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Silence or Death: The Limits of Confidentiality When a Psychotherapist is Threatened by the Patient

When considering clinician safety, the threatening and/or assaultive patient quickly comes to mind. The authors discuss the ethical and legal dilemmas in a different type of situation resting on the boundary of confidentiality. In this case, a patient convincingly admits, during a therapy session, to having committed a serious crime and subsequently threatens the psychotherapist in an effort to enforce the therapist's silence about that crime.