The best indicator, of course, would be a history of violence—fighting, hurting others, suicide, violence against animals, aggression, property destruction—particularly severe, recent, and/or frequent violent acts would definitely indicate the client was currently at high risk of being dangerous to others. The following variables are also associated with interpersonal violence:

• A history of impulsiveness or volatile temper.



• Beliefs in justified revenge or the appropriateness or efficacy of violence.



• Being male.



• Being between the ages of 15-30.



• Being unemployed.



• Moving frequently or residential insecurity.



• Living or growing up in a violent subculture or family.



• Abusing substances.



• Having lower intelligence.



• Having weapons (or other means) available.



• Having victims available (or accessible).



• Having multiple stressors (which may lessen frustration tolerance).

Whenever you suspect a client presents a potential danger to others, he or she should be assessed for lessened internal controls. For example, psychosis, organic brain syndrome, substance abuse, and paranoid suspiciousness can all cause lessened control as can certain medication interactions. Assess their coping skills, e.g., impulse control, anger management. Document and assess their psychological frame for the rage using such indicators as the context of loss, disappointment, or failure; how rage is structured into their belief system; the nature of the current expression of rage, e.g., retaliatory rage as a reaction to jealousy or anxiety.

Be very alert to threats and evaluate their purpose. Is the threat real or manipulative? Is it self-justifying or self-protecting, or is it intended to avoid some other consequence? Be especially alert to threats issued with specific detail. If a client identifies a victim and mentions time, method, contingency, and location using the active voice, this is a strong indication there is a greater likelihood of imminent danger.

Violent behavior does not, in and of itself, justify breaking confidentiality. Do not break confidentiality if all you have is suspicions, but no client words or deeds. If you are uncertain, use your best judgment, get consultation, and always maintain thorough documentation. Consider intensifying the therapy, if you determine it is appropriate, and carefully note the alteration, your reasons, and the client’s responses. When opting for such a course, the following are useful recommendations:

Intensifying the Therapy

• Increase the frequency of sessions.



• Focus on anger, controls, consequences and alternatives to violence.



• Pay close attention to even minor threats.



• Work with your client to attend to the “triggers” and to change the violent behaviors, however, be aware the client may lie to you about his or her changes in thoughts or intentions.



• Do what you determine will increase and strengthen the therapeutic alliance.

Protective Interventions

• Develop a safety plan for the potential victim, the perpetrator, and for yourself.



• Know your community's resources for victims (shelters, support groups, etc.).



• Work with family members who can more closely observe the client.



• Consider hospitalization or police actions that would serve to incapacitate the client.

NOTE: Every effort has been made to ensure that the information provided by 4therapy.com is accurate and up-to-date, however, it is important to remember that laws vary from state to state and local legislation can add further variations. We strongly urge you to stay current with your state and local laws.