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Advances in Psychiatric Treatment (2004) 10: 267-276
© 2004 The Royal College of Psychiatrists

Psychodynamic lessons in risk assessment and management1

Ronald Doctor

Ronald Doctor is a consultant psychiatrist in psychotherapy for the West London Mental Health NHS Trust (Lakeside Mental Health Unit, West Middlesex Hospital, Twickenham Road, Isleworth TW7 6AF, UK. E-mail: ronald.doctor{at}wlmht.nhs.uk), of which he is Clinical Director. In addition, he is a College tutor for the Charing Cross Psychiatric Training Scheme and Programme Training Director for the West London Higher Training Scheme in Psychotherapy. He trained at the Tavistock and Portman NHS Trust and is a member of the British Psychoanalytical Society. He was formerly a visiting psychiatrist at HM Prison Wormwood Scrubs and Supervisor and Examiner of the Forensic Psychotherapy Course at the Portman Clinic.

Risk assessment is notoriously difficult and offers a particular challenge to mental health workers. There are two main conceptual approaches to the consideration of risk assessment and management: the actuarial and the clinical methods. I use case material to examine the clinical, and in particular the psychodynamic, approach in order to illustrate that violent behaviour has meaning. Understanding its meaning and learning from it can substantially reduce the risks of further violent behaviour. Managing risk with the aid of psychodynamic psychotherapy enables the patient to become aware of his or her own mind and its function. Although this process may initially be distressing to the patient, in the longer term the aim is to enable the development of a healthier, more stable internal reality. This should, in turn, reduce the risk of dangerous acting out.


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This article has been cited by other articles:


Home page
 Adv. Psychiatr. Treat.Home page
F. Holloway
Risk: more questions than answers: INVITED COMMENTARY ON... PSYCHODYNAMIC METHODS IN RISK ASSESSMENT AND MANAGEMENT
Advan. Psychiatr. Treat., July 1, 2004; 10(4): 273 - 274.
[Full Text]

Home page
 Adv. Psychiatr. Treat.Home page
C. Witteman
Violent figures, risky stories: INVITED COMMENTARY ON... PSYCHODYNAMIC METHODS IN RISK ASSESSMENT AND MANAGEMENT
Advan. Psychiatr. Treat., July 1, 2004; 10(4): 275 - 276.
[Full Text]


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Copyright © 2004 The Royal College of Psychiatrists.