A hypothetical about psychotherapists, confidentiality, and ethics

There’s no real-world situation going on here, so no one need fuss about giving legal or medical advice. My interest is half in factual answers, half in opinions, so by the flip of a coin IMHO gets it.

Imagine a pscyhotherapist, Jake, who has among his patients a woman named Deety and a man named Zeb. The layout of Jake’s office is such that patients enter and leave by separate doors, and so far as Jake knows, neither Zeb nor Deety is aware that the other one is his patient. Jake has been counseling each of them for about six months; Zeb was his patient first by about a week; both of them were referred to Jake by another doctor. Deety is seeing a married man, who is sometimes physically abusive to her; Zeb is married and having the latest of many affairs. In their sessions, both Deety and Zeb refer to people in their lives in code, and over time Jake comes to suspect very strongly that they are talking about one another in their sessions. Moreover, Jake also believes that Zeb is less interested in getting help for his problems than he is in bragging about his exploitation of the women in his life. Though Zeb never makes an overt threat, Jake worries about the safety of his mistress if the mistress ever attempts to break off the relationship or tell Zeb’s wife what is going on. Zeb has confessed to having been extremely violent to women in the past in such situations, but claims that such behavior is long behind him.

Okay, that’s the setup. Now the questions:

[li]What is Jake ethically allowed to do here?[/li][li]Ignoring issues of ethics, what would you say is Jake’s moral duty?[/li][li]What do you think you’d choose to do in Jake’s position?[/li][/ol]


Doesn’t Jake have a legal obligation to report this to authorities?

Zeb signed a release at the beginning of therapy saying that if it was believed that he was a danger to himself or others, Jake had that obligation.

Well therapist have (or should have) a code which directs their conflicts of interest. If two patients have overlapping problems such as the above example, the therapist should excuse himself from treating one of them due to a “conflict of interest”

Now what I found interesting in Illinois there is a law that governs this. I tried to get some counseling for an issue about 5 years ago in two places and both the therapist started out by saying:

“Everything you say to me is strictly confidential EXCEPT, if I feel you may harm yourself or harm others. We are required by law to report such information to the appropriate governmental authorities.”

So in the OP case yes, they would tell. Somone is doing harm or possible doing harm to others.

I remember thinking that IL law was interesting because if you’re doing something criminal and want to stop it puts you in a bind as your therapist could have you arrested for it.

Hell if I know. But I shouldn’t think so, as Zeb has not threatened Deety or anyone else in any fashion. But I am frequently wrong.

Is it a state law or federal? We have the same thing in MA.

Not sure, but it sounds like it’s Jake’s judgement call.

Zeb says he hasn’t threatened his lover, but Deety claims her lover has hit her. Who would you believe?

If Jake has reason to believe that Zeb will (physically) hurt women who (emotionally) hurt him, and he knows Deety is going to break up with him, he should do these (in my opinion). First, without directly saying that he knows Zeb, he should counsel Deety that, if she’s afraid for her safety, to know she should call the cops, report any abuse immediately, etc. If she fails to heed the warning, and Jake knows Zeb will hurt her and he knows Deety is breaking up with her, he has the obligation to report it to authorities. If a patient is a danger to him/herself or others, the therapist must report them.