Experts in this field emphasize that use of these standardized tests is not a substitute for clinical expert assessment. As Scott and Resnick (2002) wrote: "The clinician should balance information gathered from these risk assessment instruments with clinical judgment when making recommendations regarding risk for future violence."
The authors of the landmark MacArthur Violence Risk Assessment Study (Monohan et al., 2001) won the Guttmacher Award--the prize for best writing in psychiatry and the law awarded jointly by the American Psychiatric Association and the American Academy of Psychiatry and the Law--for their book titled Rethinking Risk Assessment: The MacArthur Study of Mental Disorder and Violence. They found that there is no "magic bullet," no "unitary causes of and solutions to violence." They also stated:
Our data are more consistent with the view that the propensity for violence is the result of the accumulation of risk factors, no one of which is either necessary or sufficient for a person to behave aggressively toward others. People will be violent by virtue of the presence of different sets or risk factors å There is no single path in a person's life that leads to violence.
These authors go on to suggest the standard of practice for today's clinician who wishes to practice risk assessment:
This reliance on clinical judgment--aided by an empirical understanding of risk factors for violence and their interaction--reflects, and in our view should reflect, the standard of care at this juncture in the field's development.
In ongoing treatment, the nature and quality of the therapeutic alliance is key in managing destructive impulses and their potential. The psychoanalyst and dynamic psychiatrist, in recognizing transference, countertranference and the other vicissitudes of the therapeutic relationship, will be aware of this central fact.