Introduction

 You will always know less than you think you do about the patients or clients you examine
 There are abrnomal human behaviours that mental health treatment can’t fix
 Unknown data comes in 2 forms:
o Information withheld and known to affect violence risk
o Information withheld and unknown to affect violence risk

Biopsychosocial Model

 Individual/Psychological
o Male (Static)
  Testosterone correlates w/violence
o 15-24 (Static)
o Past history of violence: frequency, recency, severity (Static)
 Most people only ever commit one murder
 Motivation for violence
 Emotional and behavioural consequences
 When you read “torture” consider sexual sadism
o Paranoia (Static or Dynamic)
 Command hallucinations easy to fake
 Usually resisted
 Occur intermittently
 Assume they’re their imagination
 Coping strategy to manage
 Persecution dominance threat insertion (PDI), greatest risk for violence
 Most people with schizophrenia attack family – rarely flee or conceal
 Paranoid PD
 Searching for hidden meaning
 Do not laugh or cry, open to vulnerability
 Believes violence is rational
 False victimization syndrome affects 2% of people who believe they’re being
stalked when they’re not
 Psychostimulants can leave individuals paranoid up to 6 months after last use
o Intelligence below average (Static)
 Most criminally incarcerated people have lower Iqs than average
 IQ does not correlate with psychopathy
 Verbal IQ is lower than performance IQ in delinquents
 Aggression in people with mental retardation is higher than those with normal
IQs  this is because they have less ability to think of alternatives
 Physical arousal precedes violence
o Anger/fear problems
  Frequency
 Intensity, describe it
 What does the person do when they get angry?
 Ego dystonic or ego systonic
o Psychopathy and other attachment problems (Static)
 Most serial rapists are psychopaths, most stalkers are not
 Relationship b/w attachment pathology and violence
 Who raised you?
 How would you describe them as parents?
 Whom did you feel safest with as a child?
 What were your earliest memories?
 Social/Environmental Domain
o Family of origin violence (Static)
 Impulsive to overcontrolled
 MMPI-2, MCMI-III, Rorschach  blunted violence
o Adolescent peer group violence (Dynamic)
 Boy Scouts, 4H Club
 Gangs
o Economic instability/poverty
 Poverty is associated with increased criminal activity
 Sudden loss of income can increase
o Weapons history (static), skill, interest and approach behaviour (dynamic)
 Approach Behaviour  What the person does if they want a weapon but can’t
get one
 Assessment questions
 Have you ever owned or possessed a weapon?
 Who gave it to you?
 How old were you?
 What did you do with it?
 Who taught you how to use the weapons?
 Over what period of time did you use the weapon?
 Did you get any formal training (police, military, private) in its use?
 How skilled do you think you are?
 Are you still interested?
 Do you have any? (Home, work, etc.)
 Do you think you’ll want to own one when you can? (e.g. money)
 Why should I believe you?
 Person who wants a weapon but can’t have one will often pursue other media
(websites, video games, movies, etc.) that supports that view
 Watch for a change in behaviour
o Victim pool (Dynamic)
  How many future victims?
 Anything to help me get a picture of future victims?
 Victim characteristics
 Perpetrator characteristics
 Relational characteristics
 Important to assess fantasy (what does the sexual sadist masturbate to now?)
o Alcohol and/or psychostimulant use (Dynamic)
 Involved in most homicides, reduces serotonin
 Psychostimulants increase autonomic arousal
o Popular culture (Static)
 Violence conditioned sexual stimulus
 Biological Domain
o Pay close attention to first year of life for CNS issues
o History of CNS trauma (Static)
 Have you ever had an injury to your head? What happened?
 If you did have a head injury ,did you go to the hospital or see the doctor?
 Have you ever lost consciousness? If yes, when and for how long?
 Have you ever had any seizures or taken medications for seizures?
 Have you or members of your immediate family ever been diagnosed with a
brain disease or disorder
o CNS signs and symptoms (Static or dynamic)
 Client reports (symptoms) or observed (signs)
 Combining symptoms that don’t occur, exaggerrating or absurd symptoms
o Objective CNS measures (Static or dynamic)
 If you see CNS trauma or CNS signs and symptoms you should refer to
neurologist and neuropsychologist
 Warnings:
 Forensic Psych may over-interpret neurological imaging
 Genuine brain abnormalities may not be related to violence
o Did it exist when the illness ocurred?
o Did it cause the illness?
 Biology is always mediated by social and psychological factors
 Make a reasonable attempt for a referral even if you’re not able to get it
completed
o Major mental disorder (Dynamic)
 Axis I
 Treatments of Psychiatric Disorders, Second Ed.
 Synopsis of Treatments of Psychiatric Disorders, Second Ed.
 Small but significant contribution
Predatory vs Affective Violence

 Psychopaths are more frequently predatory than affective

 Most spousal batterers engage in affective violence
 Psychopaths tend to be hard-wired to be predators
 Predatory violence is more dangerous to institutional staff
 Most mass murderers are predatory
 Most serial sexual aggressors (rapists, serial murderers) are predatory
 Most stalers who get violent are affective, except those pursuing celebrities
 Most first degree murderers are predatory, most manslaughter is affective

Psychopathy

 PCL-R to measure
 Libness
o Take the client into an area where you have expertise
 Grandiose
o Most psychopaths have a heightened sense of self-worth (NOT low self-esteem like
expected)
 Lying
o MMPI-2
o Structured Interview of Reported Symptoms
 Manipulation
o A goal conflict
o The intent to deceive
o The deceptive act is successfully carried out
o Feeling of contemptuous delight
 Lack of remorse
o What is it like for you to experience________ (feeling)?
o Write down what they say and include it in the report – they’ll either evade or give an
absurd or vague answer
 Hyperactivity, Impulsivity, Attentional disorder + Conduct Problems = high risk subgroup for
psychopathy in children
 Formal thought disorder common
 Good at tactics, bad at strategy
 Impulsivity
o Motor impulsivity, emotional impulsivity, cognitive impulsivity
 Juvenile delinquency – 13 to 17
 Higher rate of recidisivism
Sexual Violence

 15% women in the US report sexual violence

 Offenders with only prior sexual offenses (no index sex offense) are less likely to sexually
reoffend than offenders with a current sexual offense

General Criminal Redicivism Risk Factors

 Young
 Have criminal friends
 Endorse attitudes tolerant of crime
 Lead an unstable lifestyle
 Have a history of criminal behavior

Sexual Redicividism Risk Factors

 a history of sexual crimes

 deviant sexual interests
 lifestyle instability with a history of rule violation
 difficulties forming stable intimate relationships with appropriate partners

Sex offenders who complete treatment are less likely to recidivate than those who do not start
treatment

Assessment Tools

 Static-99 (Hanson & Thornton, 2000)

 Rapid Risk Assessment for Sexual Offense Recidivism (RRASOR; Hanson, 1997)
 Static-99 (Hanson & Thornton, 2000), the Rapid Risk Assessment for Sexual Offense Recidivism
(RRASOR; Hanson, 1997)
 Sex Offenders Risk Appraisal Guide (SORAG), Minnesota Sex Offender Screening Tool-Revised
(MnSOST-R)

SPJ Assessment

 SVR-20
 Risk for Sexual Violence Protocol

Conceptual Actuarial

 Stable-2000
 Violence Prediction Scheme-Sexual Offender Version
 Structured Risk Assessment (Thornton, 2002)
variables that increase a woman's risk of being victimized or that promote sexual violence by men. Similar
summaries could be constructed for social and cultural variables linked to sexual violence. You should
also be familiar with and be able to identify statistical trends in sexual violence, particularly those related
to North America

Intimate Partner Violence

Principles of IPV Assessment

 Risk assessments should employ multiple sources of information

 Consider risk factors from the literature
 Assessment should be victim-informed
 Assessment can be improved with tools or guidelines
 Risk Assessments should lead to risk management

Risk factors

 History of violent behaviour towards family members, acquaintances, strangers

 History of physical, sexual, emotional abuse towards intimate partners
 Access to or use of lethal weapons
 Antisocial attitudes and behaviours, affiliation with antisocial peers
 Relationship instability, especially if there has been a recent separation or divorce
 Presence of other life stressors including employment/financial, recent loss
 History of being witness of family violence in childhood
 Evidence of mental health problems or personality disorder
 Resistance to change and motivation to treatment
 Attitudes that support violence towards women

Danger Assessment (DA), Jacquelyn Campbell (1995)

Helpful to ask clients what helped them live a violence-free life

Transition

 How has client coped in the past?

 What is the vision of transition?
 Are there goals?
 What strengths/risks are present?
 How can the client cope?

Short Term Assessment of Risk and Treatability (START; Webster et. al., 2004)

Transitional Discharge Model (Forchuk, Martin, et. al. 2005)

anger management and substance abuse interventions are particularly useful. The former should
specifically include instruction on how to remove oneself from destabilizing situations