Am J Psychiatry 1996; 153:457-465
Copyright © 1996 by American Psychiatric Association
Psychotherapists' duties to third parties: Ramona and beyond
PS Appelbaum and R Zoltek-Jick
Department of Psychiatry, University of Massachusetts Medical Center, Worcester, 01655, USA.
OBJECTIVE: This paper explores the implications for psychotherapy of a
series of court cases involving suspected childhood sexual abuse that have
raised the question of when psychiatrists and other psychotherapists can be
sued by third parties for their behavior in therapy. METHOD: The authors
begin by considering traditional legal approaches that until now, with few
exceptions, granted only patients the right to sue caregivers for
negligence. Then they turn to Ramona v. Ramona, the most publicized of a
new line of cases, in which the California courts allowed a father accused
of abusing his daughter to sue his daughter's therapists. RESULTS: The
rationale for the abandonment of the previous restrictions on liability in
Ramona was that since the father was a "direct victim" of the therapists'
negligence, traditional limitations on the therapists' duties toward him
should not apply. Related cases have used similar logic. Inherently
difficult for the courts to apply, the direct victim standard would leave
therapists unclear as to how to avoid duties to third parties, other than
by refusing to treat patients with family members who may be potential
litigants. Moreover, aggrieved third parties essentially would have the
power to bring effective treatment to a halt by filing suit or threatening
to do so. CONCLUSIONS: Although concern about therapeutic practices related
to memories of childhood abuse may be warranted, abandonment of traditional
rules against suits by nonpatients would be ill-advised. In the meantime,
therapists can take steps to lessen the probability of their becoming
involved in such litigation.
