Impact News

Responding to Violence, Suicide, Psychosis and Trauma

Dangerous Behaviour: Open Programme Workshop, London, 25.04.15

Due to the cutbacks it has become near impossible for individual applicants to attend the “Difficult, Disturbing & Dangerous Behaviour” workshop which is now almost exclusively an “in-house” bespoke programme. None-the-less, Mosaic Training are hosting an open course in London on 25th April. As this may be the only opportunity this year and you are interested, you should act quickly. The workshop costs only £89.95 and details can be found here

Filed under: Impact Training, Other Mental Health, psychosis, self-harm, Suicide, trauma, Violence, , , , , , ,

3. Violence – a different perspective

gang-youths-fighting

Most of the literature on violence is about everything except violence – the “Long, Slow Story” – and all about the factors surrounding violence. Otherwise it is about fatuous advice of the kind “don’t shout help, shout fire” – gimmicky tricks that, IMHO, have an enormous propensity for getting you into a lot of trouble.

So what do we do? Make it up? No – we take a fresh look, ask new questions and look sideways. For much of my career just one question has troubled me – “when faced with imminent violence, what can we do?” You look at a man who is shouting at their partner. He sees you looking at him, smashes the bottle and bears down on you with it. You want to change the course of events, immediately.

So where should we look? I suggest a new direction and here I will simply suggest some readings that you might find illuminating. I will start with the more populist stuff and then start narrowing it down – but each part will eventually prove to be an essential part of the jigsaw.

I start with “Blink: The Power of Thinking without Thinking” by Malcolm Gladwell (2006). It will only set you back about £7.00 and is an intriguing look at how we make remarkably effective (and sometiems catastrophic) snap judgments. It introduces the concept of “thin-slicing” and challenges the notion that thinking things through is always effective or appropriate. Like all of Gladwell’s books it’s a fascinating read.

Second up is “Thinking Fast and Slow” by Daniel Kahneman (2012) and again only costing about £7.00. Daniel Kahneman is a Nobel Prize winner and in a very entertaining way summarises a life-time of research covering the differences between thoughtful and rapid cognition.

Next up is “The Anatomy of Violence: the biological roots of crime” by Adrian Raine (2014) – a bit more expensive at around £9.00. Another very interesting read. I am not a biologist but I do want to make sure that whatever I say makes sense not only psychologically but also with the way our bodies function.

If you are fascinated about the way the brain works there are two other fascinating books. The first is by Debra Nierhoff (1999) “The Biology of Violence:  The Brain, Behavior, Environment and Violence” – brilliant stuff beautifully told. I’ve just seen that you can get it from a well-known online book retailer for as little as £2.00! Seriously buy it instead of that extra latte.

The other is perhaps more seminal, less about violence but more about how we do things fast (like react to a punch) and is by Joseph LeDoux (1999) “The Emotional Brain: The Mysterious Underpinnings of Emotional Life.” Here Joseph explains the neuro-science underpinning rapid reactions.

Next will drill down a bit into the psychological processes engaged during critical incidents. So here we should take a close look at a literature review by Andrew Moskowitz (2002) on Violence and Dissociation and here is the link

(http://forensicpsychiatry.stanford.edu/PAU/dissociation%20and%20violence.pdf)

Finally I should draw your attention to a great paper that has largely been overlooked, but is very relevant to us. It is by Artle Dyregov (2000) and called “Mental mobilization processes in critical incident stress situations” and the link is:

http://www.ncbi.nlm.nih.gov/pubmed/11232176

Of course you could just buy the book “Facing danger in the helping professions” or attend one of my courses!

In my next posting I will try to explain the “Instant Aggression Model” providing you with map through moments of terror!

Filed under: Uncategorized, , , , ,

2. Violence – Terror in the Mind

woman blurred head

So talking about the “Short, Fast Story” …

I was saying that violence is overwhelmingly a psychological affair so let me clarify what I mean. Violence is an act of aggression and yet it has relatively little to do with pain, injury or even force. We might stub our toe, fall off a bike, scald ourselves, be on the receiving end of fierce rugby tackle, or bash our head on a low doorway. The pain goes, the injury heals, we get on with our lives and forget all about it. Compare this with someone coming up to you and poking you in the chest, or spitting in your face. No real pain, injury or force – and yet you might be troubled by this for a long time.

Now let’s think about force a little more. Many of us feel that we would be at an immediate disadvantage because we are not particularly big or strong. Yet size and strength turn out not to be particularly significant – at least not in the way you expect. My best friend at school was huge – and well built – and yet he got bullied relentlessly by kids who were even smaller than me. I would tell him, “Rich, if not for you, for me, next time they do that to you – just sit on them” but he wouldn’t – his size and strength were his enemies, not his friends. Indeed when I consider some of the scariest people I have encountered, a lot of them have been remarkably small – but still scary!

Okay, many of us still say we are scared by violence – and yet the truth is that violence isn’t particularly scary and sometimes isn’t scary at all! What is scary is the fear of violence – the dreadful anticipation of what might happen as your sympathetic nervous system prepares you for the worst. When the violence takes place there are a whole host of emergency psychological processes that can take over – emotions can be de-activated, time can expand or collapse, dissociative processes engaged and the whole experience can feel unreal. After, of course, there is the trauma – the shattered belief system, the constant ruminations, the nightmares and flashbacks, disturbed arousal, avoidance and the feeling of pervasive danger. The violence itself is the least troublesome part.

The reason we fear violence is because it throws us (psychologically) into the “unknown.” Reason, understanding, reflection and problem-solving – the bed fellows of much of our professional practice – leave the room. Instead of reflecting, we are called on to react – faster than we can think, with little margin for error and possibly catastrophic consequences. We are lost, on our own and without a map.

Well that is where I come in (www.dangerousbehaviour.com ).

In the next posting I will begin to lay down the theoretical foundations to a new approach to understanding and responding to violence – or if you are impatient you could always buy my book! (www.facingdanger.com).

Finally if you want to learn about violence through a fringe theatre style training workshop, Mosaic Training are putting on “Difficult, Disturbing & Dangerous Behaviour” in London on 27th November. Click here for details.

Filed under: Impact Training, Other Mental Health, Uncategorized, Violence, , , , ,

1. Violence – The Long and the Short Stories

man staring

Since not everyone is going to attend one of my courses (www.dangerousbehaviour.com) or read my book (www.facingdanger.com) I thought I’d write a series of short posts on violence for general consumption.

When you look into the literature and at the work of clinical and forensic psychologists on violence it is almost exclusively about what I call “The Long, Slow Story.” It is about understanding the profile of violent offenders, identifying the antecedents of violence, assessing the risk of future violent offending and the treatment of violent offenders. These are matters open to rigorous scientific investigation. It is not, however, the whole of the story. The other part is “The Short, Fast Story” and that is where I come in. This involves the violent encounter itself as it happens second by second and the highly dynamic interplay between the various protagonists.

As professionals, violent behaviour is something we want to change and in “The Long, Slow Story” we can draw upon the established therapeutic literature. When addressing “The Short, Fast Story” however, that literature doesn’t help much – ignoring someone who is about to smash a bottle into your face doesn’t work, nor does challenging distorted cognitions! So it is assumed that when push comes to shove we have little influence over the aggressor’s behaviour.

Training, therefore, tends to focus on preventing or minimising the risk of violence to staff, or moves into physical restraint and breakaway techniques. Both are important and laudable and yet between the two an important gap exists – and that gap is that is overwhelmingly psychological.

In my next posting, I will explain why this so …

A final plug … there are still a few places left on the “Difficult, Disturbing and Dangerous Behaviour” workshop in London on 27th November. This is the only opportunity this year for individuals to attend. For details click here.

Filed under: Impact Training, Other Mental Health, Violence, , , , , ,

Dangerous Behaviour Workshop in London, 27.11.15

Dangerous Behaviour

Difficult, Disturbing and Dangerous Behaviour” is a dramatic workshop that is usually only delivered as an in-house, bespoke training experience delivered on commission to organisations for delivery to their own staff. This can be frustrating for staff who wish to attend as individuals. However, for the only time this year Mosaic Training are staging this course for only £69.95/person in London on 27th November. It is anticipated that this workshop will sell out quickly so if you are interested please click here for the details.

Filed under: Uncategorized, , , , , , ,

Suicide – a casual affair?

ken070912.001.003.FAIRFAX.melb.s/age news  CRYING.photograph by ken irwin  shows  generic single eye crying SPECIAL 111

ken070912.001.003.FAIRFAX.melb.s/age news CRYING.photograph by ken irwin shows generic single eye crying SPECIAL 111

Some while ago I was delivering a training course on “dangerous behaviour” to a housing association when a man popped his head around the door and enquired as to whether this was the “Ladder Awareness Training.” I have to confess, to my shame, I could not prevent myself from bursting out into laughter. Could there really be such a thing as a workshop for grown ups on how to use a ladder? Yet I was the one being silly – an organisation should discharge its responsibility to ensure the safety of its staff and the public.

Now compare this to what we do about suicide. Suicide is the most common cause of death in men under the age of 35 (Five Years On, Department Of Health, 2005) and it’s estimated that around one million people will die by suicide worldwide each year – a lot more than die falling off a ladder! Incredibly, many mental health professionals receive NO training in understanding, assessing and responding to suicidal behaviour. I recently reviewed a M.Sc Forensic Psychology course and, even though the suicide rate in prison is reckoned to be 12 times that of the general public, suicide did not feature at all on the syllabus.

Often friends and family have to wait for a loved one to make an attempt on their life before they get any help – the silver lining should be that at last they will be in the safe and competent hands of the professionals. Except they are not. Acute mental health units often do little more than observe, restrict and medicate – they do not even effectively assess risk even though that is one of their primary roles.

A woman, following a suicide attempt, is admitted to hospital on a Section 2 of the Mental Health Act. A nurse asks some questions to help ascertain whether she really wished to die (she does). During her time in the acute mental health unit no further formal assessment of suicide risk is made and as she declines medication no treatment is offered. Her suicide attempt is viewed as a response to “situational stress” and yet no-one investigates whether her situation was getting better or worse while in hospital (it was getting a whole lot worse). None-the-less, the psychiatrist says she looked happier and told him she wouldn’t hurt herself (an unexplained improvement is an indicator of acute suicide risk and 50% of in-patients dissemble prior to taking their lives) – so takes he her off the Section and allows her leave. She doesn’t return on time and eventually she is found by a helicopter rescue team by a railway track. Still there is no re-assessment of suicide risk and she is allowed to continue taking leave from the ward – despite the the fact that best predictor of future behaviour is past behaviour and it is well-known that suicide risk varies enormously over time. She starts making a list of her possessions (putting things in order?) and tells friends and family not to visit (another indicator of suicide risk), but does check that they are coping with her dog. Prior to the current crisis she had always said that the one reason she would never kill herself was her dog – and yet during her whole time on the ward she never once asked to see him (the primary protective factor). The following day she had an important appointment and yet 15 minutes before she was allowed to leave the ward – no-one asked why. She failed to return on time and only did so after frantic calls from her mother. Still there was no re-appraisal of the situation. Later that evening she again asked to leave the ward and was again allowed to do so. This time she didn’t return …

The point is that less training and less skill was applied to keeping this woman alive than was offered to the man hoping to use his ladder. Why?

You might also be interested to read this Poor mental care blamed as mother burns herself to death. Whatever this is about its not lack of resources.

Filed under: Other Mental Health, self-harm, Suicide, Uncategorized, , , ,

“Outsiders”

A new “fringe theatre style” workshop by Dr Iain Bourne using drama and narration to explore the world of personality disorders. Full details to follow – in the meantime send an email enquiry to Iain

The term “Personality Disorder” has infiltrated common parlance and is often used with great laxity in professional circles to refer to “bothersome people like that.” To do so, however, not only displays a lack of knowledge but is discriminatory and prejudicial. Even those with a more informed understanding of the concept often struggle to articulate the difference between personality disorder and mental illness.

A simple comparison may help. Many consider Obsessive-compulsive Personality Disorder (OCPD) to be a less serious form of Obsessive-Compulsive Disorder (OCD) – when in many ways they are polar opposites. People with OCPD tend to be unemotional and detached with a strong liking for order and precision in their life, are fussy, inflexible and strongly dislike change – and that is the way they prefer to be! People with OCD have a distinct mental illness with a clear neurological component in which their life, against their will, is overrun by unwanted and often distasteful intrusive thoughts and an inability to refrain from rituals and checking behaviour that they acknowledge as pointless and irrational. People with OCD are often very emotional, acutely aware of their disorder and desperate to change. Similar differences are seen in other conditions such as schizophrenia vs schizotypal personality disorder.

Actually when most people refer to “PD” they are not usually referring to OCPD but either Borderline Personality Disorder – a very real and distressing condition – or Antisocial Personality – a much vaguer condition that attempts to medicalise the criminal mind.

Both conditions are explored in “Outsiders” alongside other PDs to:

* Aid our understanding of the condition from the service user’s perspective
* Address our own biases and prejudices
* Feel more confident in challenging other professionals whose use of the term may be discriminatory
* Identify targeted strategies to assist service users in developing more fulfilled lives

Filed under: Impact Training, Other Mental Health, Uncategorized, , , , , ,

Violence in Social Work

Senior people in the Social Work and Social care comment on their own experiences of violence.

http://www.communitycare.co.uk/blogs/social-work-blog/2013/08/tackling-violence-against-social-care-staff-i-wish-there-was-a-simple-answer/?cmpid=NLC|SC|SCDDB-20130822

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Survey of Violence in Social care 2013

Community Care’s latest investigation into violence in social work and social care

http://www.communitycare.co.uk/violence-against-social-care-staff-2013/

Filed under: Violence, , , ,

Difficult, Disturbing & Dangerous Behaviour

Video about the Difficult, Disturbing & Dangerous Behaviour workshops by Iain Bourne

Filed under: Impact Training, Violence, , , , , ,