08/6/2027. Social workers completing this course receive 3hrs Ethics continuing education credits.
CEUs On-Demand, LLC has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7091. Programs that do not qualify for NBCC credit are clearly identified. CEUs On-Demand, LLC is solely responsible for all aspects of the programs.
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Request for Special Accommodations: Learners can request special accommodations by contacting the administrative team at admin@ceus-ondemand.com