Problem:
Bruce has been counseling Martha for about one year. He is concerned because she has become increasingly belligerent in the past few days. Martha is in a troubled marriage, and has recently discovered that her husband has been having an affair and is planning to ask for a divorce so he can be with the other woman. Martha is 24 years old, and has been in and out of mental health treatment for most of her life. She has been diagnosed at various times with bi-polar disorder, borderline personality disorder, and alcohol abuse. Martha occasionally holds down a job for a month or so, but mostly subsists on SSI, Medicaid and Food Stamps. In some ways, the most stable and supportive relationship she has in her life is with Bruce. Bruce is concerned because Martha has been making vague threats toward her husband in the last couple of days. She's been saying things like, "I'm gonna kill that b-----d! I'm gonna make him pay!" "If I can't have him, then nobody can, especially that b---h!" Bruce has heard Martha get angry in the past, but her tone is different these past few days. Bruce also knows that Martha has started drinking again. He can smell alcohol on her breath during sessions, and her most recent urinalysis was positive.
Bruce is seeking consultation from the team because he does not know what to do. He is aware of the Tarasoff "duty to warn," but he doesn't really know if Martha is seriously intending to harm her husband. He fears if he breaches confidentiality and reaches out to her husband, he will be throwing away a year's worth of work with Martha. He is sure she would never come back for counseling, and she has made good progress with him. On the other hand, he wants to act ethically and responsibly, and does not want to get into legal trouble. He is also worried about Martha's husband. He would feel terrible if anything happened to him and he had chosen not to warn him.