The prediction of violent behavior and the duty to protect third parties

A considerable theoretical, empirical, and clinical literature has accumulated on the prediction of dangerous and violent behavior. Despite the pleas of mental health professionals that the prediction of violent behavior is not clinically feasible, courts upholding a therapist's duty to protect third parties have created a legal duty to do so. The first generation of research studies of the clinical prediction of violent behavior focused on long-term predictions in offender populations, of little direct relevance to the setting of outpatient therapy with nonoffenders. More recent clinical research has centered on predictions of imminent violence in noncriminal populations, particularly in the process of involuntary hospitalization, but this reveals relatively low levels of predictive accuracy. Methodologic and ethical factors also limit the generalizability of such work. Given the likelihood that significant numbers of false positive predictions will result, especially in the low base rate population of outpatient treatment, it is suggested that therapists attempt to minimize the antitherapeutic influence of any breach of confidentiality.     

The so-called duty to warn: The psychotherapeutic duty to protect third parties from patients' violent acts

This article discusses the much-misunderstood Tarasoff decision that requires psychotherapists to protect third parties from patients' violent acts. Through a normative approach, the paper analyzes four important issues: what to do when potential victims are unknown; what to do about the fact that the patients' potential for violence may be incorrectly perceived; the value of warning potential victims; and, the problem of discharging potentially violent patients from the hospital. The author proposes that the courts adopt a more flexible substantial departure test in most cases that involve psychiatric negligence.     

Current analysis of the Tarasoff duty: an evolution towards the limitation of the duty to protect.

In 1976, the Tarasoff case established a new legal duty to protect third parties from a psychiatric patient's foreseeable violence. After the Tarasoff case, courts expanded the scope and role of a clinician's duty to protect, sometimes in novel ways. Later interpretations of Tarasoff began to limit significantly the situations in which a duty to protect would attach. Recent Tarasoff-type cases in which courts have rejected the clinician's duty to warn suggest that Tarasoff is declining in significance. The advent of state statutes that codify the establishment and discharge of Tarasoff duty have contributed to a further limitation of the duty to protect. Lastly, when faced with the management of dangerous patients, we advocate for a thorough, well documented assessment of risk of violence as the best means for addressing concern about potential legal liability.     

The normative and conceptual foundations of a clinical duty to protect

The continuing controversy surrounding the Tarasoff inspired duty to protect as developed by the courts and legislatures has not adequately weighed the jurisprudential foundations of such an obligation. The authors argue that the duty's misguided thrust of social control grounded in character and status seriously violates broad principles of political morality underlying the law of social control. They conceptualize an alternative--a clinical duty to protect--that coheres with these underlying values and the limits of professional abilities. They contend that any extra-clinical intervention on the part of the psychotherapist entails a role transformation requiring independent justification.     

The physics of evolution: From chaos to evolution and deep ecology

This paper summarizes the various physical science elements of the evolutionary story. The “nonlinear” revolution includes chaos, self‐organization theory, the thermodynamics of evolution, and biological evolution. The key result of the revolution is a physical understanding of how order emerges and change is driven. This paper brings the lessons of each branch of the revolution together into a single easily understood thread. The unexpected result of this revolution is an understanding of evolution as a single inexorable physical process that has given rise to everything from molecules to humankind. Here evolution is driven by energy flow and involves increasing efficiency, the growth of complexity, and the acceleration of change. This paper ties the resulting physical insights to an evolving ecological world view, looks at its ties to spirituality and applies the rules that govern the growth of complexity to business and its current crisis. The net result of the nonlinear revolution is a radical change in our everyday understanding of how the world works, a shift away from classical science's machine world to the vision of an evolving deeply ecologically intertwined world.     

A case for a duty to feed the hungry: GM plants and the third world

This article is concerned with a discussion of the plausibility of the claim that GM technology has the potential to provide the hungry with sufficient food for subsistence. Following a brief outline of the potential applications of GM in this context, a history of the green revolution and its impact will be discussed in relation to the current developing world agriculture situation. Following a contemporary analysis of malnutrition, the claim that GM technology has the potential to provide the hungry with sufficient nourishment will be discussed within the domain of moral philosophy to determine whether there exists a moral obligation to pursue this end if and only if the technology proves to be relatively safe and effective. By using Peter Singer's duty of moral rescue, I argue that we have a moral duty to assist the third world through the distribution of such GM plants. I conclude the paper by demonstrating that my argument can be supported by applying a version of the Precautionary Principle on the grounds that doing nothing might be worse for the current situation.     

The therapist's pregnancy: Evocative intrusion

This paper is concerned with addressing the complex impact of the therapist's pregnancy on the analytic treatment process. The pregnancy is seen as intensifying the transference and countertransference material so that the therapeutic work becomes more strenuous as well as more fluid, with the potential for significant therapeutic change. The paper is divided into two parts. The first section attempts to conceptualise the meaning of the experience for the therapist and patient within the framework of psychoanalytic theory. Problems of technique and management resulting from the pregnancy are examined. One of the issues considered is the manner and timing of the patient's recognition of the pregnancy. The second section of the paper contains extensive clinical material illustrating the enriched transference and countertransference processes, and the access these allow to psychotic pockets of the personality, hitherto largely unavailable for exploration.     

Information system development: From user participation to contingent interaction among involved parties

Abstract

Over the last few decades many social scientists have pointed to the importance of user participation in information system development (SD). In study A the opinions of 314 Dutch system developers on this issue were examined. The conclusion is that the majority rate the value of user participation highly. However, these data confront us with three important problems. First, we cannot be sure that the stated preferences of system developers are reflected in their actual behaviour. Second, system developers may give a different meaning to the concept “user participation” than social scientists. Third, “user participation” does not necessarily imply “user influence” on SD. Moreover, the empirical relationship between user participation and the effectiveness of SD remains unclear. In our opinion this can be attributed both to the multidimensional nature of the former concept and to the contingency of this relationship to the context of SD. Therefore, in study B, we developed a multidimensional contingency model to study the interaction among parties in SD instead of the study of user participation. In this explorative study no linear relationship between the effectiveness of SD and the interaction between users and system developers was found. Instead, effective SD seemed to require a fit between the context of SD and the interactions with and among users.     

Fairness lies in the heart of the beholder: How the social emotions of third parties influence reactions to injustice

The present research explores third parties’ (e.g., jurors, ombudsmen, auditors, and employees observing others’ encounters) ability to objectively judge fairness. More specifically, the current research suggests that third parties’ justice judgments and reactions are biased by their attitudes toward the decision recipient and, in particular, the affective aspect of those attitudes as characterized by their felt social emotions. We explore how the congruence of a social emotion (i.e., the extent to which the emotion reflects feeling a subjective sense of alignment with the target of the emotion) can influence their evaluations of recipients’ decision outcomes. The five studies presented show that congruence can lead third parties to react positively to objectively unfair decision outcomes and, importantly, that the influence of social emotions on subjective justice judgments drive third party reactions to decisions, decision makers, and even national policies.     

From left to right: Processing acronyms referring to names of political parties activates spatial associations

In line with previous studies, showing that abstract concepts like “power” or “god” implicitly activate spatial associations, in the present study we hypothesized that spatial associations are coactivated during the processing of acronyms referring to names of political parties as well. In four studies, it was found that the reading of these acronyms was accompanied by the implicit activation of spatial left–right associations. That is, participants responded faster to left-wing parties by means of a left-hand button press and vice versa for right-wing parties (Experiments 1 to 3), and participants responded faster when a political acronym was presented at the side of the screen corresponding to the political orientation of the acronym (Experiment 4). Interestingly, a correlation was observed between the effect size for left-wing parties and participants' political preferences, suggesting that the reaction time effects reflect the perceived distance of a party to one's own political orientation. Together these findings indicate that spatial representations activated in response to political acronyms do not simply reflect lexical–semantic associations or spatial metaphors, but representations of parties' political orientation relative to one's own sociopolitical position.     

The therapist's self in dialogical family therapy: some ideas about not-knowing and the therapist's inner conversation

In this article, the focus is on the therapist's self, which will be in line with Bakhtin's thinking, viewed as a dialogical self. First, the dialogical view of the self is situated in the context of psychology's traditional focus on the individual self. Then, leaning on Bakhtin and Volosinov, the self is described as a dialogue of multiple inner voices. Some of the implications of this concept for family therapy practice are examined, focusing especially on the therapist's participation in the therapeutic process and on the therapist's inner conversation. The author argues that not-knowing does not only refer to the therapist's receptivity and respect but also implies that the therapist is aware of his or her experience and reflects on how his or her inner conversation might inform and enrich the therapeutic conversation. Finally, these ideas are illustrated with a brief clinical vignette.     

The therapist's responsibility: a systemic approach to mobilizing family creativity

Three techniques, sculpting, geneograms, and family drawing are considered within a systemic approach to therapy. Frequently, emphasis is laid on either the activity of the therapist or the behaviour of the family in treatment. We focus on ways in which the therapist draws on the clients' creativity, relying for this on a correct assessment of their 'language' or 'idiom'. Certain assumptions are proposed, and case illustrations are used in their support. Our approach is that any material, or apparently no material, produced when using these techniques represents essential information which can be turned to therapeutic advantage by means of positive reframing. Although a framework within which to practise is viewed as essential, a 'game-plan' will almost certainly result in sterility and impasses in therapy. Therapist flexibility, it is proposed, is a prerequisite for creativity. We prefer to label resistance to treatment as failure by the therapist to recognize the clients' needs.     

The first to know: A systemic analysis of confidentiality and the therapist's family

Abstract

One of the most common yet unrecognized breaches of confidentiality occurs when family therapists share confidential information with their own families. For many therapists, the boundaries between professional and private seem unclear, especially pertaining to disclosing clients' confidential information. Therapists are encouraged to examine their own practices concerning sharing confidential information with their families. Therapists' families have their own rules, patterns, boundary issues, and power struggles which affect therapists' behaviors. Therapists can discuss this issue with their families and develop postures that insure clients' privacy.     

Characteristics of affected third parties and cooperative behavior in social dilemmas

ABSTRACT

The studies described in this article explore the influence of an under-emphasized determinant of cooperative behavior in social dilemmas: affected third parties. Two experiments examined the effect of characteristics of third parties on individual cooperative behavior in social dilemmas, and identified mechanisms associated with these relationships. Study 1 demonstrated that third-party need affects individual cooperative behavior, and tested prosocial motivation and intra-group trust as mediators of this relationship. Study 2 provided further elaboration by demonstrating that individual cooperative behavior was reduced when a needy third party was low on reliability, and by showing that prosocial motivation and intra-group trust mediated this relationship. This research connects the literatures on individual cooperation in social dilemmas and relational job design, and demonstrates why third parties influence individuals’ cooperative behavior.     

Love in the counter-transference: The uses of the therapist's excitement

SUMMARY

The psychoanalytic tradition has always had difficulty with the question of the therapist's sexual feelings toward the patient. This paper traces that difficulty: from Freud's original struggle to replace moralism with a psychoanalytic mode of understanding, to the more recent literature on countertransference which still seems particularly averse to the possibility of the therapist's sexual experience. By way of a discussion of a psychoanalytic psychotherapy, I argue for the sometimes central therapeutic role of the therapist's experiencing, and then containing, excitement.     

The duty to believe according to the evidence

‘Evidentialism’ is the conventional name (given mainly by its opponents) for the view that there is a moral duty to proportion one’s beliefs to evidence, proof or other epistemic justifications for belief. This essay defends evidentialism against objections based on the alleged involuntariness of belief, on the claim that evidentialism assumes a doubtful epistemology, that epistemically unsupported beliefs can be beneficial, that there are significant classes of exceptions to the evidentialist principle, and other shabby evasions and alibis (as I take them to be) for disregarding the duty to believe according to the evidence. Evidentialism is also supported by arguments based on both self-regarding and other-regarding considerations.     

Bonding in group: the therapist's contribution

Bonding is an ongoing aspect of intersubjective experience, a type of mental relationship to oneself and others. As a behavioral mode, bonding utilizes verbal and nonverbal communication primarily to establish a basic feeling of connection between individuals. Bonding is the floor, a cognitive-affective state that precedes and prepares the way for the complex processes underlying identification. The concept relates to Bion's early theory of basic assumptions, and takes on new and different meanings according to his later ideas regarding social communication. Bonding is also a therapeutic posture or technique, an element in the establishment of group cohesion, the positive transference, and therapeutic and group alliance. Case examples illustrate how the therapist and other group members bring a complex of bonding needs and anxieties that must be negotiated to establish and maintain bonding, which is a necessary condition for successful therapeutic work.