Efecto de los agentes blanquea dores s obre la pulpa dental 1 Sensib ilidad d entinaria.

Overall, the experience of VTF was described to be negative experiences because of their recognised association with risk. Patients identified the troublesome nature of violent thoughts and fantasies and described their various attempts at managing these experiences in order to reduce or eliminate potential risk of violence. An ability to recognise and manage VTF however, effectively highlights a controllable side to these experiences and importantly suggests that there is a choice to be made about a) whether or not to manage and b) how to manage them.

Such decisions are likely to based on the way in which social cues are interpreted and are dependent on social cognitive information processing skills. In the first instance, scripts related to violence or aggression may be activated in a threatening situation triggering a need for the individual to consider possible behavioural responses. This activates a series of scripts, which are each evaluated and the most appropriate script retrieved for activation in that situation. Crick & Dodge (1994) and Dodge (1980) would argue that deficits at any stage in the information processing model can increase the likelihood of violent behaviour. However, this theme appears to demonstrate that it may not be a deficit per se, but perhaps a bias in information processing which might contribute to the selection of certain behavioural scripts over others. Biases in cognitive processing have been widely identified within the offender literature but what is of particular relevance to this study is the fact that offenders can make decisions about whether or not to engage in violence.

Patients described implementing a range of techniques in an attempt to manage the experience and expression of VTF. However, these techniques were sometimes unhelpful, for example not getting the support they felt was needed and/or engaging in offence paralleling behaviours. Consequently, some patients appeared to displace the drive behind the fantasy or behind the violent action onto other problematic behaviours such as self-harm (for a review see Klonsky, 2007),

130 which may also be identified as a way of shifting the focus onto the individual himself. Alternatively, behaviours such as viewing and masturbating to pornography that are recognised as offence paralleling behaviours may also be potential treatment targets.

On the other hand, some patients who were receiving treatment for their violent thoughts and fantasies often spoke positively about the treatment they had received. Medication for example was associated with less intrusive violent thoughts, which one patient stated reduced the anxiety behind his violent thoughts and therefore enabled him to reside amongst his peers without the worry of acting on a violent thought. Talking therapies were not specifically mentioned, however some patients made reference to understanding their violent thoughts and fantasies in a psychological way e.g. making reference to activation of CAT cycles being triggered and schemas being activated, suggesting that there is some awareness of how violent thoughts are manifest within psychopathology. Furthermore, this highlights how violent thoughts and fantasies may be discussed within the context of psychological therapy sessions and that support for these experiences may be received here.

However, there were some patients who said that talking about their violent This may be due to a number of factors ranging from the nature and function of the experience (in context), the person they sought support from and how this was subsequently managed. Accordingly there may be a number of potential implications for practice. On the whole however, it seems appropriate to suggest that individualised care plans which are developed in collaboration between staff and patient that stipulate how violent thoughts and/or fantasies can be supported, may be useful to both the client and supporting staff.

Finally, the then and now sub-

on their previous experiences of managing VTF and is described as a kind of learning experience. It was generally conveyed that patients felt like they were

131 expression in what they ascribed to be a problematic manner. However, the accuracy of these claims is debatable and may be biased through attempts at positive self-portrayal. While it is not disputed that some patients may be more able to manage VTF at the present time, there remains a need to consider issues of social desirability, and/or lack of insight into these experiences.

In summary, this chapter illustrates he need to be provides some suggestion that mentally disordered offenders are able to make decisions about how to respond to aggressive or hostile social situations. However, this decision appears to depend on many factors including cognitive biases and distorted beliefs in relation to the self and others. Patients have described an awareness of the need to carefully manage their thoughts given their appraisal that some thoughts are associated with risk of action. However, the extent to which the strategies that patients used to manage these risks is unclear, given some techniques include offence paralleling behaviours. Nevertheless, this

132

CHAPTER SEVEN

THEME 4: THINKING TO DOING, TO THINKING, TO DOING

INTRODUCTION

The theme of thinking to doing, to thinking, to doing that is described in this chapter represents a progression from the theme described in the previous chapter and illustrates the escalation of violent thoughts and fantasies (VTF) to offending. This chapter describes the transactional process between thinking (violent thoughts and fantasies) and doing (violent behaviour) and captures the presence of VTF displayed in reality where they usually take the form of violent behaviours. While VTF have been identified as being used to guide or plan offences, there is also evidence to suggest that the observed violent behaviour is only a small part of what the offender has actually planned in their VTF. Simultaneously, a reverse relationship (doing to thinking) is also illustrated in which violent behaviours are

VTF, as aspects of reality and the

memory of the offence itself become integrated into their VTF. As such it is proposed that the relationship between thinking and doing is circular and ongoing with the two feeding into one another.

There are three sub-themes within the super-ordinate theme. Strategy and planning describes the function of the VTF as an aid to planning a violent assault,

out of my hands

occurred and finally thinking to doing

violent behaviour, including alternative outcomes and subsequent renewal of VTF in some cases. Each sub-theme will be discussed in turn and following this a brief discussion will place the current findings into context, with reference to the broader thematic structure and relevant literature.

133