The precedent-setting 1976 judicial decision of Tarasoffv. Regents of the University of California established a duty to protect whereby psychotherapists are expected to exercise reasonable care to protect the potential victims of their clients' violent behavior. However, no standard of care for dangerous clients has been established. In this article, the authors present a model for clinical decision making to determine the best interventions for dealing with dangerous outpatient clients. The model takes into account the degree of violence risk and the strength of the therapeutic alliance. Four cases are presented to illustrate the application of the model.Outpatient psychotherapy with a dangerous client poses a conflict for therapists between therapeutic, ethical, and legal duties to the client and a legal duty to protect any potential victims of the client's violent behavior. If a threat of violence is made known to others, either for the purpose of warning a potential victim or alerting law enforcement officials to prevent the violent act, it violates the client's confidence and could result in the client feeling intense embarrassment or anger; being charged, arrested, and possibly convicted of a criminal offense; or being denied or refusing further treatment. The therapist could also face disciplinary'or civil charges for breaching confidentiality. If, on the other hand, the threat is kept confidential, any subsequent violence might have been prevented and the therapist may feel guilt, anxiety, lowered confidence, and a reluctance to treat similar clients; also, the therapist may face a lawsuit.Before the 1976 California Supreme Court decision of Tarasoffv. Regents of the University of California, psychotherapists tended not to be concerned about legal liability for their clients* behavior outside the therapy. The Tarasoffcomt ruled, however, DEREK TRUSCOTT received his PhD in clinical psychology from the University of Windsor in 1989. He is currently a psychological consultant with the Workers' Compensation Board of Alberta,

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