THERAPEUTIC ISSUES Clear definition lacking Assessment of dangerousness

THERAPEUTIC ISSUES • • Clear definition lacking Assessment of dangerousness Therapeutic responsibility indefinite Therapist responsible for random violence

DEFINING SERVICES • Services for defined problems • Staffing to meet defined services

INTAKE ASSESSMENT • Complete intake necessary • Assessment for dangerousness

ASSESSMENT FOR DANGEROUSNESS • GENERAL RISK FACTORS* – Past history of violence – Alcohol/drug use – Organic mental disorders – Psychosis – Antisocial personality – Borderline personality *Gerard Clancy, M. D. – University of Iowa

ASSESSING FOR DANGEROUSNESS • PREDICTORS OF IMPENDING VIOLENT BEHAVIOR* – Brooding over unfair treatment – Recent threats to act out – Making plans to act out – Threatening and/or loud speech – Hypervigilance – Staring – Signs of agitation *Gerard Clancy, M. D. – University of Iowa

ASSESSING FOR DANGEROUSNESS • PREDICTIVE TRIAD – Persistent bedwetting – Cruelty to animals – Fire setting

GOOD RECORD KEEPING • • Identifying data Informed consent Treatment plan Background and historical data Progress notes Evaluation(s) Medication, diagnosis, consults Termination summary

DOCUMENTING TREATMENT • Explanation of decisions • Consultations • Consistent format

PSYCHOTHERAPIST JUDGMENT RULE • Assumes accurate predictability • Responsibility for controlling dangerous client • Therapist protector of society from mentally ill