Lisa Rochford, PhD Licensed Clinical Psychologist … · 2013-01-07 · Lisa Rochford, PhD Licensed...

Lisa Rochford, PhD

Licensed Clinical Psychologist

lisa@psychroanoke.com

540-387-3955

811 S. College Ave., Salem, Va.

Normal vs. abnormal moral development

The correlates and suspected causes of youth

violence

Discussion: How can we as therapists foster

moral development and reduce violence in

our community?

Human beings exist in interdependent relationships that entail ethical responsibilities.

The family is the primary sphere in which one learns ethical behavior.

1. How can I avoid punishment?

2. What’s in it for me?

3. Conformity – Trying to be good

4. Law and order mentality

5. Social contract

6. Universal ethical principles

(from clinicians treating RAD)

3 Stages:

Pleasure/Pain (under age 3) Do what brings pleasure, avoid what brings pain

Shame (age 3-7) Get rid of painful feelings of shame (but not

necessarily change behavior)

Mature Guilt (age 7-11) Feel guilt for harming others,

attempt to make amends,

change behavior

Reinforcing behavior you want to encourage,

punish behavior that you want to discourage

James Fox and Jack Levin, data base of mass

murders in US since 1980s, Northeastern

University criminologists, authors of “Extreme

Killing: Understanding Serial and Mass Murder”

J. Reid Meloy, clinical professor of psychiatry at

UC San Diego, School of Medicine, diplomat in

forensic psychology

Adam Lankford, assistant professor of criminal

justice at the University of Alabama, author of

forthcoming book “The Myth of Martyrdom: What

Really Drives Suicide Bombers, Rampage

Shooters, and Other Self-Destructive Killers”

male (94.4 %)

20 to 29 years of age (43.3 %)

White (62.9 %)

Have a relationship with the victim of

some kind (family 39.4 %; other 38.2 %)

Fox & Levin, 2005

Long history of failure and feelings of rejection from childhood, reaching a point where life feels meaningless and the future promises only more of the same.

Feelings of isolation/ no friends/ spending time alone. No emotional support or comfort. No one to help him deal with the demons, encourage him to do the right thing, or provide perspective.

Don’t take responsibility for own inadequacies in relationships but externalize the blame.

Fox & Levin

Power

Revenge

Loyalty

Terror

Profit

Fox and Levin

Thirst for power and control: often dresses in battle fatigues and has a passion for symbols of power, including assault weapons.

Seeks revenge against either specific individuals, particular categories or groups of individuals, or society at large. Most commonly, he seeks to get even with people he knows such as family or the boss and other employees.

Warped sense of love and loyalty or desire to save their loved ones from misery and hardship. Typically it is a husband/father who is despondent over the fate of the family unit. Sometimes, as in the case of the Manson family, the murders are done by a cult group being obedient to their charismatic leader.

May be trying to regain a degree of control over their lives.

Turvey (profiler)

Type of murderer who is usually a stockpiler of guns, assault rifles, grenades, and other exotic weapons.

Their attack is usually the result of careful planning and a desire to lash out against the world which is "not right" in some way.

Victims are usually selected at random

Knoll (2010) notes that this type usually progresses through a revenge fantasy, a hero fantasy, and then a death fantasy (the obliterative state of mind) where they must absolutely “wipe out” or destroy others who are enjoying the things that they cannot have.

They keep a running tally of all the mistreatments they've experienced at the hands of others.

They often verbalize an outburst, like "Death awaits you" or "Have a Nice Day" at the beginning of the mass murder (Hempel et al. 1999).

They are often copycats because if they are captured alive, they will admit they were inspired by others as well hoped to inspire others (Mullen 2004).

Mental illness that produced a desire to die and intensifies the following beliefs:

Deep sense of victimization that is irrational and exaggerated. Belief that killer’s life has been ruined by someone else who has bullied, oppressed, or persecuted him. The key is that the shooter feels violent vengeance is justified. In many cases the target becomes broader and more symbolic than a single person.

Desire to acquire fame and glory through killing. Eric Harris (Columbine): “Isn’t it fun to get the respect we’re going to deserve?” Elementary school – to get as much attention as possible.

Lankford, 2012

No evidence that mass murderers “snap,” but rather plan the murders and how they will carry them out for days or weeks in advance (Kleck, 2009)

Believe that their cultural goals (e.g., wealth, success, etc.) have been blocked.

Individuals who have developed a distorted self concept of themselves. Often feel shame and guilt in response to the negative social appraisals and comparisons they have made and received from other individuals in society. As a result, they accept their inferiority, but also lash out in an attempt to overcome this inferiority.

“The need to belong, defined as the desire for frequent, positive, and stable interactions with others, is a fundamental human motivation...” (Baumeister & Leary, 1995)

Exclusion or rejection causes aggression (Leary et al., 2006)

Some degree of derogation of the other individual appears to be a prerequisite for aggression

When you’re the “out group,” it’s easier to dehumanize the “in group”

In recent years, an “eclipse” of community, dwindling of social relationships including family ties and neighborliness, that once protected us

Less interaction with co-workers if telecommute/work on internet

To counteract, “reaching out to the seemingly isolated stranger sitting alone at the next table in the restaurant or working out with an iPod at the next treadmill”

Fox & Levin, 2009

Between 1949-1998:

Majority of adult mass murderers had various Axis I paranoid or depressive conditions and Axis II schizoid, narcissistic, and antisocial traits and disorders.

50% of the adult murderers had a psychiatric history and two-thirds showed evidence of psychotic symptoms at the time of the killings.

23% of the adolescent murderers had a prior psychiatric history. However, unlike adults, 63% of the adolescent murderers displayed depressive symptoms at the time of the crime, but only two of them ever showed signs or symptoms of psychosis.

Meloy, 2004

Over 2 million youth

arrested each year in the US US Surgeon General’s report

Primary reasons for arrests Substance abuse

Running away & truancy

Deliberate injury to property

Theft

Physical harm or intimidation of

others

4% are for violent crime

Instrumental

dispassionate, deliberate, goal-

driven, to obtain some reward or to

achieve a goal like a victory.

Associated with reduced anxiety.

Reactive

a frustrating or threatening act

triggers the aggression. Associated

with greater anxiety.

Dedicated neural circuitry allows expression

of reactive aggression

Low level of stimulation/Distant threat:

“freezing”

Closer threat: escape-related behavior

Very close threat/escape impossible: reactive

aggression

high in fearlessness

low emotional reactivity

high in thrill/sensation seeking

low in executive control

low in behavioral inhibition

low in responsiveness to punishment cues

More reactive regulatory system: greater

tendency toward reactive aggression with:

Increased aggression with depression & anxiety

Greater stress response can occur with abuse that

damages emotional regulation over time

Hyperactivity

as a Child

At least 50%

Oppositional

Defiant

Disorder

Hofvander et al., 2009

By Puberty

~ 33%

CD

By Adulthood, with ADHD & CD:

much greater risk for social and

emotional failure (thought to be a

genetically based subtype of

ADHD)

~ 50% of those with ADHD/CD develop

Antisocial Personality Disorder

Psychopaths engage in both reactive and

instrumental aggression

Deficits in the ability to process emotion,

including not finding others’ expression of

sadness and fear aversive

Behavioral and Antisocial: associated more

with reactive aggression

Affective and Interpersonal: associated more

with instrumental aggression, data for a

genetic basis

Poor Anger Control

Early Behavioral Problems

Serious Criminal Behavior

Serious Violations of Conditional Release

Criminal Versatility

Stimulation Seeking

Parasitic Orientation

Lacks Goals

Impulsivity

Irresponsibility

Callous/Lack of Empathy

Lack of Remorse

Shallow Affect

Failure to Accept

Responsibility

Impression

Management

Grandiose Sense of

Self Worth

Pathological Lying

Manipulation for Personal Gain

Other

Casual sexual relations

Unstable interpersonal

relations

Impairment in the

naming of fearful

and sad facial

expressions and vocal

affect

OK with angry,

happy, surprised

Reduced autonomic responsiveness to

others’ distress

Intact amygdala – “fearfulness”

can show amygdala is working

well

Responds to the fear and sadness

of victims

With dysfunctional amygdala (psychopathy),

fearlessness, lack of concern for the distress of others

Fail to generate or generate less emotional autonomic responses to fear-inducing stimuli

Anticipating electric shock

Imagining fearful or unpleasant experiences measured via electrodermal response

Reduced aversive conditioning: negative visual primes followed by neutral primes Less startle reflex to neutral than normals

Don’t understand the difference between

conventional and moral transgressions

Conventional – affecting social order (talking in

class)

Moral – harming another person or another

person’s property

Antisocial parents

Parental alcoholism

Inconsistent discipline

Lack of supervision

Also important:

Physical punishment

Poor school performance

Childhood separations

Physical punishment: child more likely to

offend.

Empathy-inducing conversation: reduces

probability of antisocial behavior. Empathy

facilitates moral socialization. Fear hinders

it.

Violent crime peaks in the 4 hours following

the end of the school day (roughly 2–6 p.m.)

35% of offenders in

special education

Mixed evidence on whether it increases

aggression or not

Engage youth in positive connections

Therapeutic relationship with you

Encourage parents to help children socialize

Encouraging opportunities to help others

Strengthen competencies

Assess and then focus on the major risk factors

present for each patient

Increase connections! Focus on Attachment

Improve caregiver-child connection through play and

positive interaction in and out of session with Theraplay®

and other therapies

Allow for attachment with you as the therapist

Assess and assist family dynamics

Be alert for parental psychopathology or alcoholism,

domestic violence

Assess and steer parents to therapy if needed.

Improve parenting practices Reduce physical punishment, foster authoritative

parenting style. Validated programs include:

ADHD and ODD-based programs such as in “Your Defiant Child” (Barkley); “Coping Power Program” (Lochman and Dodge); Aggression Replacement Training (Glick & Gibbs)

Parent Child Interaction Therapy

Love and Logic

Community action Support groups for young adults, including those on

the autism spectrum disorder.

Support for parents of children and young adults with psychological disorders

Focus on children’s specific needs:

Treatment plans in therapy Build coping skills and reduce problems with impulse

control, mood disorder, and anxiety

Watch for signs of psychosis including delusions

Abuse and neglect history Trauma-oriented therapies

School and learning history - possible bullying and learning issues Evaluations by school “child study teams” (free but

parents have to request them) or local psychologists, special education programming

More opportunities for social skills/friendship/special interest groups at school

With misbehavior, focus on the feelings of the victim and

how to make amends.

Activities that focus initially on one’s own feelings as a

point of departure for relating to the feelings of others.

Activities that focus on similarities between oneself and

others, including similar feelings.

Role-playing - imagining and acting out the role of

another.

Sustained practice in imagining/perceiving another’s

perspective.

Excellent guide for

parents and teachers –

click here: http://www.psychroanoke.com/school_improvement_r

esearch_series_-_excellent_empathy_dev_article.pdf

Besides therapies noted above, some of the best:

Small group homes or specialized foster care for offenders emphasizing personal attention and therapeutic treatment

Competency development: concentrate on improvements in academic performance, social competencies, employability, civic and other life skills

Wilderness (not boot) camps: programs providing relatively intense physical activity and therapeutic enhancement

List of Juvenile Justice validated programs:

http://www.ojjdp.gov/mpg/programTypesDefinitions.aspx

What have you found to be helpful to do with

patients/families to reduce antisocial

behavior?

What can be done in the therapy session?

What can be done in the schools?

What can be done in the community?