Confidentiality is paramount between a patient and a therapist, but it's not ironclad -- confession to a crime, or the possibility of a potential crime, is not supposed to remain a secret.
"There is no clear-cut rule that psychiatrists are ever taught, but frankly, the bar is set very low in terms of breaking confidentiality," says Xavier Amador, a clinical psychologist and adjunct professor of psychology at Columbia University's Teachers College. "If there is any certain specific threat made, you have an obligation to report it."
Lynne Fenton, a psychiatrist treating accused Colorado movie theater gunman James Holmes, 24, was so concerned about his behavior that she contacted several members of the University of Colorado's Behavior Evaluation and Threat Assessment team, known as BETA, which is responsible for evaluating potential threats, CNN affiliate KMGH reported Wednesday.
"Fenton made initial phone calls about engaging the BETA team" in "the first 10 days" of June but it "never came together" because in the period Fenton was having conversations with team members, Holmes began the process of dropping out of school, a source told KMGH.
Sources told KMGH that when Holmes withdrew from school, the team "had no control over him."
But Gene Deisinger, deputy chief of police at Virginia Tech and head of the school's threat assessment team, says, "We don't close a case solely due to someone leaving the university."
"The decision to close a case is made based on assessment that the person no longer poses a threat of violence or significant disruption to the campus or to any other identifiable target," he says.
However, Deisinger, a former clinical psychologist, added that without knowing more details, it's impossible to draw conclusions about the University of Colorado's actions.
There remains a gray area for clinicians when it comes to flagging concerns about a patient. Simply put, it comes down to a therapist's interpretation about how specific a patient is when talking about violent thoughts or plans.
A specific threat means the patient clearly identified a targeted person or group, or gave specific details like a location or a time frame.