“I have a young Korean-American client who is a college graduate student in literature. He’s a writer. I'll call him Jim. His initial presenting issues were dealing with a sense of isolation and his long-term resentment and anger from being misunderstood and bullied throughout his school career. This young man felt very alone and angry when he was younger. Jim wanted to work on this because he was concerned it might eventually affect his relationships and career. He is clearly exceptionally intelligent, and perhaps even brilliant in his work. He has been recognized for his writing and received awards since high school. He has been involved in an internship with one of his instructors, an editor for a literary magazine. He finds that very stimulating although he is doing somewhat menial work as a "gofer."
He talked about working on a graphic novel where the protagonist is dealing with anger over rejection, "and being invisible" with the themes of justice, compassion, violence, suffering, victimization and bullying, and redemption. It is very clear, that the novel is semi-autobiographical and that he identifies with the main character. The plot of the novel culminates with an intense massive act of vengeance upon the main character’s abusers. I don't want to be simplistic, and really don't want to be stereotypical or even worse, racist, so I need to be more clear if there is potential for violence with him. The conversation was disturbing to me after the recent violence at Virginia Tech. To be more blunt, my question is, how dangerous is my client?” (Details have been altered to protect the confidentiality of the client.)
• Self-Righteousness Attitude• Entitlement• Ego-syntonic Perception• Intense Emotional Arousal• Resentment• Characterlogical Nature• Isolation/Avoidance Behavior• Lack of Remorse
• Are there any aspects of paranoid personality disorder or other paranoid thinking? This can also be from paranoid schizophrenia or stimulant drug abuse (cocaine, crack, crank, methamphetamine).
• Is there a long held resentment and self-righteousness for past wrongs done to him? Or, is the upset or anger transitory? Intense feelings that are released through cathartic processes are less likely to erupt into violence.• Does he/she have mechanisms to self-soothe distress or other negative emotions (other than with drugs and alcohol or other dysfunctional behavior)? Does he/she activate them effectively or readily? Individuals, who can self-soothe to any significant degree, are more likely to keep bitterness and resentment under the threshold that ignites destructive behavior.• Is there any underlying Asperger's disorder (high functioning autism) that may be indicative of missing social cues? Does Jim give appropriate non-verbal social cues in the therapeutic interaction? Not only do many individuals in the autistic spectrum not recognize social cues, they may also not give appropriate social cues.• Does he/she present as "odd"? Mismatch between emotional content and non-verbal cues (eye contact, facial expressions, body movements, voice tone, etc.) may indicate autistic issues, or may indicate disconnection due to intense uncomfortable emotions. In addition, any individual perceived as different is more prone to being targeted for victimization by bullies.• Is his/her presentation that of a “normal neurotic?” “Normal neurotics” may have an intense presentation at the high or low end of the normal spectrum of emotions. However, they tend to be available to processing their emotions in therapy.• What is the energy of the movie for Jim? The movie Jim is doing may be cathartic and serves to mollify his resentment. It may keep him from possibly exploding violently into reality.• How does Jim feel about his recognition? Does he feel them deserved? Appreciation is the normal reaction to recognition. High fragile self-esteem or entitlement would be characteristic of narcissist individuals. Failure to get recognition can result in narcissistic rage and transitory aggression.• Does Jim feel that despite the awards, that others still don't understand or value him? That he has got recognition and awards from others from his work would seem indicative of gaining positive social validation. Thus, he would be less likely to be dangerous. If he thought that the recognition and awards come from stupid people that he feels superior to... that getting the awards are just signs of their ignorance, stupidity, perverted values, that he's fooling them, then there should be more concern.• Does he/she feel understood by anyone? By you? Individuals often seek validation from their therapist, after many life experiences of invalidation. They normally appreciate and respond positively to the validation. If the client cannot feel understood or appreciated, or dismisses validation, it would be of concern.• Does he/she feel that he can be understood by anyone? Who? Cho felt he understood the Columbine killers. Determine with whom the client identifies. Who he/she understands. Are they positive models or dangerous models?• How does he/she see his/her own anger and what does he/she do with it or in reaction to it? Even when many individuals feel their anger is justifiable, they also understand it can be dysfunctional for them. Of greater alarm, is when an individual sees the anger and the aggressive behavior that harms others, as both justifiable.• What is the ending of the novel? Is there personal redemption or just vengeance? Does the protagonist die (is doomed) or move on to "happily ever after?" Does the character have hope? Is it a transformative process for the character? For example, from doing poorly to doing well, from being alone to having positive relationships? A transformative story is a self-prophecy of hope as opposed to a story of doom.• What generation is Jim? Foreign-born, first American born with immigrant parents, second generation, or third generation or beyond? The less Americanized or closer to immigration generationally, the more likely an individual may have difficulty fitting in.• What are his/her parents like? This is a basic psychodynamic exploration- an examination of the family of origin, attachment relationships, validation, nurturing, etc.• Does he/she feel rejected now? Are these feelings transitory or ongoing? Transitory feelings come and go and are not likely to cause distractive behavior, unless he/she is highly impulsive.• Was he/she referred or mandated to therapy? Is he/she self-referred? Self-referral is an act of hope and less likely to be indicative of desperation, and thus he/she is probably less likely to be dangerous.• Are there class issues that may also apply? Class is an often forgotten discriminatory issue.• How does Jim identify? As American? As Korean? Internalized self-hatred can have ethnic or cultural origins. Internalized self-hatred can externalize into aggression against others.• Does he/she identify as normal? As special? As different? Misunderstood, etc.? How does he/she identify relative to others, such as victim to bully, or superior to inferior? The role dynamics can predict behavior at or to others.• You could ask Jim directly about the shooter at Virginia Tech. How much does he empathize versus identifies with Cho? Empathy might be indicative of understanding Cho’s pain, while identification may be indicative of seeing himself in that role.
“From the questions you prompted me with, even before seeing him again, I was able to gather that my client was most probably needing affirmation and that his attitude is more hopeful. It is clear that he was reaching out for some support and that his work most probably is cathartic. I feel empowered and will move forward in the therapy. I will use the questions to further assess him, and whether my current sense of his low or non-propensity to violence is correct.” About four months later, I received an additional communication from the therapist regarding her client. “My former Korean-American client is doing a lot better. He’s starting a paid post-graduate internship at the literary magazine this fall. He won an award for one of his short stories that included a financial prize. He has had a lot of support from his former instructors and myself. Although I haven't heard from him in a while, he usually contacts me for a few sessions when a crisis or he needs to work through something stressful.”
1. Specific Triggering Event2. Opportunistic Behavior3. Sense of Entitlement4. Self-Righteous Attitude5. Ego-syntonic Perception6. Self-Esteem Gain or Loss7. Intense Emotional Arousal8. Pleasure9. Resentment10. Functional Reinforcement (Positive or Negative)11. Characterlogical Behavior or Perceptions12. Transitory Behavior or Perceptions13. Isolation/Avoidance Behavior14. Social15. Presence or Lack of Remorse
1. frustration2. cultural issues3. bullying4. borderline behavior5. narcissistic behavior6. paranoid behavior7. sociopathic behavior8. psychotic violence9. substance abuse ignited aggression
• dealing with specific triggering events,• likelihood of engaging in opportunistic behavior,• sense of entitlement,• origins and the consequences of a self-righteous attitude,• development and consequences of ego-syntonic perception,• how self-esteem is gained or lost with the behavior,• dealing with intense emotional arousal that affects the behavior,• pleasure versus displeasure of the negative behavior,• development of and intensity of resentment,• degree of functional reinforcement from the behavior (positive or negative),• how established or characterlogical is the behavior or perceptions,• whether the behavior or perceptions are transitory, and how to get past them successfully if they are transitory,• degree of isolation/avoidance behavior,• need for and success at social relationships and interactions,• presence or lack of remorse
• lack of remorse,• pleasure in the violent behavior,• absence of intense emotional arousal,• ego-syntonic nature of the behavior,• lack of resentment fueling the behavior,• opportunistic nature of getting away with the behavior,• disinterest in social sanctions,• characterlogical nature of the behavior
• potential functional gain in self-esteem and social status within the gang for the high risk behavior,• need to arouse intense anger in order to be violent,• lack of motivating resentment against a target,• displeasure in the act,• ego-dystonic experience• remorse for harming someone.