Therapeutic Risk Management for Violence: Chain Analysis of Other-directed Violent Ideation and Behavior

Abstract

Violence risk assessment is a requisite component of mental health treatment. Adhering to standards of care and ethical and legal requirements necessitates a cogent process for conducting, and then documenting, otherdirected violence (ODV) risk screening, assessment, and management. In this 5-part series, we describe a model for achieving therapeutic risk management of the potentially violent patient, with essential elements involving: clinical interview augmented by structured screening or assessment tools; risk stratification in terms of temporality and severity; chain analysis to intervene on the functions of ODV ideation and behavior; and a personalized safety plan to mitigate/manage risk. In this fourth column of the series, we describe chain analysis as a critical tool for assessing and intervening on ODV ideation and behavior. We identify the pathways of reinforcement that can cause ODV to persist, and how to navigate potential barriers to completing ODV chains. Using a case example, we demonstrate how to apply chain analysis to ODV ideation and behavior and offer interventional strategies that can be used to disrupt the chain and ultimately reduce the risk for violence.

Therapeutic Risk Management for Violence: Safety Planning for Other-directed Violence

“…Discussion of a recent episode of ODV through a chain analysis represents an ideal opportunity to demonstrate this concept. In a previous column in this series, chain analysis was described as “a functional approach that employs a behavioral chain to determine the factors maintaining ODV ideation and behavior.”5 A chain analysis, when conducted effectively for ODV, will help illustrate how intense emotions can reduce one’s ability to think clearly and make decisions that are consistent with one’s goals and values. It also provides an opportunity to identify target areas of intervention, that is, the “when and where” to use the safety plan.…”

“…In these scenarios, determining the function of the therapy-interfering behavior is critical to allow the individual to effectively use the safety plan. Once the therapy-interfering behavior associated with implementing the safety plan is determined, a chain analysis5 in which the therapy-interfering behavior is the target behavior can be created. This chain analysis will allow the client and therapist to determine how the therapy-interfering behavior is functioning for the individual.…”

“…In this column, we describe how to use identified target areas of intervention gleaned from a chain analysis of ODV ideation and behavior to initiate the discussion of the rationale and utility of safety planning with individuals for whom the plan would be beneficial. 5 We then discuss how to collaboratively develop coping strategies and identify sources of support throughout each step of the plan using a clinical case example introduced in previous columns in this series.…”

“…The SPI serves as a tool to prevent a crisis and/or manage a crisis without engaging in harmful behavior, thereby serving the same function in therapeutic risk management for other-directed violence (ODV) as it does for self-directed violence. In this column, we describe how to use identified target areas of intervention gleaned from a chain analysis of ODV ideation and behavior to initiate the discussion of the rationale and utility of safety planning with individuals for whom the plan would be beneficial 5. We then discuss how to collaboratively develop coping strategies and identify sources of support throughout each step of the plan using a clinical case example introduced in previous columns in this series.…”

Practical Steps Towards Identifying and Assisting Victims of Domestic Violence

“…To close out our series addressing therapeutic risk management for violence, [1][2][3][4][5] it seems appropriate to present a guest column reflecting on the needs of victims of violence. To this end, guest columnists Chien and colleagues offer an excellent overview on the subject of domestic violence, with concrete guidance about screening, risk assessment, and safety planning for domestic violence.…”