title: Psychosocial approaches to violence and aggression: contextually anchored and trauma-informed interventions.
abstract: Psychosocial interventions are part of the complex understanding and treatment of violent behavior in our state mental health hospitals. A comprehensive assessment of violence and aggression includes attention to all 3 domains of prevention and assessment (primary-institutional, secondary-structural, and tertiary-direct). Trauma experiences and their consequences may include behavioral violence and aggression. The authors' premise is that trauma is a universal component in the individual assessment of violent behavior. Therapeutic interventions must include a trauma-informed formulation to be effective. Organizational commitment to trauma-informed, person-centered, recovery-oriented (TPR) care is crucial to the efficacy of any of the interventions discussed. Thus, the dynamic nature of the individual, interpersonal, environmental, and cultural factors associated with the daily operations of the inpatient unit need to be assessed through the lens of primary and secondary violence prevention, building on the recognition that the majority of persons served and staff have significant trauma histories. Once a compassionate, respectful, empathic, and empowering approach is embraced by leadership and staff, the work with individuals can proceed more effectively. Interventions used include a variety of cognitive-behavioral, interpersonal, and somatosensory therapies. These interventions, when effectively applied, result in more self-esteem, self-mastery, self-control for the person served, and diminished behavioral violence.
authors.affiliation: 1Office of Training and Development,Massachusetts Department of Mental Health,Westborough,Massachusetts,USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Horowitz
authors.affiliation: 2Central Office Research Review Committee,Massachusetts Department of Mental Health,Boston,Massachusetts,USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Guyer
authors.affiliation: 5Clinical and Professional Services,Massachusetts Department of Mental Health,Boston,Massachusetts,USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Sanders
mesh_terms: D000374:Aggression / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D006801:Humans; D011570:Psychiatry / Q000379:methods* / Q000639:trends; D014754:Violence / Q000517:prevention & control / Q000523:psychology*; D014947:Wounds and Injuries / Q000523:psychology*
keywords: Aggression; prevention; psychosocial; trauma informed; violence; violence assessment