Warning Signs

I pressed on. "When I talk to my detective friend, I wouldn't reveal my patient's name, wouldn't even say that a patient told me. I'd just make an oblique suggestion about my concerns, just enough to get my friend to get the police department to look for explosives at Royal's house."

Raymond's face could hardly have been more skeptical. "I've heard your rationalization. I'm still wondering about your reasoning."

"What if there is a bomb planted there? Somebody could get killed if it went off. Royal's wife, Susan, Susan's health aide-somebody. If it turns out that nothing's there, I just look a little silly. My cop friend is used to that."

Raymond didn't quite smile and he didn't quite start shaking his head. But it was close. "Say there is something there. And the police find it… What if your patient's son's fingerprints are on the device? In effect, you've turned him in to the police, based on confidential information you had no right to divulge."

"Lesser of two evils. Tarasoff says I have to give a warning if I feel that someone's in danger based on what a patient tells me."

He opened a palm and held it up like a traffic cop. The pink edges of the soft flesh around his palm surprised me, even though I'd seen Raymond's hands a hundred times before. He said, "Not quite right. The court's Tarasoff decision says that you have to provide a warning if your patient makes an overt threat against an identifiable person. Based on what you've told me, your patient hasn't threatened anyone, Alan. No one. And regardless, I've not seen any court decision that extends the Tarasoff ruling to include hearsay. This isn't your patient threatening anybody. This is your patient talking about what somebody else might be pla

I argued back. "But if it were child abuse that I was hearing about, it wouldn't make any difference. Hearsay or no hearsay, right?"

"The child-abuse exception is handled specifically under Colorado law, Alan. This isn't."

I couldn't argue with the point that Raymond was making, so I moved the argument in a different direction, saying, "What if what's going on is that my patient actually wants me to turn her son in? What if that's her agenda with me? She can't stop him herself, she can't bring herself to turn him in, so she wants me to do it for her. She keeps talking about the Klebolds and the Harrises. There's a message there that I can't ignore."

He didn't respond right away, so I persisted. "The parents of the Columbine murderers may have failed their children and their community with their ignorance or their denial of what their children were pla

"And you don't want to be accused of making the same mistakes as the Jefferson County sheriff?"

"No, I don't, Raymond. I don't. One of those two, Harris or Klebold, was in psychotherapy, too. He was seeing a psychologist. What if he actually told the guy he was pla

"We don't know what that psychologist knew."

"But I know what I know."

"Do you?"

I said, "I don't want people to die when I might have had enough information to prevent their deaths."

"Especially your wife."

"Of course, especially my wife."

"You're not even certain she's been threatened, are you?"

"I can't risk it, Raymond. I can't."

"I suggest you step back and see the parallel process, my friend."

"What are you talking about, Ray?"

"Your patient is struggling with whether or not she has enough information to do what most parents consider unthinkable-turning her own son in to the authorities because she believes he may be pla

I said, "The moral obligations are clear for both of us, Ray. My patient should act. Failing that, I should act."

"Are the moral ambiguities so invisible to you? Are you in any position to make that judgment? I think I've made a damn good case that your objectivity is compromised, Alan. The bottom line is that you shouldn't be treating this woman at all. Your motivation as her therapist is not limited to assisting her with psychological concerns. Not at all. That alone should cause you to excuse yourself. Another therapist, an objective therapist, should make the decision about what to do with these supposed threats."

"How can I turn my back on what I know?"

"You know a mother's fears. That's all that you know. I don't think that's enough."

"She's telling me something, Raymond. She's telling me enough."

Raymond stood. He said, "I've not seen you like this before. You seem to want to believe that the rules don't apply right now."

I could no longer keep the intensity I was feeling out of my voice. "What rules? There aren't any rules that apply to this situation. Ethical standards evolve, Raymond, we both know that. There are always new situations developing that the old rules don't address."

"And this is one?" he asked skeptically. "You're sure of that?"

"Before Tarasoff, therapists couldn't even warn potential victims that they'd been threatened. Now we can-we must. That's a change. That's an ethical evolution. Circumstances required it."

"And you want the freedom to decide that this is the foundation for another ethical evolution? Tarasoff wasn't the result of a rogue therapist rewriting the rules, Alan. It was a California Supreme Court decision."

I scrambled to my feet. "I've never been in a position like this before. You have to admit these circumstances are unique."

His eyes flaring, he countered, "You have a patient who needs an objective outlet for exploring an issue that is troubling her. What, I ask you, is unique about that circumstance? It happens to both of us every day. The only thing that's unique about this situation is that you've decided to substitute your judgment for your patient's. How long do you think our profession can survive therapists doing that?"

"You know exactly what I mean. This is… different."

He dabbed at one corner of his mouth with the paper napkin. "Then act like it's different, Alan. The way I see it is that you're trying to straddle a high fence and you can't seem to get either foot on the ground. On one side you're making a case that your concerns are so great that they warrant your violating ethical principles that I know you hold dear. On the other side you're apparently not quite concerned enough about any of it to just go to the police and state your case. You have to get off the damn fence one way or another. Either it's a serious threat and you put your judgment ahead of your patient's, or it's not a serious threat and you shut up and help her with her struggles."

I pressed. "How would you get off the fence? If it were Cynthia in danger? Or one of your kids?"