Limiting the psychotherapist-patient privilege: the therapeutic potential

The author first explores the law of the psychotherapist-patient privilege along with the traditional rationale for the privilege. The results of studies challenging the assumptions upon which the privilege rests are summarized. Finally, the potential therapeutic advantages are explored. The author suggests that the absence of an absolute privilege might in fact prevent harmful behavior. Those patients who communicate to their therapists the desire or intent, for example, to commit a crime, might not act on their urges for fear of disclosure of the communication in a future criminal proceeding.     

Waiver of the psychotherapist-patient privilege: implications for child custody litigation

The psychotherapist-patient privilege, rooted in both common and statutory law, is predicated upon the public policy goal of protecting the reasonable expectation of privacy of individuals seeking psychotherapy. The privilege is not absolute, however. State and federal courts are far from uniform in determining how and when the privilege should be waived, in whole or in part, through implication, inadvertence or the affirmative action of the parties. In the family law context, the law that has evolved around the exercise of this privilege is even more complex as the needs of children add another wrinkle to the goal of balancing the imperative of confidentiality with the need for useful information that may be provided.     

The dangerous patient exception to the psychotherapist-patient privilege: the Tarasoff duty and the Jaffee footnote

With the U.S. Supreme Court's 1996 decision in Jaffee v. Redmond, all U.S. jurisdictions have now adopted some form of evidentiary privilege for confidential statements by patients to psychotherapists for the purpose of seeking treatment. The majority of states, following the decision of the Supreme Court of California in Tarasoff v. Regents of the University of California, have also adopted some form of duty by psychotherapists to breach confidentiality and warn potential victims against foreseeable violence by their patients. Largely unresolved is whether there should be a dangerous patient exception to the evidentiary privilege parallel to the Tarasoff exception to confidentiality. This Article argues that exception to the evidentiary privilege should be evaluated separately from the exception to confidentiality. Whether or not a Tarasoff duty to warn existed at an earlier time, exception to the evidentiary privilege should be made only where psychotherapists' testimony is necessary to prevent future harm to patients or identified potential victims. Applying this standard, the dangerous patient exception generally would not apply in criminal actions against patients, but would apply only in proceedings for the purpose of protecting patients or third parties, such as restraining order hearings or proceedings to hospitalize patients.     

Assessment and training of social competence in dangerous psychiatric patients

Traditional approaches to the assessment and treatment of individuals who have demonstrated dangerous behavior have been based upon a trait model of personality. The social competence model differs from the trait model by assuming that much behavior is situationally determined, that new socially competent behavior patterns can be acquired through observation of models and practice, and that the frequency of undesirable behaviors can be reduced by increasing the frequency of incompatible, desirable behaviors. This paper reports the applications of the social competence model to the assessment and treatment of men in a security hospital, including individuals confined because of specific offenses, such as sex crimes, arson, and institutional assault, as well as those with high overcontrolled-hostility scores, low overall social skill ratings, and low popularity ratings from their peers. The social skills training approach that we have employed has been most successful with sex offenders and arsonists. The results suggest that the most withdrawn and shy individuals derive the greatest benefit from our social skills training approach while overassertive individuals benefit least. It is hypothesized that staff may reward unassertive patient behavior and punish assertive behavior and that future research must focus on changing this pattern in order to foster socially competent behavior by institutional residents. While many problems remain to be answered, our preliminary results suggest the usefulness of the social competence approach in the assessment and treatment of dangerous psychiatric patients and offer the possibility that the approach may lead to better control of violent behavior in the future.