Violence risk assessment

This comes from a violence risk assessment tool being developed. At the time of publication (2006) there was accumulating evidence that this is a valid measure and more research is being conducted. So as far as the empiricists are concerned it is looking good but is still not 100% ok from empirical research point of view. From the average guy in the street this is quite a good risk assessment tool with some significant scientific backing. It certainly is used a good deal in the literature

Like suicide risk questionnaires it uses the mathematical approach. You add up how many things the person has, the more they have the more risk there is of them acting violently. However as you would have found if you have read my book on suicide it pays to look at the various sections in more detail in order to get a more accurate assessment of risk. However disregarding that I make other comments on this assessment tool.

Historical

Previous violence

Young age at first violent incident

Relationship instability

Employment problems

Substance use problems

Major mental illness

Psychopathy

Early maladjustment

Personality disorder

Prior supervision failure

Clinical

Lack of insight

Negative attitudes

Active symptoms of major mental illness

Impulsivity

Unresponsive to treatment

Risk management

Plans lack feasibility

Exposure to destabilizers

Lack of personal thought

Noncompliance with medication attempts

Stress

Australian Psychological Society (2006)

This originally came to my attention because I was writing about the difference between thoughts and behaviour. I have mentioned before that some clients can come to counselling expressing distress abut the thoughts they are having. I recall a woman who had a fear of sharp knives because when she saw them she had thoughts of stabbing her husband. My first statement is there is a very big difference between fantasy and behaviour. Or there may be some kind of sexual fantasy. Again I will say there is a big difference between fantasy and behaviour. What some find very erotic in fantasy would be completely non erotic in real life.

One should note in support of this the list composed above by hard core empiricists has no mention of violent thoughts or fantasies at all.

My thoughts on further aspects of the assessment tool to consider:

Substance use problems. People who are habitual users of marijuana and opiates like heroin are less likely to be violent compared to those who use stimulants like amphetamines, also alcohol with its strong disinhibiting effects and steroids.

On the section of previous violence I would also investigate any previous violence against self as well. It is plausible from a human psychology perspective that if a person is physically violent to self they have more ‘permission’ to be physically violent to others compared to the person who has no self directed physical violence.

Also I would add in previous exposure to physical violence as we know modeling can have an impact on human behaviour. The person as a child:

At the first level were they told about violence in the home or heard violence in the home.

At the second level did they see first hand violent acts in the home between others.

At the third level did they experience violent acts in the home to them self from another.

At the fourth level did they engage in violent acts towards others in the home.

The higher the level experienced the more permission they have to do physically violent acts on others as an adult.

The early decision to use violence as a solution to problems. By using such techniques as the bad day at black rock one can ascertain if the child made the early decision that violence is a viable way to solve problems. Some children make this decision and some do not. Those who do not are far less likely to use physical violence no matter how many of the criteria they meet in the above lists.

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Sameness in relationships **

In relationships of any depth there is a natural tendency for both parties over time to become more the same. They will tend to become more like one another.

When any two people spend time together they will tend to model and introject each other. This is inevitable and indiscriminate and can not be avoided. Humans will instinctively do it whether they are aware of it or not.

This process is easily explained in transactional analysis

This shows how the wife models or introjects her husband’s personality into her own Parent ego state and of course he does the same with her over time. As mentioned before this process can not be avoided and will happen instinctively.

The copying relates to the behaviour, thoughts, attitudes and feelings of the other. All these parts of the others personality become our own after time. However husbands and wives do not end up as clones of each other and they do remain different over time. Of course the Parent ego state is but just one aspect of the personality and we all also have an Adult and Child ego state and these can be quite different between the two partners. However there is a tendency to sameness in the way described and this does not have to be an equal process.

Modeling can even occur between animal and human

People will tend to model more on those who are of more perceived potency and emotional importance. Thus the introjection between the married couple may be at different degrees. That is, one does more introjection than the other and generally speaking it is the more dominant party in the relationship who will be introjected more than the other way around.

This has been studied in some depth before and is presented in the DSM-IV by the American Psychiatric Association (1994) who discuss the Folie a Deux or a shared delusional disorder. In this case two people who are in a close relationship over time develop the same delusional belief system. There tends to be one dominant party and the more submissive party takes on the delusion of the other. This means that should the relationship end the more submissive party will tend to drop the delusion over time even though the submissive party probably has a tendency to have the same delusional beliefs.

Of course they don’t have to be delusional beliefs but can be beliefs or views about anything including religious views, political views, attitudes to neighbours, relatives, friends and so forth.

It should be noted that even after the introjection has taken place there are other potent psychological processes at work that further develop the sameness in a couple. The most obvious example of this is the phenomena of group think. In this situation when two or more people get together there is internal pressure in the group towards uniformity which leads the group to come up with same consensus that maybe false or not.

Group think can result in:

Illusion of invulnerability that can encourage excessive optimism and risk taking

Unquestioned belief in the group’s morality and goals which can result in the group members ignoring the consequences of their actions

Self censorship of deviations in the group’s beliefs and goals

Suppression of dissent by more powerful members in the group

Feelings of anonymity

Discount self responsibility

As two people talk and discover that they tend to have the same attitude or opinion about something this can give them a false sense of security as is described above. “If others think the same as I do then that makes my views more correct or right” is the reasoning behind group think. Thus if a husband and wife have introjected similar views from the other about something, group think can play a part in further fostering the sameness.

Most often this does not matter all that much if they are political views, religious views or dislike for their next door neighbours. However if the views will tend to incite racial hostility or religious persecution then there is a much more serious problem.

This can also involve similar views about suicide. That is, views like suicide is an OK solution to a problem, everyone has the right to choose and so forth. If they have introjected these from each other and then have a sense of group think, in extreme cases one can end up with the suicide pact. Both parties agree to suicide at the same time.

Even if there is no suicide pact it will make suicide a more easy choice for one of the parties in the relationship for the reasons just mentioned. Thus in working with the suicidal it is instructive to make an assessment of the relationships that the suicidal individual is involved at that time to see if any of these psychological processes are at work.

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