Counseling Today, Online Exclusives

Behind the Book: Harm to Others: The Assessment and Treatment of Dangerousness

By Bethany Bray June 9, 2015

The most effective solution to rampage violence, such as school or workplace shootings, is early, easy and frequent access to care for potential perpetrators, says Brian Van Brunt, author of Harm to Others: The Assessment and Treatment of Dangerousness.

Counselors play an integral part in this care, through identifying individuals who are at-risk and Depositphotos_31165405_sproviding treatment to move those individuals off the pathway of violence. These two skill sets – assessment and treatment of dangerousness – are essential, yet often lacking in counselor training and education programs, Van Brunt says.

In order to accurately identify individuals who pose a threat, counselors must work against the assumption that mental illness is often coupled with dangerousness or violence.

“Clinical staff typically are asked to assess individuals with mental health disorders who pose a potential for risk to others,” Van Brunt writes in the book introduction. “… ‘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 office (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 … Although mental illness may be an important contributing factor in any of these [clients], the core of any assessment must be based on threat assessment principals, not clinical pathology.”

Van Brunt, the senior vice president of the National Center for Higher Education Risk Management Group, has a doctoral degree in counseling supervision and education. He is past president of the American College Counseling Association (ACCA), a division of the American Counseling Association.

 

Counseling Today caught up with Van Brunt to talk about his book, Harm to Others, and the importance of the assessment and treatment of dangerousness.

 

What do you hope counselors take away from the book about this topic?

I think there is a dearth of training in our field when looking at the assessment and treatment of those who represent a harm to others. Many graduate and doctoral programs teach suicide assessment and risk assessment, but few focus on the assessment of dangerousness in a way that is based on workplace violence literature. Simply stated, we are well prepared to assess a psychotic patient who is hallucinating and make a determination around commitment or hospitalization, but not prepared very well to assess the high school student who threatens to “go all Columbine” if they don’t have a grade on their final paper changed from a D to a C.

My book provides counselors clear and practical guidance on the fundamentals of how to conduct a violence risk assessment. Harm to Others closes the knowledge gap for new and seasoned clinicians being asked to conduct these kinds of assessments and work with challenging, hostile and difficult patients.

 

In your opinion, what makes professional counselors a “good fit” for violence assessment and training? What unique skills do they bring to the table?

I’d suggest a willingness to learn about how to do this important work in a research-supported manner. In my experience, an enthusiasm to learn more about violence and risk assessments is much more critical than an advanced academic degree. Many in the threat assessment community come from law enforcement or counseling backgrounds and have learned how to complete risk and threat assessments through on-the-job training, individual scholarship through workplace violence books and articles, and training through organizations such as the Association of Threat Assessment Professionals (ATAP) and the National Behavioral Intervention Team Association (NaBITA). But the underlying connection for a “good fit” tends to be a willingness to devote the time and energy to this scholarship.

This can create a bit of a challenge since there is no current licensure or certification standard when it comes to violence risk or threat assessment, so there is no objective standard of what makes a good threat assessment that exists in the law enforcement or psychology field at this time. As with clinical licensure and certification, a focus on research-informed practice, adherence to ethical standards found in both psychology and law enforcement, individual supervision and hands-on experience would be the four pillars I would suggest when preparing to do this kind of work.

I would also suggest the ability to build rapport and lower an individual’s defenses is critical in this work. Forming an attachment with the person who is being assessed is key to obtaining accurate data in order to build a valid risk or threat assessment. Crisis and emergency clinicians, those who work with personality disorders in their client caseload, family therapist and those who assess and treat teenagers often have skills in developing rapport and connection in difficult and adverse conditions.

 

 

What are some misconceptions you feel counselors have about dangerousness in clients?

I think one of the biggest problems that leads to misconceptions is an over-reliance on mental health diagnosis when it comes to assessing or treating dangerousness. There is an assumption that mental health problems such as depression, autism spectrum disorders (ASDs), post-traumatic stress disorder (PTSD) or anxiety leads to dangerousness or violence. This is one of the reasons I stress a solid overview and study in the field of threat and violence risk assessment. This is a problem beyond mental health concerns. And this distinction is often a difficult one for the public or untrained clinician to always appreciate. For example, the diagnosis of depression isn’t a central risk factor for targeted violence; instead we look at hopelessness and desperation. The diagnosis of ASD isn’t the concern; it’s the potential accompanying social isolation that prevents the assessment of the escalating threat.

There is also the distinction between ‘being a threat’ and ‘making a threat.’ This is often a source of difficulty for those new to this work. While direct threats are always cause for concern, the follow up assessment of the lethality of this threat becomes paramount. While all of us understand we would be concerned with someone at work who tells his supervisor “I’m going to come into work tomorrow with a katana sword and go all Kill Bill (the Quentin Tarantino films about an assassin) on you,” the real assessment here comes in understanding issues of weapons access, action and time imperative, fixation and focus on target and similar risk factors. I reference many of these factors in Harm to Others and refer frequently to the giants in the field such as Reid Meloy; Stephen Hart; Mary Ellen O’Toole; Michael Gelles and James Turner; and Frederick Calhoun and Stephen Weston to help counselors develop a deeper understanding of the questions they should be asking when assessing or treating a potentially violent client.

 

 

Do you feel today’s counselors are coming out of graduate school with adequate training/knowledge of violence assessment and treatment?

Unfortunately, the answer is no.

There are a number of excellent programs out there such as George Mason University’s forensic program chaired by Mary Ellen O’Toole and Alliant International University’s program under Eric Hickey in California, but assessing and treating potential dangerousness in clients is an issue that hasn’t yet been included in most psychology graduate programs. There certainly is a focus on crisis counseling, assessing suicidality, conducting mental health assessments and assessing and treating violence in higher risk clients with bi-polar, substance abuse, or psychotic disorders, but none of this really gets to the underlying core of work on violence and risk assessment that exists in the professional literature on workplace violence.

 

What would you want all counselor practitioners — marriage counselors, addictions counselors, mental health counselors, etc. — to know about violence assessment and treatment?

Well, first, I would suggest an understanding that these are two different skill sets. Assessing a potential threat is different than on-going therapy and treatment with a potentially violent or dangerous client.

Second, I would want all licensed clinicians to at least have a basic understanding of the risk factors related to targeted or rampage violence. If I was in a room of counselors and I asked what the risk factors were for suicide, I would quickly get a response. They would tell me being a male, age 18 to 22 years old. They would talk about lethality, access to means, prior attempts, situational stressors and having a plan. Suicide risk factors are well taught and well understood not only by clinicians; even the lay public has a foundational knowledge of what to look for if they were concerned about a potential friend or colleague who might be suicidal.

When it comes to risk factors that indicate a potential for harm to others, I think most clinicians draw a blank. They may guess at social isolation or wearing all black. They may suggest an anti-social tendency or disenfranchisement. They may talk about being on medication or playing violent video games. But few clinicians have a good understanding of what risk factors are supported by literature to better understand the risk of rampage or targeted violence. In Harm to Others, I provide several lists of these risk factors with practical examples of how to assess and mitigate these items to help prevent future violence.

While we do not excel at predicting violence; this remains a holy grail for the violence risk and threat assessment field. While we will never develop an accurate model of violence predication, we can certainly identify risk factors and prevent violence. Think of the risk factors of a heart attack. We understand these well: lack of exercise, being obese, hereditary factors, poor diet, and smoking. Each of these risk factors are targeted by public health prevention and education programs to reduce the risk of a heart attack. Yet, we can’t predict a heart attack. This is how we should think about identifying the risk factors for rampage or targeted violence. Our goal becomes prevention and intervention, rather than predication.

 

In the book introduction, you write, “The most effective solution to rampage violence is early, easy and frequent access to care for potential perpetrators.” In your opinion, how can counselors play a role in this access to care?

Quite frankly, we need to become that care. The reality is those who most need to be in counseling to change the path to violence they are on are the least likely to show up and remain connected to care.

It reminds me of the streetlight effect — the old story about the drunk man looking for his keys. It goes like this: A policeman sees a drunk man searching for something under a streetlight and asks what the drunk has lost. He says he lost his keys and they both look under the streetlight together. After a few minutes the policeman asks if he is sure he lost them here, and the drunk replies, no, and that he lost them in the park. The policeman asks why he is searching here, and the drunk replies, “this is where the light is.”

Most of us spend our time providing therapy with those clients who voluntarily come in for treatment, but those in real need, those who have lost hope and find their only solace by sitting alone andSecurity business man avoid danger risk planning these kind of horrific attacks, are not connected to care. Our mental health system fails them under the guise of individual rights. We do not have an adequate step between voluntary outpatient care and involuntary inpatient commitments.

We need a mental health system in the United States that functions more like our child protective service system. When a child is found at risk, an investigation occurs and a caseworker is assigned. The case remains open until the risk is mitigated. We don’t have a system like that for violence risk to others. Too many times we end up shaking our heads saying things like “Well, we all are concerned, but there is nothing we can do until the person breaks the law or threatens someone.” We say, “They need to be in counseling, but they aren’t an acute danger to themselves or others, so we can’t mandate or force the issues.” We need to address this gap. Without the ability to require care once the risk factors are identified, there is little hope to reduce targeted violence.

And of course, this raises the specter of Big Brother. The recent National Security Agency (NSA) scandal doesn’t help matters much either. Yet, we are willing to take away individual rights of parents when a child is at risk. I struggle with why we don’t have a similar mechanism in place when there is an individual who has many of the risk factors, yet hasn’t broken any laws or doesn’t meet commitment criteria. We need to address this Goldilocks problem when the porridge is neither too hot nor too cold. How do we attend to the student everyone is concerned about, but hasn’t yet broken the law or school conduct code?

 

 

What advice would you give to a counselor who wants to work on/improve their violence assessment and treatment skills? What resources would you point them toward?

There are three trainings that I would recommend for a counselor looking to improve their skills in violence risk assessment.

  • The Association of Threat Assessment Professionals was the place I started my journey in the area of threat assessment. They offer an amazing conference each August in Anaheim, California.
  • My organization, NaBITA also offers detailed training in violence risk and threat assessment and we hold our conference annually; this fall it is in San Antonio.
  • Stephen Hart also offers a wonderful set of trainings and workshops on the topic of Structured Professional Judgment (SPJ) through the company Proactive Resolutions.

If attending a conference or training is outside of your budget, I would suggest the following three books that have been very useful in my personal training and experience in violence risk and threat assessment.

  • The first is Reid Meloy and Jens Hoffmann’s International Handbook of Threat Assessment (2013). This collection of articles provides the reader with a sound overview of the current state of the field.
  • The second book is by Michael Gelles and James Turner: Threat Assessment: A Risk Management Approach (2003). This book is a very accessible starting place for those interested in the process of threat assessment.
  • The final book would be Mary Ellen O’Toole’s book Dangerous Instincts (2012). This text offers uncanny insight into the world of identifying and assessing threat.

 

What inspired you to write this book?

I’ve written several other books that circled this topic. Ending Campus Violence: Prevention Strategies and New Approaches to Prevention (2012) was written to a college and university administration and student affairs audience. A Faculty Guide to Disruptive and Dangerous Behavior in the Classroom (2013) was written to faculty who wanted better guidance on managing classroom behavior and identifying dangerous students.

This book, Harm to Others came from frequent requests (I’ve received) at trainings from counselors and psychologists around the country who are being asked to conduct violence risk assessments on their clients. This book provides them with a practical guide full of examples and additional resources to better assess and work with dangerous individuals.

 

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About the author

 

Brian Van Brunt is president of the National Behavioral Intervention Team Association and senior vice president of the Pennsylvania-based National Center for Higher Education Risk Management (NCHERM) Group, a law and consulting firm that addresses risk management issues in educational settings. An author of several books, he is a frequent speaker and trainer on issues of threat assessment, mental health and crisis management across the globe.

Van Brunt has a doctoral degree in counseling supervision and education from the University of Sarasota/Argosy and a master’s degree in counseling and psychological services from Salem State University in Massachusetts.

 

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Branding-Box_Van-BruntHarm to Others: The Assessment of Treatment of Dangerousness is available from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222

 

 

 

 

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For more information

Brian Van Brunt was also interviewed for a recent American Counseling Association podcast, titled “Harm to others.” Listen to the hour-long podcast here: counseling.org/knowledge-center/podcasts/docs/default-source/aca-podcasts/ht052—harm-to-others

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

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