Violence risk assessment

Suicide risk points inward; violence risk points outward — toward a third party. When a client signals intent to harm someone else, the counselor has to assess the danger and, when a duty is triggered, act to protect. Examiners test whether you can spot the indicators and take the right protective steps.

Start with the risk indicators. The strongest predictor of future violence, just as with suicide, is a history of past violence. Other indicators: access to weapons, a specific and identifiable target (a named victim), a concrete plan, substance use/intoxication, active psychotic symptoms (especially command hallucinations or threat/control-override delusions), impulsivity, and antisocial traits. The most alarming combination is a specific threat + a named, identifiable victim + the means to carry it out — that convergence is what shifts a case from clinical concern to protective duty.

When risk is real, take protective actions. Options escalate with the level of danger and may include: intensifying treatment and increasing session frequency, voluntary or (where warranted) involuntary hospitalization, means restriction (removing access to weapons), notifying and warning the identifiable potential victim, and notifying law enforcement. Document your risk assessment and reasoning carefully.

These protective steps live inside a duty context — the clinician's legal/ethical duty to protect identifiable third parties, which in many jurisdictions can include a duty to warn. The landmark case here is Tarasoff v. Regents of the University of California; the detailed legal mechanics and case history are covered in the Domain 1 legal/ethical topic. For this crisis-work topic, the takeaway is simply that a credible threat to an identifiable victim can override confidentiality so the counselor can act to keep someone safe.

Clinical Pearl: As with suicide, past violence is the strongest predictor of future violence — and the trigger for protective action is the convergence of a serious threat and an identifiable victim, which can override confidentiality (Tarasoff duty to protect).