NUBE 2024

Political ideology and beliefs are rarely illegal and seldom relevant in psychiatric emergency care. Nonetheless, security and intelligence professionals are increasingly recognizing that ideologically motivated violence is a leading threat. From skirmishes at public protests, to threats against public health leaders and poll workers, to insurrection, incidents both isolated and expansive are increasingly coming under public scrutiny. And as law enforcement agencies do a better job of embracing multidisciplinary strategies like behavioral threat assessment and management, This presentation will provide a basic overview of what is known about ideologically motivated violence in the United States and provide practical guidance for PES clinicians in evaluating and understanding people at the intersection of violence risk and extreme ideological beliefs.

First, clinicians must be able to carefully navigate potentially fraught discussions about political ideology in clinical settings. There has long been an opprobrium about discussing politics in the workplace. Delving deeply into political beliefs in behavioral health settings is complex and perilous, with notable risk of transference and countertransference leading to disruptions in the therapeutic alliance. Practical guidance on navigating these turbulent waters will be offered.
Second, clinicians need to understand that the overlap between political extremism and violence risk is small and nuanced. Extremist ideology may be incidentally noted during an evaluation or the ideology may be expressly linked to violent threats or behavior as the primary cause for evaluation. While the adage to use individualized assessment and individualized treatment plans holds true for people with extremist beliefs there are specific considerations which will be discussed pertinent to evaluation of people which apply in the evaluation and management of violence risk.

Third, considerations related to clinical and administrative decision-making will be explored. Just as law enforcement is increasingly partnering with behavioral health and social services for threat management cases, so too do we need to reach out in the management of our high-risk cases. Identifying psychiatric illnesses and social stressors amenable to clinical interventions is critical. Peer supports for hate-based ideologies and for parents of people with extremist ideologies may be available in some regions. In some cases, people who are ambivalent about continued engagement with extremist organizations may respond well to CBT and RET even in the absence of other psychopathologies.
Case examples, critical terminology, and guidance for building both ad hoc and lasting productive partnerships between clinical services and law enforcement partners will be woven throughout the presentation.

Learning Objectives:

Assess risk factors for violence relevant for people with strong political and ideological beliefs.

Formulate strategies for consultation and documentation in high risk clinical cases.

Develop personal strategies to recognize and mitigate personal and organizational countertransference.