Brian Van Brunt Assessment The Treatment and of Dangerousness AMERICAN COUNSELING ASSOCIATION 5999 Stevenson Avenue | Alexandria, VA 22304 | www.counseling.org Assessment Treatment The and Dangerousness of Copyright © 2015 by the American Counseling Association. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the written permission of the publisher. 10 9 8 7 6 5 4 3 2 1 American Counseling Association 5999 Stevenson Avenue | Alexandria, VA 22304 Associate Publisher | Carolyn C. Baker Digital and Print Development Editor | Nancy Driver Production Manager | Bonny E. Gaston Copy Editor | Ida Audeh Cover and text design by Bonny E. Gaston. Library of Congress Cataloging-in-Publication Data Van Brunt, Brian. Harm to others: the assessment and treatment of dangerousness/ by Brian Van Brunt, EdD. pages cm Includes bibliographical references and index. ISBN 978-1-55620-342-8 (pbk. : alk. paper) 1. Violence—Evaluation. 2. Violence—Treatment. 3. Violence in the workplace. 4. Violence in the workplace—Prevention. 5. School violence. 6. School violence—Prevention. 7. Violence—Case studies. I. Title. HM1116.V36 2015 303.6—dc23 2014016245 “You see us as you want to see us . . . In the simplest terms, in the most convenient definitions. But what we found out is that each one of us is a brain . . . and an athlete . . . and a basket case . . . a princess . . . and a criminal. Does that answer your question?” —The Breakfast Club “Passion . . . it lies in all of us. Sleeping, waiting, and though unwanted, unbidden, it will stir, open its jaws, and howl. It speaks to us, guides us . . . passion rules us all. And we obey. What other choice do we have? Passion is the source of our finest moments; the joy of love, the clarity of hatred, and the ecstasy of grief. It hurts some- times more than we can bear. If we could live without passion, maybe we’d know some kind of peace. But we would be hollow. Empty rooms, shuttered and dank . . . without passion, we’d be truly dead.” —Angelus, Buffy the Vampire Slayer Dedication To Bethany, “There’s something you’d better understand about me ‘cause it’s important, and one day your life may depend on it: I am definitely a mad man with a box!” —Dr. Who Kat is a guppy. —Dad Preface | vii About the Author | xi PART 1 | Assessment of Violence Chapter 1 Understanding Violence | 5 Chapter 2 Preparing for the Assessment | 23 Chapter 3 Case Studies | 41 Chapter 4 Central Threat Concepts | 79 Chapter 5 Additional Threat Concepts | 93 Chapter 6 Risk Factors Identified in the Literature | 109 Chapter 7 Structured Professional Judgment | 121 PART 2 | Treatment of Dangerousness Chapter 8 Learning to Listen | 143 Chapter 9 Understanding Their Story | 153 Chapter 10 Learning to Think Differently | 165 Chapter 11 Taking It Step by Step | 175 | v vi | Table of Contents Chapter 12 Searching for Meaning | 187 Chapter 13 Case Studies Treatment Summary | 199 Appendix A On-Campus Risk Assessment Informed Consent | 209 Appendix B Off-Campus Provider Questions | 213 Appendix C The Structured Interview for Violence Risk Assessment (SIVRA-35) | 215 Appendix D ATAP “Risk Assessment Guideline Elements for Violence: Considerations for Assessing the Risk of Future Violent Behavior” | 219 Appendix E Reality Therapy WDEP Worksheet | 231 Appendix F An Existential Exercise | 233 References | 235 Index | 245 Over the years, I have had the opportunity to offer trainings to thou- sands of clinicians, administrators, and law enforcement offi cers inter- ested in reducing the likelihood of violence in educational settings and in the workplace. Through the process of writing this book, I’ve had a chance to smooth out some of the concepts I want to share, and I’ve had the opportunity to receive feedback from individuals I’ve taught about the effectiveness of how I share the concepts. It’s my hope that this book provides the very best summary of my thoughts, clinical ex- pertise, and experience in the area of assessing and treating violent individuals. I make use of frequent case examples and try to keep my language grounded and conversational—to make this book the kind of book I like to read when it comes to learning new tasks and looking at innovative ways to work with clients. I hope the style is one that sits well with you. The central theme of this book is this: The most effective solution to rampage violence is early, easy, and frequent access to care for poten- tial perpetrators. This care involves (a) assessment to identify the indi- viduals who are at risk and (b) treatment to move those individuals off the pathway to violence. The fi rst part of this book, which covers Chapters 1–7, is centered on the assessment of violence. Using my clinical experience and the threat assessment literature, I outline what counselors need to be aware of and vigilant for when working with threat assessments. Part II, Chap- ters 8–13, explores a variety of treatment options available for longer term treatment of potentially violent clients. Counselors, psychologists, social workers, couples therapists, and pastoral counselors are likely to be familiar with the phrase “danger to self or others.” There are hundreds of books, trainings, journal ar- ticles, and graduate school classes dedicated to assessing suicidality | vii viii | Preface and treating clients who are at risk for killing themselves. Organiza- tions that focus on this population include the Jed Foundation (http:// www.jedfoundation.org), Suicide Prevention Resource Center (http:// www.sprc.org), and American Association of Suicidality (http:// www.suicidology.org/home). Clinical staff typically are asked to assess individuals with mental health disorders who pose a potential for risk to others. Examples include the individual experiencing a manic phase in his or her bipolar disorder or a patient who has a psychotic break and begins to act the commands issued by hallucinatory voices. “Harm to others,” in other words, is focused more on mental health motivating causes that drive individuals to violence. However, the problem lately has been that many of the individuals being dropped off at the counselor’s offi ce (particularly in K-12 and higher education settings) are making threats or posing a threat to others but have no indication of mental health problems. A student, upset at a friend, posts on Facebook that she is “coming over to your house with a knife to kill you.” Another student threatens a college professor as a result of a poor grade on an assign- ment. Still another uses social media and tweets: “I’m going to bring a bomb to school tomorrow.” Although mental illness may be an important contributing factor in any of these three examples, the core of any assessment must be based on threat assessment principles, not clinical pathology. An entire com- munity of law enforcement, human resources, and federal agencies (Naval Criminal Investigative Service, Central Intelligence Agency, Federal Bureau of Investigation, Homeland Security) is exploring the assessment of threat and dangerousness. This is the information I want to bring to the counseling community in the fi rst half of this book. One quick summary of the approach is offered by Mohandie (2014): “Four categories of information inform threat assessment: (1) warning signs or leakage, (2) risk factors, (3) stabilizing factors, and (4) precipitating events” (p. 129). It’s my hope to reach out to counselors, psychologists, social work- ers, and other clinicians who are required to assess violence in schools (K-12), in higher education settings (residential and community col- leges), and within the community in order to provide them with a bet- ter understanding of threat assessment principles as they apply to the assessment of dangerousness. Chapter 1 introduces several key concepts (e.g., leakage, direct com- municated threats, and the importance of attending to writing and so- cial media) that are useful in understanding the literature and history of assessing dangerousness. Chapter 2 describes what should be in- cluded in an informed consent document, the difference between as- sessment and treatment, and the importance of gathering information from various sources. Concepts such as establishing rapport, building connections, and lowering client defensiveness are reviewed. Chapter 3 introduces the two case studies, Stacie and Dustin, that are used throughout the book to illustrate key points related to assess-