What should a therapist do with a patient like James Holmes?

Aug 4, 2012

First Court Hearing Held For Alleged CO Movie Theater Shooter

Accused movie theater shooter James Holmes makes his first court appearance at the Arapahoe County on July 23, 2012 in Centennial, Colorado. According to police, Holmes killed 12 people and injured 58 others during a shooting rampage at an opening night screening of “The Dark Knight Rises” July 20, in Aurora, Colorado. Credit: RJ Sangosti-Pool/Getty Images

The alleged perpetrator in the Aurora, Colorado massacre, James Holmes, had been treated by a psychiatrist who warned University of Colorado officials about the suspected killer, according to one report. No action was taken against Holmes because he dropped out of graduate school, but the case has reignited a debate about when therapists or counselors should or should not breach doctor-patient confidentiality.

Professionals are legally and ethically required to break confidentiality when they believe an identifiable victim is in imminent danger; however, making this determination can be a less than straightforward process. Whether or not a patient has a history of violence is often a key factor in deciding when to breach confidentiality, warn the appropriate parties and possibly recommend that the patient be hospitalized.


No therapist can predict a patient’s future behavior, but how should they go about determining whether or not to violate the confidence of their patients, if ever?

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