Our Big Little Lies Burning Question: Is a Therapist Ethically Obligated to Report Abuse?

Every episode of HBO's miniseries Big Little Lies leaves me with more questions than answers — it's part of the show's genius. I am, however, particularly confounded by Celeste's plot line and whether the show is dealing with it in a way that, in reality, would be considered ethically and legally sound. So I spoke to a professional who provided some insight into the domestic violence portrayed in the show.

If you haven't made it past the first few episodes, you might want to consider bookmarking this page and reading it later — it contains spoilers.

After watching only two episodes, it's quite clear that Nicole Kidman's character, Celeste Wright, is the victim of severe domestic violence. Celeste's husband Perry, played by Alexander Skarsgard, is manipulative, insecure, at times quite charming, and extremely violent. The couple has a pseudoerotic relationship with violence: Perry lashes out fiercely after some perceived indication that Celeste does not love him, beats her, and then the two eventually reconcile through rough sex.

As the show progresses, Celeste's bruises multiply. The violence is not just occasional: she expects it but has somehow rationalized the violence as partly her fault, which she reveals when the couple eventually seeks therapy in the third episode. In their first few meetings with the therapist, Dr. Amanda Reisman, Perry admits he is sometimes violent, though the level of his aggression is certainly downplayed. They both concede that the violence is typically followed by sex.

Eventually, Celeste attends a session alone with Reisman, who perceptively understands that Perry's violence is far more fierce than either of them let on. Reisman knows that Perry attacks Celeste regularly and presses her to realize how dangerous the marriage is. There's one scene in particular, at the end of episode four, when Reisman tells Celeste that she should schedule another solo appointment with her. "Let's come up with a plan for the next time he hits you," Reisman says at the end of the episode.

"Hold up," I thought as I watched the scene, questioning the boundary between fiction and reality in the story: is a therapist obligated, by any standard, to alert authorities of domestic abuse even if both parties admit its occurrence while seeking treatment? Furthermore, is it ethical, or legal, for a therapist to fail to report instances of known domestic violence, even without the patient's permission?

Short answer: it's complicated. According to Kim Mills, the communications executive at the American Psychological Association, it depends greatly on each individual case. "Reporting is not required in all instances," Mills wrote in an email. "The therapist might be able to make a workable plan with the abused victim to empower her to safely protect herself from the next abuse situation, depending upon the specifics of the situation."

Mills also said each state has varying mandatory reporting laws. In California, where the show is set, there is no mandatory reporting law for domestic violence between partners — there are laws that require therapists to report violence against children and the elderly, however. And it is legal, if the therapist can argue that a patient is in imminent danger, for a doctor to disclose violence without the patient's consent.

In the specific instance of Perry and Celeste's relationship, Mills says the couple would have signed an agreement that outlined the parameters of their therapy. "The psychologist would have obtained informed consent from both patients at the start of therapy," Mills wrote. "A part of the information given to the patients would be under what circumstances the psychologist would be obligated to breach confidentiality and report." Though, Mills added, many psychologists will not accept couples as patients if abuse is already alleged.

When abuse is gradually revealed through treatment, a psychologist typically has a framework for assisting the victim before contacting authorities. "Psychologists often use clinical skills to work with patients to empower them to take necessary steps to protect themselves," Mills wrote. "If there were a duty to report the abuse, many psychologists would start from a discussion with a patient about the need to report and attempt to obtain consent to make the report or have the patient be a part of the reporting."

During the second to last episode of Big Little Lies, Celeste is regularly attending sessions alone with Reisman and, together, they formulate a plan for her to leave Perry. Reisman also encourages her to confide in someone about the abuse in case there is a custody battle and to document her bruises and wounds. By the end of the episode, it's apparent Celeste wants to leave Perry: she rents an apartment just within the boundaries of their town, Monterey, CA, so that she has somewhere to take their children when she leaves.

While Perry and Celeste's story is fictional, their relationship dynamic is sadly one that often transpires in reality. The undeniable "realness" of their violent waltz is what makes it so difficult to watch: we empathize with Celeste and, on some level, understand why it might be challenging for her to leave her husband. Ultimately, however, the therapist plays a vital role in helping Celeste realize that she must leave for her safety and her children. One could even argue that Reisman's role in Celeste's awakening may have been impeded if she had gone directly to authorities before Celeste was willing to admit her husband's abuse, and the cycle would have continued — and there are only so many possibilities for how the violence could culminate.

There isn't one easy answer to how a therapist should respond when confronted with a relationship like Celeste's and Perry's — however, professionals are typically well-equipped to deal with the nuances of their situation. Ultimately, a healthcare provider will do what is most beneficial for the patient within the boundaries of the law.

If you or a loved one are in need of any help, the Office on Women's Health has several resources for assistance.