Article Summary: Operationalzing the Assessment and Management of Violence (Doyle & Logan, 2012)



In their article, Doyle and Logan (2012) suggest a system, Short-Term Assessment of Risk and Treatability (START), for assessing violence risk that addresses shortcomings of current methods. Studies have estimated between one in 10 and one in three admissions are preceded by violence toward others. Although assessing violence risk has been widely studied, there are far fewer studies related to managing and reducing risk once identified.


Risk judgments made based on total scores of risk factors is only loosely related to risk management. The structured professional judgment (SPJ) approach to risk assessment considers not only the presence or absence of specific risk factors, but also specific individual and contextual factors. There are six stages of SPJ:


  1. Gather information from a variety of sources.
  2. Consider the presence and relevance of risk factors – historical, current,  contextual, protective.
  3. Develop a risk formulation – motivators (drivers), (dis)inhibitors, destabilizers. Here the clinician discusses whether or not these risk factors are relevant to the individual’s potential to be violent in the future.
  4. Consider risk scenarios, e.g. repeat, escalation, twist. This step directly links risk assessment to risk management by formulating a judgment about risk and protective factors, and how these factors impact potential for violence in the future.
  5. Develop risk management strategies derived from the most relevant risk and
    protective factors.
  6. Summary of judgment including judgments of the urgency of action, risk in other areas, any immediate action required, and when the next review should occur.


Several risk assessment tools have been validated to assist in short-term risk assessment, stage two in SPJ. These include:


  • Violence Screening Checklist (VSC):
      • Assesses risk for aggression upon admission
      • Consists of four items: history of physical attacks and/or fear-inducing behavior during the two weeks prior to admission, absence of recent suicidal behavior, diagnosis of schizophrenia or mania, and male gender
  • Brøset Violence Checklist (BVC):
      • Developed to help nurses assess risk of imminent violence upon admission and during hospital stay
      • Consists of six items: confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects
  • Dynamic Appraisal of Situational Aggression (DASA):
      • Developed to help clinical decision-making on admission units
      • Consists of the six items from the BVC, as well as negative attitudes and impulsivity
  • Classification of Violence Risk (COVR):
      • Developed to predict violence in the community after discharge
  • Violence Risk – 10 items (V-Risk 10):
      • Assesses risk for inpatient violence


The START is a brief guide for assessing risks, strengths, and treatability. It was developed based on forensic mental health services, but can be applied in a variety of mental health settings. Preliminary evidence suggests the START has the potential to be a useful tool in informing clinical judgment. Studies have also indicated adequate reliability and validity in a variety of settings and different countries. The START assesses risk across the following domains: risk to others, suicide, self-harm, self-neglect, substance misuse, unauthorized leave, and victimization. It consists of 20 dynamic items that may change across days or weeks. Changes in the items could result in an elevation or reduction of risk. All items can be considered as both risk factors and protective factors. The 20 items include:

1.            Social skills
2.            Relationships
3.            Occupational
4.            Recreational
5.            Self-care
6.            Mental state
7.            Emotional state
8.            Substance use
9.            Impulse control
10.          External triggers
11.          Social support
12.          Material resources
13.          Attitudes
14.          Medication adherence
15.          Rule adherence
16.          Conduct
17.          Insight
18.          Plans
19.          Coping
20.          Treatability


The next step is to address the fourth and fifth stages of SPJ by considering risk formulation and developing risk management strategies. When developing a risk formulation, it is important to first address the question “risk of what” because risks can have different antecedents. One should consider different scenarios an individual may decide to be harmful in the future, called scenario planning. Scenario planning is not prediction, but rather it is based on identifying why an individual has acted in a violent way in the past.


The final stage includes risk management, or taking action to prevent the identified future scenarios from happening in the future. Risk management strategies include treatment, supervision, and victim safety planning.


Doyle, M., & Logan, C. (2012). Operationalizing the assessment and management of violence risk in the short-term. Behavioral Sciences and the Law, 30, 406-419.


Danielle McNeill, M.S., M.A.
WKPIC Doctoral Intern



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Friday Factoids: Violence, Video Games, and Slenderman



When one thinks of deadly murderous duos, names that may come to the mind include: Leopold and Loeb; Lucas and Toole; Bianchi and Buono; and Lake and Ng. It’s no surprise to most that these notorious and sadistic male killers were accomplices who acted out their fantasies on their victims. Rarely do we hear of female killer duos like Gwen Graham and Catherine May, two nurses who smothered six patients in their care; Delfina and Maria Gonzales, who lured unsuspecting women into a deadly cult of prostitution; Christine and Lea Papin, French maids who gruesomely murdered their employers and their daughter with a hammer; and Pauline Parker and Juliet Hulme, two obsessed and devoted teenagers who murdered Parker’s mother. While these women were from an era that predated the internet, one wonders if their exposure to violent images in television media and video games would have driven many more to commit such heinous acts.


With the arrival of the World Wide Web and internet video games, young children and teenagers were exposed to an onslaught of video content that has become increasingly realistic and violent.  Research conducted in the 1980s by Huesmann and Eron (1986) as cited by the American Psychology Association (APA, 2013), determined that elementary students who watched excessive amounts of television violence displayed higher levels of aggression as teenagers.  Recently, two 12-year- old girls from Wisconsin attributed their violent attack and attempted murder of their best friend to an online video game called “Slenderman.” The girls stated they desired to earn favor with the mythical character by luring their friend to the woods near their home and stabbing her 19 times. Prior to the attack, the girls repeatedly played the video game and planned the attack for months. When asked by authorities their motivation for such a violent act, the girls reported they wanted to prove Slenderman was real.


According to Traister (2014), belief in a mythical fantasy world can intensify the connection between young women and can potentially lead to violent behavior. Traister further added, “The two Wisconsin preteens aren’t the first to confuse socially-crafted fiction into reality.” Unsurprisingly, this will not be the last.  Virtual reality internet video games on our youth can be something that will continue to worry parents and may perhaps become the focus of significant future psychological research.


Huesmann, L. R., & Eron, L. D. (1986). Television and the aggressive child: A cross-national comparison. Hillsdale, NJ: Erlbaum.


Traister, R. (2014). The slender man stabbing shows girls will be girls too. Retrieved from


Violence in the Media (2013).  Psychologist study tv and video game violence for potential harmful effects. Retrieved from


David J. Wright, MA., MSW
WKPIC Doctoral Intern



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Friday Factoids: The Power of (and Potential Problems with) Humor


Do psychologists have a sense of humor? Was Johnny Carson the “King of late night television?” Of course! I rest my case.


Seriously though, humor in the work place has been a tremendous outlet for stress reduction. We all have read how laughter improves mood or increases satisfaction. While all of this has been supported in current literature, one has to be careful that the humor is not in “poor taste.”  Scott (2014) mentioned that “approximately 70% of individuals surveyed said that workplace jokes concentrated on making fun of co-workers based on elements such as age, sexual orientation and weight.”  Remember, what may be funny to you can be perceived by others as inappropriate.


I close with appropriate office humor taken verbatim from Burton (2014):

1. Two psychotherapists pass each other in the hallway. The first says to the second, “Hello!” The second smiles back nervously and half nods his head. When he is comfortably out of earshot, he mumbles, “God, I wonder what that was all about?”


2. Receptionist to psychologist: “Doctor, there’s a patient here who thinks he’s invisible.”
“Tell him I can’t see him right now.”


3. There are three guys going through an exit interview at a mental hospital. The doctor says he can release them if they can answer the simple mathematical problem: What is 8 times 5?

The first patient says, “139.”

The second one says, “Wednesday.”

The third says, “What a stupid question. It’s obvious: The answer is 40.”

The doctor is delighted. He gives the guy his release. As the man is leaving, the doctor asks how he came up with the correct answer so quickly.

“It was easy, Doc. I just divided Wednesday into 139.”


4. A Stanford research group advertised for participants in a study of obsessive-compulsive disorder. They were looking for therapy clients who had been diagnosed with this disorder. The response was gratifying; they got 3,000 responses about three days after the ad came out. All from the same person.



Burton, N. (2014). The Very Best Psychology Jokes: Top 21 psychology, psychotherapy, and psychiatry jokes. Retrieved from


Psychology humor—clinical (n.d.) Retrieved from


Scott, E. (2014). Workplace Humor: How to reduce stress with inoffensive office humor. Retrieved from


David J. Wright, MA., MSW
WKPIC Doctoral Intern



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Friday Factoids: A Call for Action on Teen Violence



Amid the rise in teen violence, one must agree that our society’s most precious resource is endangered. Violence among teens seems to be a common theme in headline news.  On June 11, 2014, a news report on the Today Show indicated that there were 74 school killings since the Sandy Hook Shootings. Enough is enough!  I’m frustrated, angered, and enraged. What has occurred in our society that has led our teens astray and caused them to become violent individuals?


As future professional psychologists, how are we addressing this problem?  I encourage your feedback, thoughts, and answers. Below are just a few  news captions that are disturbing and should be a wakeup call for change to take place in our current system: “Brutal killing of teenage girl tied to suspects’ satanic ritual” (Rogers, 2014); “Colorado teen says he and his girlfriend killed grandparents for inheritance” (Associated Press, June, 2014); “Teen admits killing parents because they confiscated his iPod”  (Best, 2014); “Twisted Twins: Teens confess to brutal murder of mother” (Beck, 2014); “Ottawa teen killed at prom after-party in alcohol-fueled brawl” (Hensley, 2014).


These headlines of killings were brutal and senseless. Who is at fault? Nowadays, the media seems to fault parents. But, is this a fair statement?  Have parents given up on their children? Are parents afraid to chastise their kids in this day and age due to fear of imprisonment? Does government dictate how parents are to raise the kids of today?  Our most precious resource is hurting and need a voice. Are we to take the attitude of “the new normal”–or will we rise to this challenge and find new and different ways to combat this problem?


Associated Press (June, 2014). Colorado teen says he and his girlfriend killed grandparents for inheritance. Retrieved from


Beck, C. (2014). Twisted twins: Teens confess to brutal murder of mother. Retrieved from


Best, J. (2014). Teen admits killing parents because they confiscated his iPod. Retrieved from


Hensley, N. (2014). Ottawa teen killed at prom after-party in alcohol-fueled brawl. Retrieved from


Rogers, B. (2014). Brutal killing of teenage girl tied to suspects’ satanic ritual. Retrieved from


David J. Wright, MA., MSW
WKPIC Doctoral Intern



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Friday Factoids: Link Between Vitamin D and and Psychosis?


One may have thought that vitamin D was only associated with bone density, skin conditions, sunlight exposure, or cardiovascular functioning. While it is commonly known throughout the medical and psychological community that vitamin D is linked to brain development and functioning, recent studies suggest that a deficiency in vitamin D may correlate to brain dysfunction and the onset of psychosis, including major depression and schizophrenia.


As cited by Brauser (2013), researchers conducting a study in the United Kingdom determined that patients at an in-patient psychiatric facility who presented with first-episodes of psychosis (FEC) had very low levels of vitamin D, and surprisingly were three times more likely to be completely deficient in vitamin D than their healthy same-aged peers. Vitamin D is unlike many other vitamins. It is also a steroid hormone that releases neurotransmitters such as serotonin and dopamine.  According to Greenblatt (2011), researchers found vitamin D receptors on cells in the region of the brain associated with depression. Greenblatt further stated that numerous research studies determined that low levels of vitamin D3 have been linked to Seasonal Affective Disorder; affecting serotonin levels in the brain.


While research studies do show a link between vitamin D deficiency and depression, it is unclear whether the relationship is causal. Brauser quoted Dr. John Lally, a clinical research fellow at United Kingdom National Psychosis Unit, stating: “we are not sure whether vitamin D deficiency is part of the psychosis itself or the result of lifestyle choices.”  Dr. Lally further said that extended periods of hospitalization and the use of anticonvulsants may also cause a deficiency in vitamin D. Interestingly, further examination is needed to determine the causal relationship between vitamin D and the early onset of psychosis. Perhaps the takeaway for clinicians is to consider vitamin D levels in their patients and its impact on their mental health.



Brauser, D. (2013).  Vitamin D deficiency linked to onset of psychosis. Retrieved from


Greenblatt, J. M. (2011).  Psychological consequences of Vitamin D deficiency.  Retrieved from


David J. Wright, MA., MSW
WKPIC Doctoral Intern






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Friday Factoids: Bullying and Risk for Suicide



One of the most common concerns that arise in counseling with children and teens is the aspect of bullying. Bullying can have lasting effects on a person’s self-esteem and view of himself.


Dr. Susan Swearer, bullying expert, discussed in an article on the APA website (2010) how bullying is not a new issue. She discussed how a researcher in the early 1980s began studying bullying as a result of three boys ages 10 to 14 that committed suicide in 1982 due to being bullied. Dr. Swearer stated that where in the past bullying could only occur during face-to-face encounters, now with the widespread use of technology, bullying can occur seven days a week, 24 hours a day.


Dr. Swearer (2010) discussed that parents and teachers must intervene when they see bullying take place. The student(s) who are doing the bullying must be told to stop. The bullying behaviors need to be documented and be kept as records. One of the most important steps to take is for the victim to feel that they have a support network of students and adults. The student who is being bullied should feel connected to school and home. Students who are being bullied may also benefit from either individual or group therapy in a place where they are able to express their feelings.


Researchers have attempted to look at a student’s risk factor for committing suicide as a result of bullying. Every story has been found to be different but the one thing that is known is that depression is a risk factor for committing suicide; therefore, symptoms of depression in students should be taken very seriously and properly treated. Dr. Swearer discussed the importance of parents monitoring their child’s behavior online in order to ensure their child is not bullying others or a victim of bullying. Bullying is a real problem for children and teens and any psychologist who works with young people, who are being bullied, should assess and treat any signs of depression or anxiety and provide the proper support that the young person needs. (Swearer, 2010)


Swearer, S. (2010, April 2). Bullying: What parents, teachers can do to stop it. Retrieved from


Cindy A. Geil, M.A.
WKPIC Doctoral Intern



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Friday Factoids: What is Play Therapy and Why Does It Matter?



Play is a child’s job when they are young. The natural medium of communication for children is play and activity. Play is the way children learn what no one can teach them.

Children’s play represents the attempt of children to organize their experiences and may be one of the few times in children’s lives when they feel more in control and therefore, more secure.


The philosophy behind child-centered play therapy considers play as essential to children’s healthy development and that play gives concrete form and expression to children’s inner worlds. Emotionally significant experiences are given meaningful expression through play. One of the major functions of play is changing of what may be unmanageable in reality to manageable situations through symbolic representation, which provides children with opportunities for learning to cope by engaging in self-directed exploration.


When a child is given complete freedom in her play, she can act out aspects of her life that are emotionally significant to her. A child can show through the use of toys how the child feels about herself and the significant persons in her life. When a therapist gets on the child’s comfort level through play, the play provides a means through which conflicts can be resolved and feelings can be communicated. Due to these reasons, play therapy is one of the most beneficial interventions with children with emotional and behavioral issues. (Landreth, 2002).


Landreth, G. L. (2002). Play therapy: The art of the relationship, 2nd ed. New-York, NY: Brunner-Routledge.



Cindy A. Geil, M.A.
WKPIC Doctoral Intern




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Congratulations, Dr. Lorence!


Go big, or go home!



WKPIC would like to congratulate Margarita Lorence, 2012-2013 intern, on completing her dissertation and graduation requirements. Way to go, Dr. Lorence! Now, go change the world. We know you can do it.

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Friday Factoids: Therapist–Or Hypocrite?



askstephanNo one wants to be called a hypocrite. A hypocrite means you are a fraud. You say one thing but live in a different way. How many times are we hypocrites as therapists?


We tell our clients that they need to spend more quality time with their spouse or children but we stay at the office late into the evening and are too tired and worn out to spend quality time with our families once we get home. How many times have you recommended an exercise regimen to a client while you hit the snooze on the alarm skipping your workout time?


We, as therapists, often disregard our own advice by ignoring the messages we say day in and day out and fail to implement them in our own lives (Kottler, 2003). If we believe the advice is so important for a healthy life, why do we not take our own advice? When we fail to take care of ourselves and our personal lives it can lead to burnout and the inability to be good therapists to our clients. One of the most important things for our clients might be for us to leave the office and spend time with our family, replenishing ourselves so we are better equipped to work with them the next time we see them.


In summary, take your own advice!


Kottler, J. A. (2003). On being a therapist. 3rd ed. San Francisco, CA: Jossey-Bass.


Cindy A. Geil, M.A.
WKPIC Doctoral Intern



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Friday Factoids: Trust and Caring are Keys to Clinical Supervision



As psychologists, we will most likely supervise practicum students, interns, or postdoctoral students at some point in our careers. Campbell (2006) explains that the key to a successful supervisory relationship is to create an atmosphere of safety and trust, promote shared understanding and agreement about the tasks and goals required, and be fair, respectful, and empathic toward the needs of supervisee.


One of the most important things a supervisor can do is to show the supervisee that you care about them on a personal level. The supervisee also needs to know that the supervisor genuinely cares about them on a professional level and is invested in their development as a psychologist. If a supervisee feels that the supervisor views them as a burden or another task to check off on their list of “to do’s,” a trusting relationship will never be developed. If a trusting relationship is never developed, the supervisee and his or her clients both suffer. A supervisee in this type of relationship will not feel that they can go to their supervisor for consultation without feeling that they are going to be brushed off quickly. Thus, the supervisee will stop going to the supervisor for advice.


Some personal attributes that have been identified as essential to effective supervision include trustworthiness, authenticity, genuineness, openness, tolerance, respect, empathy, flexibility, an ability to confront, a concern for supervisee’s growth and well-being, and sense of humor (Campbell, 2006). Often times, a supervisor will be the driving force that provides confidence to a training psychologist. What an amazing and influential responsibility! We might not always know the best answers as future supervisors but this can be easily forgiven when a supervisee and supervisor have a supportive and trusting relationship with each other.


Campbell, J. M. (2006). Essentials of clinical supervision. Hoboken, NJ: John Wiley & Sons, Inc.


Cindy A. Geil, M.A.
WKPIC Doctoral Intern



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