15.3: The Therapist-Client Relationship

Learning Objectives

• Describe three concerns related to the therapist-client relationship.

Three concerns are of paramount importance in terms of the therapist-client relationship. These include the following:

• Confidentiality – As you might have learned in your introductory psychology course, confidentiality guarantees that information about you is not disseminated without your consent. This applies to students participating in research studies as well as patients seeing a therapist.
• Privileged communication – Confidentiality is an ethical principle while privileged communication is a legal one, and states that confidential communications cannot be disseminated without the patient’s permission. There are a few exceptions to this which include the client being younger than 16, when they are a dependent elderly person and a victim of a crime, or when the patient is a danger to him or herself or others, to name a few.
• Duty to Warn – In the 1976 Tarasoff v. the Board of Regents of the University of California ruling, the California Supreme Court said that a patient’s right to confidentiality ends when there is a danger to the public, and that if a therapist determines that such a danger exists, they are obligated to warn the potential victim. Tatiana Tarasoff, a student at UC, was stabbed to death by graduate student, Prosenjit Poddar in 1969, when she rejected his romantic overtures, and despite warnings by Poddar’s therapist that he was an imminent threat. The case highlights the fact that therapists have a legal and ethical obligation to their clients but, at the same time, a legal obligation to society. How exactly should they balance these competing obligations, especially when they are vague? The 1980 case of Thompson v. County of Alameda ruled that a therapist does not have a duty to warn if the threat is nonspecific.

Key Takeaways

You should have learned the following in this section:

• There are three concerns which are important where the therapist-client relationship is concerned – confidentiality, privileged communication, and the duty to warn.

Review Questions

1. What are the three concerns related to the therapist-client relationship? Describe each and state any relevant court rulings relevant to them.

Check This Out

Can you play video games so much, that it becomes addictive? Does this mean that it is a diagnosable mental illness to be listed in the DSM 5-TR? Currently, the disorder is only listed in the DSM 5-TR as a condition for further study and is called internet gaming disorder. It is thought to include symptoms such as:

• Preoccupation with Internet games
• Withdrawal symptoms when not playing Internet games
• The person has tried to stop or curb playing Internet games, but has failed to do so
• The need to spend increasing amounts of time engage in Internet gaming
• A person has had continued overuse of Internet games even with the knowledge of how much they impact a person’s life
• The person uses Internet games to relieve anxiety or guilt or to escape
• Loss of interests in previous hobbies and entertainment except for internet gaming

Interestingly, the DSM-5-TR says the mean prevalence of 12-month Internet gaming disorder is approximately 4.7% across multiple countries and is similar in Asian and Western countries. It is more common in males than females. It is comorbid with major depressive disorder, OCD, and ADHD.

And, the ICD now includes gaming disorder in its 11th edition.

For more on this “disorder,” check out the following articles:

• Psychology Today – https://www.psychologytoday.com/us/blog/here-there-and-everywhere/201407/internet-gaming-disorder-in-dsm-5
• The Cognitive Psychology of Internet Gaming Disorder (2014 article in Clinical Psychology Review) – www.sciencedirect.com/science/article/pii/S0272735814000658
• CNN – https://www.cnn.com/2017/12/27/health/video-game-disorder-who/index.html
• Huffington Post – https://www.huffingtonpost.com/christopher-j-ferguson/the-muddled-science-of-internet-gaming-disorder_b_9405478.html
• WHO – www.who.int/features/qa/gaming-disorder/en/

What do you think?

Module Recap

And that’s it. Our final module explored some concepts that transcend any one mental disorder but affect people with mental illness in general. This included civil and criminal commitment and issues such as NGRI or the insanity plea, what makes someone dangerous and what we should do about it, and determining competency to stand trial. We then moved to patient rights, such as the right to treatment and, conversely, the right to refuse treatment. Finally, we ended by discussing the patient-therapist relationship and specifically, when the patient’s right to confidentiality and privileged communication ends, and the therapist has a moral and legal obligation to warn. We hope you find these topics interesting and explore the issues further through the links that were provided and peer-reviewed articles that were cited.