2. Intuition, Conceptualization, & Resp - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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 How Dangerous is this Person? Assessing Danger & Violence Potential Before Tragedy Strikes
Chapter 2: INTUITION, CONCEPTUALIZATION, & RESPONSIBILITY


Chapter 2: INTUITION, CONCEPTUALIZATION, & RESPONSIBILITY
For cases and people in the media, the therapist or professional can join the lay public in idle contemplation and judgment about these publicly exposed individuals involved in violence or abuse of one type or another.  In most situations, people more involved with or familiar with both perpetrators and victims might comment on whether there were signs or indicators of brewing violence in subsequently violent individuals.  For the general public, speculation may be largely voyeuristic without real consequences and most critically without true responsibility.  For various authorities, individuals who have impact on public policy, and professionals including the therapist, there are real violent or fatal consequences for inaccurate, inadequate, or ignorant professional speculation can lead to inability or inefficiency assessing another individual's potential for violence.  For a family member, a friend, a classmate, a supervisor, or a work colleague, there may also be horrific consequences for failed identification of violence potential.  In addition to legal responsibilities: duty to protect (from as determined per the Tarasoff ruling (Casebriefs, 2012) where the psychiatrist failed to take sufficient actions to protect Tatiana Tarasoff from Prosenjit Poddar who told the psychiatrist in therapy that he intend to kill her), child abuse, domestic abuse, and elder abuse reporting mandates, or instituting an involuntary institutionalization for example, the therapist or professional has practical interactions with individuals that may reveal potential violence potential.  

Whether the therapist or professional is beholden to legal mandates or not, he or she can gain clinical awareness and insight to the likelihood of the client becoming abusive or violent because of emotional and psychological issues.  This assessment or awareness is completely what the therapist does, if not also what many other professionals do.  The therapist assesses clients based on their emotional and psychological state in combination with experiences and history that explain their past and current choices and behaviors.  It is not a stretch by any consideration to assert that the therapist also constantly interprets all relevant elements to predict subsequent behavior.  While the therapist may not always specifically predict what the client may do, sound clinical awareness and assessment should make it so that the therapist is seldom surprised at his or her client’s behavior or choices.  In other words, the therapist is well cognizant of the client’s habits, tendencies, and inclinations.  The therapist cannot claim with integrity that he or she seeks to learn about and comes to understand the client, and then later assert that the client’s behavior was completely unanticipated.   Such a claim would undermine the fundamental credibility of psychotherapy.  Many other professionals function similarly.

As the consulting therapist, I advised the therapist-writer Sandra of the e-mail to consider certain key elements about Jim.  As the therapist considered how the minimal to high degree that Jim reflected or manifested these various elements, an intuitive sense of his probable violent potential became more clearly conceptualized.  Sandra could sense the relevant issues that were stable and compelling one way or another, and also identify the issues that she needed to further investigate to solidify her assessment.  In the case with Jim, initial feedback from myself as the consulting therapist pointed to issues that mitigated potential for violence.  Feedback also guided Sandra to get clarification and depth about other issues that further confirmed low probability of danger.  Therapy or Sandra as the therapist conceptually stabilized and she took appropriate direction based on the assessment.  If on the other hand, there were compelling issues that indicated a greater possibility for aggression, abuse, or violence- or for emotional and therefore, behavioral volatility and instability, therapy would need to address further explore such issues.  With such direction to focus on relevant issues, the danger of the client becoming violent or otherwise acting out may be reduced significantly.  The issues can be worked on to foster greater emotional and psychological stability (less emotional reactivity), address underlying issues as appropriate, and set boundaries for safe functioning- both for oneself and for interacting with others.  The therapist can monitor the relative arousal and/or ability to follow healthy direction and observe limits for safety and stability.  In doing so, the therapist may be able to prevent some degeneration in relevant areas for the individual necessary for violence prevention.  

Action, treatment, intervention, or therapy should alter depending on the differing profiles and concurrent violence potentials.  Ineffective action or treatment may be directly tied to assessment failures.  This is relevant across a spectrum of situations and individuals where there is a possibility of assertiveness becoming aggression and violence.  A meta-analysis of batterers’ treatment found that current interventions are largely ineffective (Babcock et al. 2004). One potential reason for this discouraging finding is that distinct treatments may be needed for different “types” of aggression (Merk et al. 2005). Indeed, researchers in the area of intimate partner violence (IPV) have hypothesized that “a systematic examination of how and why different men use violence against their wives…. could lead to increases in therapy effectiveness” (Holtzworth-Munroe and Stuart 1994, p. 476). The distinction between use of proactive and reactive violence is a promising avenue for treatment matching. Understanding antecedents, motives, and functions of partner violence may prove to be valuable in designing the appropriate treatment for a particular batterer” (Ross and Babcock, 2009, page 607).  In considering the distinctions between reactive and proactive violence, and to add to a comprehensive spectrum of relevant issues, the therapist must also be aware of antisocial personality disorder.  Antisocial personality disordered individuals, sociopaths, or psychopaths tend to commit both reactive and proactive types of violence.  However, the sociopath’s use of proactive abuse is more pronounced, less amenable to relationship negotiation, and to standard therapeutic interventions.  

While the lay public and public media is quick to label perpetrators of socially inconceivable violence as sociopaths or psychopaths, violence however can derive from other characteristics and circumstances.  Violence can be related to a multitude of issues: attachment issues, dependency, emotional reactivity, cognitive or social information processing, family and cultural models of abuse, gender roles, various stressors, and other issues that affect and trigger emotional arousal- specifically, anger.  These issues underlie and predict reactive violence.  There are different types of reactive violence or different types of reactive violent perpetrators.  Among reactive perpetrators, proactive violence may be present in lesser or greater degrees.  In addition, the sociopath or psychopath- otherwise clinically known as the individual with antisocial personality disorder presents differently with a style of abuse even more strongly focused on proactive power and control than primarily reactive perpetrators.  There may be aspects or tendencies for reactive violence, but sociopaths often tend to be proactive perpetrators.  Of major important is that intervention, treatment, and therapy that would be otherwise effective for emotionally reactive based abuse often does not work with sociopaths.  Worse than not working with sociopaths, standard therapy and possibly some forms of anger management or violence prevention treatment may perpetuate exploitation, intimidation, domination, and abuse.  


ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
phone: (510) 614-5641
fax: (510) 889-6553
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