A Near-Fatal Assault on a Psychiatric Unit

Therapeutic management of violence in residential care for severely mentally ill clients: An application of intrapsychic humanism∗

“…While a history of violent behavior is recognized as the single most accurate predictor of a risk for subsequent violence (Davis, 1991;Monahan et al, 2001), mentally ill clients often are unable to provide an accurate history, especially when it concerns illegal behavior. For instance, Labrash and Cain (1984) describe a client who, after not answering an intake nurse's questions about his background, suddenly jumped from his chair and strangled her, almost to the point of death. Underscoring the difficulty in predicting violence, stereotypes can create systematic errors in predicting violence; clinicians overestimate the risk of violence by male patients of color, and underestimate the risk of violence by women (McNiel & Binder, 1995).…”

“…Staffs inability to understand clients' inner distress and respond adequately to their constructive motives is caused when personal motives (such as staff's discomfort with a client's violent feelings, or staff's wish to believe they have been effective and cured a client of violence) preempt their caregiving motives (motives to respond by genuinely fostering the client's developmental process). One of the most common ways in which clinicians' personal motives take over their caregiving motives is that, as researchers repeatedly document, clinicians feel uncomfortable adequately asking about and evaluating client violence (LaBrash & Cain, 1984;Monahan et al, 2001).…”