20. Application of Criteria Process - 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 20: APPLICATION OF CRITERIA PROCESS


Chapter 20: APPLICATION OF CRITERIA PROCESS
Another strategy based on this process does not focus on the profiles.  Some therapists or professional do not use or prefer not to use diagnostic categories, especially personality disorders to direct their work.  The layperson tends to have only perfunctory awareness of professional diagnosis and may misinterpret and mis-assess using them.  However whether someone is a licensed therapist, trained professional, or a concerned person, the sense about an individual  of concern or interest starts with an instinctive amalgamation of cues from diverse sensory inputs, conscious, semi-conscious, and unconscious experiences.  Sergeant Patricia Wilson of the Alameda County Sheriff's Office (California) shared the experience or stance that many law enforcement officers when queried how they knew to proceed, intervene, or monitor individuals who eventually committed violent crimes (personal communication).  "I could tell that was a bad guy."  Fifteen minutes into the intake interview for the drug diversion program, the treatment leader knew that the man was probably a sociopath who was trying to work the system to avoid incarceration, fines, and problems at work.  After a testy exchange between the therapist and the teenager, the teenage boy jumped up, came over to the therapist, and leaned into the therapist's face.  "Mother-fucker, no one fucking disrespects me like that!  I'll kick your fuckn' ass!  You don't talk shit to me, mother-fucker!"  Despite the intensity, profanity, and overt threat to get his "fuckn' ass" kicked, the therapist remained calm.  He knew that the teen was not dangerous.  These are professionals whose training includes recognizing hostility, aggression, and violent tendencies.  Yet, a large part if not the essential ability to identify the potential for aggression or violence may exist in individuals without or prior to professional training.  Many people have experiences of sensing dangerous or safe tendencies in others that have been proven by subsequent events.

After the tour, Ward, his wife, adult daughter and her buddy caught the beginning of the museum music and dance "nightclub."  Attendees entering after 6pm could after paying a cover charge, also buy alcohol, dance to music, and socialize among the exhibits.  Observing the energy and movement of several twenty-something year old men through a large window, without hearing anything that was said, Ward sensed imminent violence. The words, "Something is going to happen," were barely out of Ward's mouth, before someone had thrown another guy ten feet across the foyer.   Gerald walked into the equipment room of the high school gym for his part-time job.  3:15pm, it was time to get to work assisting with organizing all the equipment for the various sports currently going on.  Five other teen boys along with the equipment manager were sitting or standing in the room doing the usual- sports talk, stories, and arguments about who is the best clutch shooter in the NBA.  Gerald recognized everyone, but no one was more than someone you passed in the hall. The equipment manager nodded a hello, while most of the boys briefly glanced at the newcomer but continued with their impassioned discourse.  One teen however, Wayne held Gerald's eyes with great intensity.  Gerald was shocked to see intense rage in Wayne's eyes, while the smallest smile played on his lips.  There was an invitation... a challenge... a dare to engage in battle.  In that quick moment of eye contact, Gerald knew that Wayne was looking for... hoping for a reason to get violent.  Wayne wanted a confrontation and thus, an excuse to hurt someone.  It did not have to be Gerald, but Gerald was a potential candidate for him to vent his rage and aggression.  Gerald quickly looked down and broke eye contact.  He did not want anything to do with Wayne.  Wayne was dangerous.  Ginger decided to warn her about Zarah the second week Naomi started work.  But Naomi had already figured it out.  There was some nasty business going on behind Zarah's friend demeanor and plastic smile.  Naomi knew better than to let her guard down around Zarah.  She instinctively knew that Zarah would eviscerate her if it served Zarah's ambitions.  On the other hand, growling gruff Gavino could bark a lot but had a heart of gold.  Naomi could tell he was a gentle soul who looked out for the new or vulnerable employees.  

Individuals including professionals such as Sergeant Wilson and many others in law enforcement, the drug diversion treatment leader, and the therapist as well as non-professionals such as Ward, Gerald, Naomi do not just recognize a "bad guy."  While they may not be able to articulate the conceptual foundation or easily name the relevant cues that constitute their judgment, further in depth consideration will find identifiable theories and principles and compelling cues to support their instinct.  This process offers validation of such accurate judgment through revealing both relevant theories and criteria that constitute relevant cues.  The previous section focused on using the profiles, which validate potentially applicable theories of issues or disorders.  Identifiable criteria that comprise formal diagnoses can be utilized without using labeling.  Professionals without specific expertise in an issue or diagnosis can more easily recognize these criteria.  The layperson or non-professional should find the criteria more likely to be within their personal experience.  Differences, similarities, and groupings among criteria can guide therapy, treatment, or interactions with the individual of concern.  Certain criteria would tend to be universally available to be or appropriate to be targeted in therapy or treatment.  They may open or facilitate intimate or productive relationships.  Alternately, they create blockages against therapeutic or professional intervention.  Or, complicate and harm interpersonal communication and functioning.

This process can apply beyond violence assessment to extend to many types of issues and therapy, treatment, and relationships in general.  The therapist, professional, or concerned person can consider the applicability of each criteria to the individual.  If criteria are applicable, there are strategies or interventions that are indicated to be available, along with inherent challenges to implementing the suggested strategies and interventions.  On the other hand, if criteria are not applicable, alternate strategies or interventions are indicated to be available with their inherent challenges as well.  The therapist, professional, or concerned person can assess the individual regarding each criteria for relevance on its own to determine a strategy or intervention.  Or as described previously, gather assessments in a composite profile to determine a conceptually sound plan and process with identified goals.  The therapist, professional, or concerned person would need to do assessment with each unique individual, couple, family, or set of circumstances to develop a specific overall strategy.  While a strategy, for example for one individual who is borderline will probably be similar to another borderline individual or couple with another borderline member, minor or major differences in their criteria may significantly alter therapeutic, professional, or interpersonal treatment strategies and techniques.  

COMMON ENTRIES AND BLOCKAGES ACROSS PROFILES
The seventeen criteria suggest the following strategies as appropriate and more effective.  Each strategy also has naturally accompanying practical challenges.  These constitute common entries and blockages across the profiles for therapy, treatment, or intervention.  The therapist, professional, or concerned person should consider this discussion’s applicability to his or her client or individual of interest.  Many of the assertions that follow may be applicable, but it must be kept in mind that there also required will be important distinctions, qualifications, or alternative conclusions when dealing with a specific individual rather than the hypothetical generic client or individual and assessments.  When a criterion is applicable or relevant to the individual, there will be interventions or strategies that are indicated.  The therapist, professional, or concerned person should strongly consider following through on or activating such interventions or strategies as entries to promoting change, growth, or for protection and stabilization.  However, despite the logic of suggested interventions or strategies, there are usually inherent challenges to successfully following through on them.  These blockages need to be taken into consideration.  Communication and actions should be adapted to manage these challenges and avoid sabotage or disruption whenever possible.  Anticipating and addressing challenges to therapy, treatment, or intervention may be as critical to success as identifying the entry to working with the individual.  The following is a summary of the seventeen criteria along with logical interventions and strategies they suggest, along with significant challenges to the individual and from the characteristic that make it difficult for him or her to be able to follow through.  And, make it difficult for the therapist, professional, or concerned person to successfully implement.



1. SPECIFIC TRIGGERING EVENT
Yes, if a specific trigger is relevant or applicable, then the intervention or strategy indicated is to identify & remove triggers that ignite the problematic aggression, violence, or other behavior.  

The therapeutic or other challenge to the intervention or strategy is that there may be multiple triggers, any of which can be igniting.  In addition, the individual may not be activated by practical triggers, but by symbolic emotional, psychological, cultural, or other triggers.  Identifying symbolic triggers may be difficult depending on potentially low psychological sophistication of the individual.

No, if a specific trigger is not relevant or applicable, then the intervention or strategy of identifying and eliminating trigger is not the focus for intervention.  

The therapeutic or other challenge if a specific trigger not being relevant or applicable is that the negative behavior may be unpredictable or opportunistic.   Uncovering how and why the behavior occurs is challenging if a pattern is not readily identified.  If the behavior is opportunistic, then the challenge is to eliminate any opportunities for the behavior.  This may be difficult.

2. OPPORTUNISTIC BEHAVIOR
Yes, if it is relevant or applicable that the behavior is opportunist, then the intervention or strategy indicated is to identify and eliminate opportunities for the behavior.  The pedophile has to be kept away from children.  Norteňos need to be separated from Sureňos- gang members need to be separated from rival gang members.  A bully has to be monitored to prevent domination of smaller or weaker children, or as the case may be adults who are timid or afraid to assert themselves.

The therapeutic or other challenge to the intervention or strategy is difficulty eliminating opportunities and especially, multiple alternative opportunities.  The aggressor, abuser, or violent individual can seek other opportunities.  Since opportunities may abound despite supervision, identifying motivations that cause seeking opportunities for the behavior is another important challenge.

No, if opportunism is not relevant or applicable for the behavior, then the intervention or strategy of eliminating opportunities would not be a primary focus for intervention.

The therapeutic or other challenge that results if opportunism is not relevant or applicable is that negative behavior may be unpredictable or intensely triggered.   Lack of predictability makes intervention or protection difficult.  Identifying relevant triggers may be difficult as well.

3. SENSE OF ENTITLEMENT
Yes, if possession of a sense of entitlement for the behavior is relevant or applicable, then the intervention or strategy indicated is to find ways to remove entitlement, change the person's expression of his or her entitlement to something less problematic or harmful, and/or attempt to block the behavior with clear relevant negative consequences.

The therapeutic or other challenge to the intervention or strategy is that the persons' sense of entitlement may be deeply entrenched.  He or she may strongly hold emotionally, psychologically, and/or cognitively an imbalance in moral equity that requires the aggressive, abusive, or violent behavior.

No, if a strong sense of entitlement for the behavior is not relevant or applicable, then the intervention or strategy indicated is to directly assert harm to the individual that his or her behavior as being wrong, inappropriate, and ineffective to his or her greater goals.

The therapeutic or other challenge if a strong sense of entitlement is not relevant or applicable is that the direct intervention or strategy to assert his or her behavior as being wrong risks causing the individual to feel judged and thus, provoke defensiveness.

4. SELF-RIGHTEOUS ATTITUDE
Yes, if a self-righteous attitude to behave in a fashion is relevant or applicable, then the intervention or strategy indicated is to challenge or alter the moral stance of righteousness.  Demonstrating the questionable morality or amoral quality of harming another challenges self-righteousness.

The therapeutic or other challenge to such an intervention or strategy is when the individual has a very strong rigid morality, especially if they are tied to hidden or unarticulated values.  More obvious morality may be tied to cultural training, while hidden values may come from a dysfunctional family system with lots of secrets and implicit rules.

No, if self-righteousness is not relevant or applicable to the individual's behavior, then the intervention or strategy indicated is to strong assert amorality of the behavior.  And, one can assert that the individual is failing his or her own values.

The therapeutic or other challenge if self-righteousness is not relevant or applicable is the risk of sounding judgmental about the individual.  This may provoke defensive behavior that is also problematic. While the individual may not appear self-righteous, he or she may have implicit or secret dysfunctional values that need to be uncovered.

5. EGO-SYNTONIC PERCEPTION
Yes, if ego-syntonic perception of his or her behavior (behavior fitting ones sense of self) is relevant or applicable, then the intervention or strategy indicated is to invoke and evoke changes in self-identity incompatible with behavior.  For example, changing self-definition from needing to be a man who takes no crap, to being a man who is strong enough to let some things go may reduce reactive anger and aggression.  

The therapeutic or other challenge to such an intervention or strategy is when the individual has an intractable problematic identity tied to compulsive and compelling unacknowledged underlying issues.

No, if ego-syntonic perception is not relevant or applicable and the individual perceives his or her behavior as ego-dystonic (against one sense of self), then the intervention or strategy indicated is challenge the individual that he or she has failed his or her existing positive sense of self.

The therapeutic or other challenge if ego-syntonic perception is not relevant or applicable is finding and evoking positive motivating but non-shaming adaptations in self-definition.  For example, "That's not who you want to be," must not imply "You're wrong or bad for who you are."

6. SELF-ESTEEM GAIN OR LOSS
Yes, if gain or loss of self-esteem for the individual is relevant or applicable, then the intervention or strategy indicated is to provide ways to enhance the individual's self-esteem.

The therapeutic or other challenge to the intervention or strategy of boosting self-esteem is that the individual may have significantly damaged or fragile self-esteem or low self-esteem.

No, if the individual's behavior is not tied to self-esteem and thus not relevant or applicable, then the intervention or strategy indicated is to challenge problematic behavior directly.  The behavior's lack of positive functionality or negative consequences would be more compelling for change rather than tying change in behavior to self-esteem.

The therapeutic or other challenge if self-esteem is not readily or apparently relevant or applicable is a direct intervention or strategy is risk of triggering resistance or defensiveness based on unidentified other motivations.

7. INTENSE EMOTIONAL AROUSAL
Yes, if intense emotional arousal in the individual is relevant or applicable, then the intervention or strategy indicated is to reduce arousal or shift arousal.  High emotional reactivity is often the core problem igniting negative behavior.

The therapeutic or other challenge to the intervention or strategy of reducing arousal is that high emotional reactivity can be very difficult to manage, slow, or reduce.

No, if intense emotional arousal is not relevant or applicable to the individual's behavior, then the intervention or strategy indicated is to focus on logic or functionality of behavior to activate change.

The therapeutic or other challenge when emotional arousal is not relevant or applicable- that is, the individual chooses problematic behavior dispassionately is that emotional disconnection may be an indication of other severe underlying issues.  This can include disassociation and trauma or underlying narcissistic personality disorder or antisocial personality disorder.

8. PLEASURE
Yes, if the individual experiencing his or her behavior as pleasurable is relevant or applicable, then the intervention or strategy indicated is to find ways to interrupt and remove pleasure and to create adverse uncomfortable consequences to the behavior.  

The therapeutic or other challenge to such interventions or strategies is difficulty in removing the pleasure and lack of alternative options or consequences.    Intervening is particularly difficult if the pleasure from the behavior is from an underlying antisocial personality disorder.

No, if the individual gaining pleasure from the behavior is not relevant or applicable- that is, the behavior causes displeasure, then the intervention or strategy indicated is to intensify already adverse consequences.  Confronting the individual with other likely or imminent negative unpleasant consequences may be effective.  

The therapeutic or other challenge is pleasure in the behavior is not relevant or applicable is that interventions or strategies intensifying unpleasant consequences risk causing resentment and causing the individual to feel victimized.

9. RESENTMENT
Yes, if resentment motivating behavior is relevant or applicable, then the intervention or strategy indicated is to identify and resolve resentments for the individual.  

The therapeutic or other challenge to the identifying and resolving resentments is that they may be deeply embedded resentments.  The individual may have significant investment in keeping his or her resentments, or the resentments have morphed into paranoia.

No, if resentment is not relevant or applicable as motivating the behavior, then the intervention or strategy indicated is to directly focus on benefits and functionality of the behavior.  Behavior not buttressed by resentments are more likely to be retained or relinquished based on merit- that is, whether it works in the individual's best interests.  

The therapeutic or other challenge resentment appears not to be relevant or applicable is the existence of hidden and unacknowledged resentments that drive behavior.

10. FUNCTIONAL REINFORCEMENT (POSITIVE OR NEGATIVE)
Yes, if this function reinforcement from the behavior is relevant or applicable- the individual gains rewards or suffers punishment for behavior, then the intervention or strategy indicated is to emphasize and increase negative consequences while blocking positive reinforcement for problematic behavior.  In addition, beneficial consequences should be sought while negative consequences reduced or eliminated for alternative positive behaviors.  

The therapeutic or other challenge to such interventions or strategies is the existence of competing positive social, financial, or power benefits for negative behavior.

No, if functional reinforcement is not relevant or applicable to the behavior, then the intervention or strategy indicated is identify and apply negative consequences to the behavior.  In addition, other motivations to avoid negative behavior and substitute positive behavior need to be identified and activated.  

The therapeutic or other challenge when functional reinforcement is not apparently relevant or applicable may be difficulty identifying compelling relevant negative or positive reinforcements.

11. CHARACTEROLOGICAL BEHAVIOR OR PERCEPTION
Yes, if the individual possessing characterologically based behavior or perceptions is relevant or applicable, then the intervention or strategy indicated is to identify and facilitate characterological change.  

The therapeutic or other challenge this intervention or strategy is first in correctly identifying characterological issues.  The second and most difficult challenge is that characterological issues- in particular personality disorders by definition are extremely complex and resistant to being changed or altered.  

No, if characterological issues are not relevant or applicable as the root for behavior or perception, then the intervention or strategy indicated is to problem-solve behavior based on each situation.  

The therapeutic or other challenge of characterological issues apparently not being relevant or applicable is identifying and addressing unacknowledged influences and vulnerability.

12. TRANSITORY BEHAVIOR OR PERCEPTIONS
Yes, if seeing the behavior or perception as transitory is relevant or applicable, then the intervention or strategy indicated is to prevent reoccurrence of behavior and addressing situations and triggers for relapse prevention.   In addition, identifying and altering how perceptions are formed in certain situations and with specific triggers can help break the perception-behavior link.  

The therapeutic or other challenge to such interventions or strategies is identifying and addressing causes or unacknowledged influences to perceptions and behaviors.

No, if behavior and perceptions are revealed to be not transitory and thus, not relevant or applicable, then the intervention or strategy indicated is first to identify the underlying causes and patterns of behavior and perception.  Next intervention or strategy is to deal with the causes and then to break negative patterns while perpetuating and extending positive patterns.  

The therapeutic or other challenge if transitory behavior or perceptions are not relevant or applicable is difficulty in altering habitual or characterological issues and patterns.

13. ISOLATION/AVOIDANCE BEHAVIOR
Yes, if isolation or avoidance behavior for the individual is relevant or applicable, then the intervention or strategy indicated is to create feedback mechanisms and people or other references for the individual to look to for guidance about behavior.  Since the individual is not particularly motivated by social rewards, another intervention or strategy would be to utilize non-social consequences to behavior.

The therapeutic or other challenge to such interventions or strategies is the individual's continued lack of or avoidance of (denial, minimizing, projection) reality checks and social feedback.

No, if the individual isolating or avoiding social interaction is not relevant or applicable, then the intervention or strategy indicated is to activate social responsibility, reputation concerns, and negative social consequences.  

The therapeutic or other challenge if isolation and avoidance is not relevant or applicable is that there may be social dynamics, peer group and/or media culture that validate negative behavior.

14. SOCIAL
Yes, if this being social is relevant or applicable to the individual, then the intervention or strategy indicated is to activate social responsibility, reputation concerns, and negative social consequences.  

The therapeutic or other challenge to such an intervention or strategy is that there may be social dynamics, peer group and/or media culture that validate negative behavior.

No, if a desire to be social is not relevant or applicable to the individual, then the intervention or strategy indicated is to emphasize negative non-social consequences.  In addition, mechanisms to create feedback are required.  

The therapeutic or other challenge if desire to be social is not relevant or applicable is the individual's continued lack or avoidance of (denial, minimizing, projection) reality checks and social feedback.

15. PRESENCE OR LACK OF REMORSE
Yes, remorse is relevant or applicable to the individual, then the intervention or strategy indicated is to provoke and utilize the individual's remorse for having harmed others as motivation.  

The therapeutic or other challenge to this intervention or strategy is a risk of shaming the individual or activating self-condemnation.

No, if remorse is not relevant or applicable to the individual, then the intervention or strategy indicated is to find other personal motivations for change.  

The therapeutic or other challenge if remorse is not relevant or applicable is the lack of guilt or shame in harming others does not exist to motivate change.  The individual does not care whether he or she has or will harm others.

16. EMPATHY
Yes, if the individual's sense of empathy for others feelings is relevant or applicable, then the intervention or strategy indicated is to provoke relatedness with others feelings.  

The therapeutic or other challenge to such an intervention or strategy is the individual may have inaccurate projection or interpretation of others feelings.  On the other hand, the individual may be oversensitive to others feelings and experience them as more intense than they are.

No, if empathy in the individual is not relevant or applicable- that is, he or she lacks empathy, then the intervention or strategy indicated is to facilitate emotional relatedness, or this proves difficult to find alternative motivations for the individual to change behavior.  

The therapeutic or other challenge if not having empathy- that is, empathy for another as not relevant or applicable is that the individual may experience a feelings competition where only one person's (obviously, his or her own) feelings may exist and the other person's feelings are dismissed.   This automatically complicates compassion-based therapy.  Lack of empathy may be due to an underlying antisocial personality disorder.

17. HISTORY
Yes, if a personal history of the behavior as repetitious is relevant or applicable, then the intervention or strategy indicated is to identify and break the pattern of behavior.  

The therapeutic or other challenge to such an intervention or strategy is deeply entrenched patterns resistant to change.

No, if personal history of the behavior as repetitious is not relevant or applicable, then the intervention or strategy is to problem-solve behavior based on each situation.  

The therapeutic or other challenge if repetitious personal history of the behavior is not relevant or applicable is to identify and address hidden, secret, unexpected, and unacknowledged influences for the behavior.

The therapist, professional, or concerned person may find the strategies and accompanying challenges resonate with his or her clinical, professional, or personal experiences and informative for future assessment.  In some cases, the suggested strategy may be inherently difficult.  For example, someone who lacks empathy may be unable to develop or find empathy and/or may actively resist empathizing with another person’s feelings.  Identifying and resolving resentments is a logical strategy, but may be virtually impossible if the resentments are deep and calcified.  Facilitating characterological change with the individual with a personality disorder is by definition very difficult.   If someone enjoys being abusive and violent, removing the pleasure from the behavior may be impossible short of “A Clockwork Orange” (Burgess, 1962) styled negative reinforcement (in the dystopian novella, Alex is negatively reinforced- virtually tortured so that his violent urges and behavior became highly adverse to him).  Despite intrinsic difficulty of a suggested strategy, the strategy may remain logical and necessary.  Failure to facilitate change with a sound strategy becomes further diagnostic information for the therapist, professional, or concerned person.  It may indicate the complexity and depth of issues for the individual.  It also indicates the viability or practicality of making change or effective therapy, treatment, or intervention.  The therapist, professional, or concerned person may also see or favor other strategies and experience additional or alternative challenges.  There may be other relevant criteria beyond the seventeen discussed that the therapist, professional, or concerned person considers or discovers to be important for assessment and for guiding therapy, treatment, or intervention.


ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
(510) 614-5641 or (510) 582-5788
fax: (510) 889-6553
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