Emerich, Protect, Violence

1. Duty to Protect throughDuty to Protect through
WarningWarning
Emerich v. the PhiladelphiaEmerich v. the Philadelphia
Center for Human DevelopmentCenter for Human Development

2. Principle 5: ConfidentialityPrinciple 5: Confidentiality
““This code of ethics does not prohibit aThis code of ethics does not prohibit a
psychologist from taking reasonablepsychologist from taking reasonable
measures to avoid harm when a client hasmeasures to avoid harm when a client has
expressed a serious threat or intent to killexpressed a serious threat or intent to kill
or seriously injure an identified or readilyor seriously injure an identified or readily
identifiable person or group of people andidentifiable person or group of people and
when the psychologist determines that thewhen the psychologist determines that the
client is likely to carry out the threat or theclient is likely to carry out the threat or the
intent of the client.”intent of the client.”

3. Basic FactsBasic Facts
Gad Joseph participated in psychotherapyGad Joseph participated in psychotherapy
with Mr. Scuderi at PCHDwith Mr. Scuderi at PCHD
Joseph had a history of violence towardJoseph had a history of violence toward
his Teresa Hausler, his live-in partnerhis Teresa Hausler, his live-in partner
She broke off the relationship and movedShe broke off the relationship and moved
to Readingto Reading

4. Basic FactsBasic Facts
On June 27, 1991, Joseph phoned hisOn June 27, 1991, Joseph phoned his
therapist and advised that he was going totherapist and advised that he was going to
kill Ms. Hausler.kill Ms. Hausler.
A session was scheduled at 11 am. At thatA session was scheduled at 11 am. At that
session, Joseph indicated that he wouldsession, Joseph indicated that he would
kill Hausler if she returned to thekill Hausler if she returned to the
apartment to collect her belongings.apartment to collect her belongings.

5. Basic FactsBasic Facts
Mr. Scuderi recommended that JosephMr. Scuderi recommended that Joseph
voluntarily commit himself. He refused;voluntarily commit himself. He refused;
however, he stated that he would not hurthowever, he stated that he would not hurt
Ms. Hausler. Session ends at noon.Ms. Hausler. Session ends at noon.
At 12:15 pm, Hausler phones Scuderi,At 12:15 pm, Hausler phones Scuderi,
explained that she is returning to theirexplained that she is returning to their
apartment. She wanted to know aboutapartment. She wanted to know about
Joseph’s whereabouts.Joseph’s whereabouts.

6. Basic FactsBasic Facts
Mr. Scuderi instructed Hausler to not to goMr. Scuderi instructed Hausler to not to go
to the apartment and return to Reading.to the apartment and return to Reading.

7. Pennsylvania Supreme CourtPennsylvania Supreme Court
DecisionDecision
Under certain circumstances, a mentalUnder certain circumstances, a mental
health professional has a duty to protecthealth professional has a duty to protect
by warning a potential third-party victimby warning a potential third-party victim

8. Some specifics from the CourtSome specifics from the Court
1. When the patient has communicated to the1. When the patient has communicated to the
professional,professional, a specific and immediate threata specific and immediate threat
of serious bodily injuryof serious bodily injury againstagainst a specificallya specifically
identified or readily identifiable third partyidentified or readily identifiable third party
2. And when the professional determines (or2. And when the professional determines (or
should determine under the standards of theshould determine under the standards of the
mental health profession) that the patientmental health profession) that the patient
presents a serious danger of violence to thepresents a serious danger of violence to the
third partythird party

9. Some specifics from the CourtSome specifics from the Court
3. Then the professional3. Then the professional bears a duty tobears a duty to
exercise reasonable care to protect byexercise reasonable care to protect by
warning the third party against suchwarning the third party against such
dangerdanger

10. Lack of clarity in decisionLack of clarity in decision
1. “A specific and immediate threat" of1. “A specific and immediate threat" of
serious bodily injury is not well definedserious bodily injury is not well defined
Temporal issue in playTemporal issue in play
2. “Serious danger of violence" is not well2. “Serious danger of violence" is not well
defineddefined
Involves prediction of violenceInvolves prediction of violence

11. Important points to noteImportant points to note
A careful, thoughtful, and clinically soundA careful, thoughtful, and clinically sound
assessment must be conducted in theassessment must be conducted in the
appropriate cases to determine whetherappropriate cases to determine whether
the patient presents a serious danger ofthe patient presents a serious danger of
violence to a third party.violence to a third party.
(Future liability may attach if such an(Future liability may attach if such an
assessment is not conducted in anassessment is not conducted in an
adequate manner.)adequate manner.)

12. Important points to noteImportant points to note
The clinician is balancing the need toThe clinician is balancing the need to
protect others in the community with theprotect others in the community with the
patient’s right to privacy, which is apatient’s right to privacy, which is a
cornerstone of psychotherapy.cornerstone of psychotherapy.
(Future liability may attach if care is not(Future liability may attach if care is not
care in breaching confidentiality.)care in breaching confidentiality.)

13. Helpful HintsHelpful Hints
Conduct a thorough risk assessmentConduct a thorough risk assessment
a. Is the threat immediate?a. Is the threat immediate?
b. Is the victim clearly identifiable?b. Is the victim clearly identifiable?
c. Does this rise to the level of seriousc. Does this rise to the level of serious
bodily harm or death?bodily harm or death?
d. Not every utterance of violence is ad. Not every utterance of violence is a
threat.threat.
e. Evaluate risk factorse. Evaluate risk factors

14. Helpful HintsHelpful Hints
If the criteria for warning is not met, butIf the criteria for warning is not met, but
violence remains an issue, it needs to beviolence remains an issue, it needs to be
addressed in therapyaddressed in therapy
Ongoing focus of treatmentOngoing focus of treatment
Document any strategies, plans, orDocument any strategies, plans, or
updated evaluationsupdated evaluations

15. Helpful HintsHelpful Hints
If the criteria are met, then a warningIf the criteria are met, then a warning
needs to be issued.needs to be issued.
a. Who needs to be warned?
b. How is the warning communicated?
c. How much information is shared?

16. Helpful HintsHelpful Hints
Documentation is crucial in suchDocumentation is crucial in such
circumstances, whether or not a warningcircumstances, whether or not a warning
is issuedis issued
Document relevant pointsDocument relevant points
Detail violence assessmentDetail violence assessment
Document any consultationsDocument any consultations
Record the decision-making processRecord the decision-making process

17. Case ExamplesCase Examples