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Mind Reader
Therapist Jamie Matter knows too well the difficulty of identifying violent patients' intent on harm.

By Jamie Matter

It was any therapist's nightmare: there, below the banner headline about a highly public shooting, was my former client's name -- he was the shooter. Fortunately, no one died, and he was captured without further harm to anyone. But what could I have done, anyway?

Under California law, there are a number of things a therapist can do. If he judges the client to be a serious threat or danger to self or others, the client can be held for 72 hours in a psychiatric hospital without the client's consent. Only certain licensed therapists -- or the police -- can order someone held against their will on psychiatric grounds. Most of these cases end up being for suicidal clients, not those dangerous to others.

There is also the Tarasoff notification, which is required by law if the therapist thinks the client has made a credible threat against an identifiable other. In this case, the therapist is required to warn the intended victim as well as law enforcement. So every therapist is constantly aware that he or she might need to report a potentially dangerous client -- and we are on the lookout, believe me. But a therapist is not a mind reader.

It's not easy to determine who should be reported or when. If my client says, "I feel like killing my ex," but doesn't have a plan, how credible is that threat? I know he could get a gun, but so could anyone. Many of us say angry things we don't plan to act out.

Why didn't I report my client when I had him in treatment? Because he wasn't violent when I knew him. He did not have an anger problem. He was not paranoid. He didn't have hallucinations telling him to do violence. He made no threats. Did he withhold information because he knew he could be reported for planning violence? I don't think so. He was simply a troubled man trying to get his life together.  

Many of us have potentially violent clients, but we can't be sure who they'll be. It's any therapist's nightmare.

With a Perspective, I'm Jamie Matter.

Jamie Matter is a licensed marriage and family therapist who lives in San Francisco.
 

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