Preventing Violence: The Mental Health Community Must Step Up!

Following the terrible events at Newtown, CT, there have been many calls for the mental health community to step up to fight this senseless violence.

The question is “How?”  While the links between violence, mental illness and gun control are very complex, is it possible that we can do more?  Certainly the mental health community knows how to help people deal with trauma, grief and loss, and On Good Authority has produced several programs on these topics.  But what do we know about prevention?

Do we know enough about what some researchers have called “Pathways to Violence” to be predictive?

Do we know enough about threat assessment, warning behaviors, and risk factors?

What about assessing likely severity and probability of outcome?

Can these behaviors be identified, coded, and utilized in a valid manner?

Is there a “People who might be Violent Someday” database, as there is with sex offenders and with people who threaten the President?

Do we report schizophrenics to some as yet unknown place?

Do we report anyone who seems weird?

Do we report people with Asperger’s?

What about our ethical standards regarding confidentiality and duty to warn?

Once a person is identified as a serious risk, then what?

And really, given the demographics of the rarity of these terrible events, and the epidemiology showing that only 4 percent of violence in the United States  can be attributed to people with mental illness, would new laws about this be overreacting?

You might wish to read the excellent article, “The Role of Warning Behaviors in Threat Assessment: An Exploration and Suggested Typology,” by J. Reid Meloy, Ph.D.*, Jens Hoffmann, Ph.D., et al, published in Behavioral Sciences and the Law, 2011.  Here is the link:

Let’s try, in these next few weeks, to pool our ideas and get a dialogue going.  Then we can pull a report together and send it to—where?  To our professional organizations?  To Homeland Security?  To our representatives in Congress?  To the FBI, as with people who threaten the President?  Maybe one of you knows.

Surely, with our collected knowledge, we can make some contribution to help save our children and ourselves from massacres like these.

Barbara Alexander, LCSW, BCD


How Essential is it that Patients Tell the Truth?

Every therapist working with adolescents has had the experience of being questioned by parents who don’t think the child is telling the therapist the whole story.  But in Psychoanalytic Social Work (June, 2010), Ron Langer discusses a case where he serendipitously discovered that much of what the patient talked about was not true; yet the patient’s mood and functioning appeared to significantly improve over the course of the therapy.  Using the work of Otto Fenichel on pathological lying, he concludes that sometimes, believing the patient is more important than knowing whether what the patient is saying is true.

The moral of this, as we discuss at length in On Good Authority’s program, “Facebook and Google and Twitter—Oh My!” is don’t snoop around online for information about your patients!

You can learn more about this program by visiting our course catalog for details.

“Web Therapy” Actress Lisa Kudrow Plays the Worst Therapist Ever

If you have ever wanted to see examples of what NOT to do as a therapist, then you should watch “Web Therapy,” on the Showtime channel.

Here in this outrageous comedy, Lisa Kudrow portrays a mega-diva therapist, who can scarcely take her mind off herself, so she gives her patients 3 minute computer video sessions in a Skype like situation. Her sessions are short because she says she doesn’t want to deal with dreams and feelings and things like that.
This show will have you laughing hysterically and cringing at the same time.

Of course, listeners to On Good Authority’s continuing education programs would NEVER do the things this therapist does — you are all much too well educated!

Still, you might wish to check out our programs on “Online Therapy” and “The
Therapeutic Relationship, just to be sure you’re on the straight and narrow!

To whom does a child belong?

In a recent article in Ethnos, (volume 68), Erdmute Albert wrote that among the Baatombu in Northern Benin (which is in western Africa), child fosterage is not an exception in crisis situations, as in western cultures, but the common upbringing pattern. Until some years ago, most of the Baatombu children did not grow up with their biological parents, but were fostered by “social parents.” There is a strong attitude of shame related to biological parenthood and an attempt to deny it. The children are not told who their parents are. In public, the biological parents keep a bashful distance from their offspring, do not show emotion, and the social parents are regarded as the true parents. This arrangement of the concrete practices of fosterage is deeply imbedded in their norms and ideas about parentage.

Among anthropologists, this is a “functional” approach to the practical problems of raising children. But it does raise the question of, “To whom does a child belong?” Obviously, this practice of social parenting, common in many parts of Africa, is quite different than the Euro-American conception of children as belonging exclusively to their biological parents. Of course, many American adolescents are quick to say that they belong only to themselves. But when western children spend their childhood in foster care, multiple issues of attachment develop.

We discuss aspects of attachment and many ethical issues regarding children in our programs. Please visit our course catalog for details.

Gender Differences in Mental Illness

Men and women are different—at least when it comes to mental illness. Women are more likely to be diagnosed with anxiety or depression, while men tend toward substance abuse or antisocial disorders, according to a new study published by the American Psychological Association.

Published online in APA’s Journal of Abnormal Psychology®, the study looked at the prevalence by gender of different types of common mental illnesses. The researchers also found that women with anxiety disorders are more likely to internalize emotions, which typically results in withdrawal, loneliness and depression. Men, on the other hand, are more likely to externalize emotions, which leads to aggressive, impulsive, coercive and noncompliant behavior, according to the study. The researchers demonstrated that it was differences in these liabilities to internalize and to externalize that accounted for gender differences in prevalence rates of many mental disorders.

Lead author, Nicholas Eaton, MA, states that gender-focused prevention and treatment efforts should be considered. “In women, treatment might focus on coping and cognitive skills to help prevent rumination from developing into clinically significant depression or anxiety,” and “In men, treatment for impulsive behaviors might focus on rewarding planned actions and shaping aggressive tendencies into non-destructive behavior.”

In our recent program on “The Therapeutic Relationship,” ten experts discuss issues in psychotherapy ranging from attachment, mindfulness, and cultural complexities to neuroscience and termination. Please visit our course catalog for details.