Informed consent, client rights, and duties to warn or protect
Informed consent, client rights, and duty to warn or protect
This domain tests what clients must be told before services and what a psychologist may do when a client poses a serious danger. Maryland law and the APA Ethics Code both shape the answer.
Core rules
- Obtain informed consent at the outset and document it. Discuss the nature of services, risks, benefits, alternatives, fees, confidentiality limits, and the right to withdraw.
- Client rights include privacy, access to records, respectful treatment, and information about grievances. Minors and legally incapacitated clients require special attention to consent and parental rights.
- Maryland has no general mandatory 'Tarasoff' warning statute for all psychologists. Confidentiality law permits disclosure when necessary to prevent or lessen a serious threat to an identifiable person, and the APA Ethics Code permits disclosure to protect. The psychologist should choose a reasonable protective action: warning, hospitalization, increased treatment, or notifying authorities.
Worked example
A client states he will shoot a named coworker. The psychologist assesses imminence, attempts to hospitalize, and, if that fails, warns the coworker and law enforcement. The reasoning: disclosure is permitted to protect, and the action must fit the risk. Documenting the assessment and steps is essential.
Traps
Do not assume every threat requires breaching confidentiality; assess seriousness and identifiability. Do not promise absolute confidentiality. Do not rely on a generic 'duty to warn' rule without checking Maryland's permissive framework.