The Ex-Partner, the Handgun, and the Limits of Confidentiality
Dr. Samuel Okafor, a licensed psychologist in Baltimore, has treated 34-year-old Mr. D for eight months for post-traumatic stress disorder and alcohol use disorder. Mr. D recently separated from his girlfriend, who has a new partner. In session he is agitated, says he has bought a 9 mm handgun, and describes a plan to go to the girlfriend’s office on Friday at 5 p.m. “to make her pay.” He has a specific route and says he has been drinking. He refuses voluntary hospitalization and says, “If you tell anyone, I’ll never speak to you again-and you’ll be sorry.” He denies current suicidal intent. Dr. Okafor practices in Maryland, where the girlfriend lives and works. Dr. Okafor has no release authorizing contact with her. He has 20 minutes before his next client.
1. Does Maryland law permit or require Dr. Okafor to act despite confidentiality? Explain the duty.
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Maryland does not have a single Tarasoff-style statute, but Maryland law recognizes that a psychotherapist may have a duty to protect identifiable third parties when a client presents a serious danger. Confidentiality under the Psychology Act and the psychotherapist-patient privilege are not absolute; they yield when necessary to protect the client or others. Dr. Okafor should assess imminence, intent, means, plan, and the girlfriend’s identifiability. Here the plan is specific, the means are present, the target is identifiable, and alcohol increases risk. The duty may be satisfied by a range of steps, not only warning: arranging emergency evaluation, hospitalization, police involvement, or warning the target. The least intrusive effective option should be chosen. The client’s threat to end therapy does not override the duty.
2. What specific steps should Dr. Okafor take in the next few hours?
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Do not let the client leave in an agitated, intoxicated state without a plan. Keep him in the office if safe, call 911 or mobile crisis, and arrange an emergency psychiatric evaluation; Maryland’s emergency evaluation process may apply. If he leaves, call police and give the minimum information needed. Warn the girlfriend directly or ask police to do so, and tell her the specific concern. Consult a colleague or attorney. Document contemporaneously. If he is hospitalized, coordinate with the facility. Do not abandon him; schedule follow-up and clarify that the therapeutic relationship can continue with new safety conditions.
3. What may Dr. Okafor disclose, to whom, and how should he document it?
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Disclose only the minimum necessary: the nature of the threat, the client’s identity, the planned time and place, and the risk. Do not release the full record without authorization or legal process. Document the risk assessment, the options considered, the rationale for the chosen action, the people contacted, and the times. Note what the client was told about limits of confidentiality at intake and in this session. If a warning is given, document exactly what was said. If law enforcement is involved, record names and report numbers. The record should show that the decision was clinically and legally reasoned, not punitive.