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On this track, we will discuss concerns regarding the therapist-client confidentiality boundary in regards to the risk of a school shooting incident. We will also discuss the six step Action technique for fact based risk inquiry regarding confidentiality ethics. These six steps are attitudes that support or facilitate violence, capacity, thresholds crossed, intent, other’s reactions, and non-compliance with risk reduction interventions.
In Michigan in 2000, six-year-old Kayla Rolland and a little boy who was her classmate had an argument. The next day, the little boy, also six, brought a 32 caliber semiautomatic to school. Bringing the gun out of his bag, the little boy told Kayla, “I don’t like you” and shot her in the chest. The bullet pierced Kayla’s heart. The little boy who shot Kayla later reported that he had not meant to kill Kayla, merely to scare her. He did not seem to display any comprehension that pulling the trigger of a gun kills, nor did he show any remorse.
School shootings seem to have become a nationwide crisis. Incidents have occurred in almost every part of the United States, and in almost every age group, from Kayla’s death in early elementary school, to the Columbine shootings in high school, to the shooting perpetrated by a college student at Virginia Tech. As you know, much attention among education and mental health professionals has focused on what can be done to identify the perpetrators of these shootings before violence occurs. In my experience, one of the most crucial issues discussed has concerned issues of confidentiality in counseling students at risk.
Before we begin our discussion of issues specific to confidentiality in regards to school shootings, I will briefly review the Tarasoff case and its implications for therapists. As you know, the Tarasoff (Ter-AS-off) case concerned a young man named Prosenjit (pro-ZEN-yet) Poddar (po-DAR), who indicated in a session with a university counselor that he wished to harm a woman. Even though Poddar did not mention her by name in the session, the woman was identifiable by information given to the counselor.
The first version of the Tarasoff decision, made in 1974, identified the responsibility of therapists as the “duty to warn,” or inform third parties of a risk posed by a client. However, as you know, the decision was extended in 1976, to establish that therapists have a “duty to protect” third parties from dangers posed by a client.
Possible actions that may discharge this duty to protect, in connection to duties imposed by state regulations, include warning the potential victim that he or she may be in danger, notifying law enforcement, or taking other steps that may be appropriate considering the particulars of the situation, such as pursuing hospitalization.
One proposed technique for managing Tarasoff situations in regard to school shootings is a six step fact based risk inquiry. This technique is called the “ACTION” technique. “Action” can be used as a simple mnemonic to easily recall these factors.
6-Step ACTION Technique
The greater the perceived justification, the greater the likelihood of action. In addition, it is useful to assess the client’s appraisals of provocation or intentionality from others (a hostile attribution bias), violent fantasies, self-statements, expectations about the success of violence, and whether the client believes that violence will accomplish or further his or her goal.
Step #2 - Capacity
Step #3 - Thresholds Crossed
In summary, it is helpful in considering potential Tarasoff applicability not only to ask about the existence of a plan, but what steps the client has taken to further that plan.
Step #4 - Intent
These behaviors that indicate a commitment to action include consideration of potential consequences, consideration and rejection of alternate solutions, and an attitude of having ‘nothing to lose’.
Step #5 - Reactions and Responses
For example, a client who reports that when he angrily told his best friend he was going to kill a teacher perceived as antagonistic, his friend responded with, ”well someone ought to” might perceive the justification for his violent act as stronger. The client’s perceived barriers or discouragements to the act might also be fewer.
Step #6 - Noncompliance with Risk Reduction
On this track, we have discussed concerns regarding the therapist-client confidentiality boundary in regards to the risk of a school shooting incident. We also discussed the six step Action technique for fact based risk inquiry regarding confidentiality ethics. These six steps are attitudes that support or facilitate violence, capacity, thresholds crossed, intent, other’s reactions, and non-compliance with risk reduction interventions.
On the next track, we will discuss the first five of nine explanations of school shootings, and how these theories hold up under professional scrutiny. These first five popular explanations of school shootings are, mental illness, ‘he just snapped’, family problems, bullying, and peer support.
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