Tag Archives: Mental health professional

Mandated reporting of violence risk?

Likely, you are participating in the current national soul-searching after the latest tragic school shooting/mass murder. In our angst we ask, “Why God?” and “What can we do to try to stop this kind of senseless killing?”

It is the second question that is on my mind right now.

Political debates will abound about gun control measures or the right to bear arms. In my humble opinion it is time to move beyond that debate and address the treatment of those who are most at risk to engage in mass killings. I have no idea about the mental status of this most recent killer but that shouldn’t stop us from trying to figure out how to better care for such individuals.

Who is at risk? A complex matter

Violence risk assessments have morphed over the years from clinical judgment (turns out our intuition wasn’t very accurate!) to an actuarial approach looking at factors like: active psychotic symptoms, family problems, history of aggression/domestic violence and or criminal behavior, social withdrawal/skills deficits, and substance abuse. But of course, there are many who have positive indicators on several of these factors who are in no danger of becoming a mass murderer. Still others meet none of these risk factors and yet become killers. [Read Randy Otto’s short paper on violence risk assessment and discussion of the historical, clinical, and environmental factors of violence risk]

One possible (partial) solution

Right now mental health professionals and educators are required to report possible child abuse. In addition, we counselors have duties to warn and protect when our clients indicate they are an imminent (meaning, immediate) danger to self or other. Sadly, many adults in high risk categories are not likely to be in treatment (due to costs, treatment availability and refusal) and may have enough sense not to make threats to those who are obligated to report.

So, what might we do to help those who do come in contact with at-risk individuals? In some states, all civilians are required to report potential child abuse. What if we develop a reporting mechanism for civilians to report those who are making statements about violent acts?

To make this procedure work, there are some additional changes we would have to enact (some of which are not simple)

  • We would have to engage in a large public awareness campaign and to train law enforcement and even mental health professional to recognize risk factors
  • We would need to develop humane but required treatment protocols
  • We would need to stop cutting public funds for mental health (and increase quality of community mental health care providers), and
  • We would need to consider limiting some of the currents rights to decline treatment when a number of the risk factors are present (this is, of course, no small matter. In this country we have the right to be insane…as long as we don’t hurt others).

Some need a rescue

Soon after the Connecticut shooting, The Huffington Post ran an op ed blog post by a mother of a mentally ill young man. It went viral as it was “a gorgeously written piece” by a mother whose son’s behavior terrified her. She well described the isolation and inability to find proper treatment and care for a son she loved but could not control. Almost as soon as her piece went public, others outed the writer as a person with mental illness who publicly blogged about wishing to strangle her children (see above link for that story). Despite her lack of judgment in prior writings, the original piece reminds us that there are many families suffering without avenues to help the ones they love. If we are going to make progress in quelling mass violence, we had better start building better mechanisms to treat the mentally ill and to support their family members.


Filed under counseling science, Psychology, Uncategorized

Want consultation for your difficult trauma cases?

Just a reminder to those of you who are counselors and therapists out there, starting in January, Dr. Langberg and I will be offering group and individual consultations to mental health professionals seeking help for their domestic and international trauma recovery cases. We will be running a once a month group consultation on Fridays beginning mid January (runs for 6 months) here in the Philadelphia region. If you have any interest in joining the group or having your own private consultation, please check out our website for application and consent forms: http://globaltraumarecovery.org/group-consultation/

Group consultations are a great way to get feedback on a difficult case, learn from peers, as well as easier on your pocketbook.†


†consultations can not be considered supervision as we have no authority over your practice.

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Filed under Abuse, christian psychology, counseling, counseling skills, Post-Traumatic Stress Disorder, Psychology

Ethics violations: Why we all think we won’t screw up…and one thing you need to protect yourself from you

Every counselor, social worker, psychologist, and other mental health workers get professional ethics education. Such training is designed to teach us to “do no harm.” What mental health professional gets into the field to do harm? We all believe we are going to work for the betterment of our clients.

So, why do we sometimes fail to act in accord with good professional ethics?

Rarely is it because we don’t know the rules. Consider the most recent issue of the APA Monitor on Psychology and the short ethics piece by Alan Tjeltveit (a colleague of mine and fellow CAPS member) and Michael Gottlieb. (You can read the electronic version here; turn to page 68.)  In it, the authors nail the reason why with this quote,

Too many professionals complete their training without the emotional education and awareness needed to avoid self-deception and to act in the prudent, considered manner that society expects and that represents professional ethical excellence. (p. 72)

Self deception

We fail to take a skeptical (note…not fearful) stance toward our own thoughts, feelings, and attitudes. Since we know we are going to work for the good of others we often stop considering that some other values that we hold might get in the way. For example, I might value avoiding conflict and so not address a safety concern with my client for fear they will get angry with me. Or, as the authors of the article point out, I might practice when I am too distressed to help others–because I believe I can still manage the situation (see page. 70).

The One Protection You Most Need

As necessary as it is to keep taking ethics updates from continuing education providers, it is even more important to have a close colleague who doesn’t take you too seriously and is willing to ask the hard questions. Yes, we need an operating sense of values. We need to be tuned to our conscience. We need the Holy Spirit’s help in loving our neighbor as ourself. But, more importantly, we need to stop trusting in our own judgment and acknowledge that hidden values sometimes operate more powerfully than we expect. Desires to be liked, to avoid conflict, to maintain power, to satisfy longings have ways of creeping in. One of the reasons God puts us in community is that we need others to speak into our lives.

Do you want to avoid ethical missteps? Who exists in your life who has the access and capacity to speak into your life; to ask questions others might not think to ask?


Filed under Abuse, christian counseling, christian psychology, counseling, counseling science, counseling skills, ethics, Uncategorized