Board-certified psychologists serve as models of excellence across various specialty domains in how they provide clinical assessment and care. Importantly, part of this excellence is the ability to perform competent risk assessment and management. We addressed suicide-specific risk education and training in our previous article (AhnAllen et al., 2025) and here discuss other-directed violence in an effort to increase competency in properly responding to behavioral emergencies and ensure compliance with legal mandates.
A legal precedent for psychologists to notify and protect individuals at risk for violence victimization from their clients was set in Tarasoff v. Regents of the University of California 17 Cal.3d 425 (1997). The California Supreme Court stated, “When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another [person], he incurs an obligation to use reasonable care to protect the intended victim against such danger. … [This duty] may call for [the therapist] to warn the intended victim or others likely to apprise the victim of the danger, to notify the police, or take whatever other steps are reasonably necessary under the circumstances (APA LRAS, 2005).” However, the duty to warn and protect varies by state. The vast majority of states mandate the duty to warn and protect in line with the Tarasoff ruling or embed the ruling in their common law (Gorshkalova & Munakomi, 2023). Other states have permissive legal rules surrounding the duty to warn and protect, and a small minority of states have no guidance (Gorshkalova & Munakomi, 2023).
As is the case with suicide, other-directed violence risk assessment and management is necessary across all clinical assessment and care domains. In this article, we will describe current societal trends in homicidal behavior with a brief discussion of the recent surge in acts of violent extremism/domestic terror, highlight the current status of other-directed violence risk education and training in doctoral-level psychology education programs, offer recommendations for how psychologists can positively impact their patient populations through competent other-directed violence risk assessment and management, and conclude with recommended policy, education, and training changes for ABPP specialty boards to consider for integration into their other-directed violence risk assessment and management procedures.
Societal Trends and Vulnerable Populations
A person dies by homicide every 21 minutes in the United States (Centers for Disease Control and Prevention (CDC, 2024). Specifically, the CDC reported that 22,830 individuals died by homicide in 2023. This equates to about 6.8 deaths per 100,000 persons, which is relatively consistent with the 2021 and 2022 rates (7.8 and 7.5 deaths per 100,000 persons, respectively) but still represents an elevated rate since 2014 (4.4; Council on Criminal Justice (CCJ, 2023). According to available statistics, individuals and groups at greatest risk of becoming victims of homicide include young adults, Black individuals, and males (CCJ, 2023). Black individuals (26.5/100,000 people) were arrested for homicide at a greater rate than White individuals (4.1/100,000 people; CCJ, 2023). Additionally, homicide is most frequently carried out via the use of a firearm; firearms are used in 77% of all homicides, and the use of firearms has also risen consistently since the early 2000s (CCJ, 2023).
Domestic terrorism in the U.S. is an additional concern pertaining to other-directed violence. While Bongar and colleagues (in press) detail how domestic terrorism has not increased in rate within the U.S. overall, far-right violent extremism has, according to the National Institute of Justice Journal (Chernak et al., 2024). Furthermore, an analysis of data from the U.S. Extremist Crime Database identified approximately 227 far-right extremism-related events that have led to 520 deaths (Duran, 2021). In contrast, far-left extremists engaged in approximately 42 events that led to 78 deaths. On the whole, domestic terrorism, particularly far-right extremism, has risen to the forefront of homeland security and is a significant contributor to other-directed violence in the U.S.
Ultimately, psychologists play a role in fostering community well-being and security via the provision of mental health services and competent other-directed violence risk assessment and management. Accordingly, it is crucial that psychologists receive adequate training in other-directed violence risk assessment and management, which will help ensure that they can competently assess and manage risk as it arises in clinical practice.
Current Doctoral Education of Psychology Students
Doctoral psychology graduate programs do, in fact, provide better and more comprehensive education and training (e.g., via newly created course training modules) in risk assessment and management than in the past, according to previous national surveys (AhnAllen et al., in press). However, education and training are still not sufficient to develop the requisite competence needed in risk assessment and management to properly protect community public health. According to our survey research on APA-accredited doctoral and internship programs (Kleespies et al., 2023), only 25.4% of doctoral psychology program directors reported that their programs offered other-directed violence risk management training. Further, only 7.7% reported that their programs offered a formal course that included other-directed violence risk management. While most programs were reported to incorporate some sort of suicide risk assessment and management into seminars and/or courses (88%), other-directed violence risk assessment and management was reported to only be incorporated into 42% of graduate program seminars/courses. The courses most noted to include other-directed violence education and training were ethics and psychological assessment, among others; however, only 1-10% of those courses were reported to have dedicated time allotted to the study of other-directed violence risk assessment and management. Despite a lack of training and education, nearly 2/5 graduate and nearly 3/4 internship program directors reported considering education and training on other-directed violence risk assessment management as “very important.” Accordingly, despite some advances in other-directed violence risk education and training, the quantity and quality of it is lacking and incongruent with the perceived importance of the said education and training.
There are numerous ways and methods to improve doctoral-level psychology graduate programs’ other-directed violence risk assessment and management. These include the development of courses that integrate suicide and other-directed violence risk assessment and management together. Programs might also develop content within qualifying examinations about legal responsibilities associated with the duty to warn and protect. Internship training programs, and potentially practicum programs, are encouraged to provide clinical training with individuals who are at varying levels of risk of violence to promote competence development in both assessment and management in an applied manner. Further, at the board-certification level (ABPP), we outline several ways to address the described education and training gaps to improve the potential for psychologists to protect public health.
Board-certified Psychologists Provide Other-Directed Violence Prevention and Management
Board-certified psychologists assist to prevent and manage other-directed violent thinking and behavior among their client populations. Opportunities exist for an increased focus and education on the psychology of violence and factors involved in its development, such as specific serious mental illnesses. Board-certified psychologists, as stewards of their profession and specific areas of expertise, can play a significant role in advocating for better quality violence risk assessment education.
Board-certified psychologists across specialties provide violence risk assessment and treatment for diverse communities of individuals, some of which are at an increased risk for homicidal thinking and behavior. The existing research describes specific groups/persons that may be at an increased risk for homicidal thinking and behavior as it relates to the perpetration and/or victimization of other-directed violence (compared to the general population), including:
- Adolescents diagnosed and hospitalized with psychiatric comorbidities (e.g., hospitalized with mood disorders, anxiety, ADHD, personality disorders, and/or suicidal ideation, see: Sun et al., 2022; Clinical Child & Adolescent Psychology)
- Individuals with substance use disorders (e.g., alcohol use disorder) and access to firearms (e.g., see: Matthay, 2025; Addiction Psychology)
- Individuals with personality disorders (e.g., psychopathy, see: Heirigs, 2021; Clinical Psychology)
- Individuals with mood disorders (see Swanson, 2021; Clinical Psychology)
- Individuals with a history of childhood maltreatment/abuse (see Heirigs, 2021; Clinical Child & Adolescent Psychology)
- Individuals with a history of incurred abuse/intimate partner violence (see Spencer & Stith, 2018; Couple & Family Psychology, Forensic Psychology)
- Individuals with serious mental illness (e.g., via psychosis, see Witt et al., 2013 & Youn et al., 2025; Serious Mental Illness)
- Individuals with polytrauma and myriad health conditions (e.g., via chronic pain, TBI, PTSD; see Blakey et al., 2018; Clinical Psychology)
- Individuals with neurological factors linked to disinhibition, impulsivity, and/or frontal cortex dysregulation (see Song et al., 2025; Clinical Neuropsychology)
Recommendations for ABPP Specialty Boards
As leaders in their field, board-certified psychologists are at the forefront of improving other-directed violence risk assessment and management, such as with the previously mentioned at-risk populations. Specialty boards can help improve systems of education and training to improve their members’ ability to provide quality risk assessment and management. Boards may consider establishing/monitoring eligibility qualifications as well as developing and utilizing violence-specific risk vignettes within oral examinations to evaluate candidate competence. For example, vignettes may include requiring a written statement on how a candidate might enact a specific duty to warn and protect (in compliance with national/state legal codes), violence-specific risk factors, and assessment and response procedures could help ensure that candidates have the competence to conduct violence risk assessment and management. Boards may also create and disseminate vignettes through digital means and artificial intelligence to replicate (as much as possible) the real-world scenarios they may face related to other-directed violence ideation. Oral examinations can serve as a “capstone” event for violence risk assessment and management competency; such an exam may include ethical dilemmas that involve disclosure and/or legal principles, as well as identifiable risk factors associated with increased risk for violence towards others. The oral exam traditionally demonstrates applicant sophistication with the APA ethical code (APA, 2017). By establishing a standard operating procedure with guidelines, education, and training, ABPP has the potential to create a set of processes that expand attention to other-directed violence risk assessment and management competency across its membership. In turn, ABPP will emphasize the importance of risk management that will inevitably support the protection of the public.
Summary
Other-directed violence continues to be one of the leading causes of death in the U.S. As has been the case with suicide risk assessment and education, over the past 30 years there have been some improvements in the education of psychologists on other-directed violence risk education and training. The American Psychological Association (APA) currently does not provide specific guidelines or educational competency expectations for violence risk assessment and management. To improve competence regarding other-directed violence risk assessment and management, the creation of professional standards (at the board-/certification-level, e.g., with ABPP) for other-directed violence risk education and training is highly recommended. Specialty boards within the ABPP can create and monitor these guidelines and standards to improve their members’ (and prospective members’) competency. Further, board-certified psychologists are stewards of the profession and subject matter experts. In turn, we strongly recommend that board-certified psychologists also pursue additional training and continuing education opportunities. In short, with improved education and training, psychologists will demonstrate enhanced opportunities to protect public health from the devastating impacts that violence has on the community.
Education and Professional Practice Recommendations
Below are recommendations that are offered to improve other-directed violence risk assessment and management education and training, broken down by group:
- Doctoral Graduate Programs: Consider creating and implementing a formal behavioral emergencies class that incorporates BOTH suicide risk assessment and management AND other-directed violence risk assessment and management. In doing so, doctoral-level programs will set a strong educational foundation for all future licensed psychologists in comprehensive risk assessment and management competency.
- Doctoral Clinical Training Sites: Provide training opportunities for trainees with clients who have risk factors associated with increased risk for other-directed violence. Provide requisite supervision to help trainees develop a strong set of tools and skills to identify and mitigate risk for violence. This will promote a training foundation for future licensed psychologists to apply risk education into practice in a competent manner.
- Licensed Psychologists: Seek out and engage in continuing education programs and stay current with violence risk assessment and management research to maintain and increase competence. The American Psychological Association’s Office of Continuing Education in Psychology office offers CE programs in violence through online courses (APA CEP, 2025) as well as in the Monitor on Psychology (DeAngelis, 2021), amongst various other resources from APA (APA, 2025).
- ABPP Specialty Boards: Find ways to integrate other-directed violence-related education and training content into relevant specialty boards via the use of standard operating procedures such as guidelines, as well as oral examination and qualification requirements for its members.
References
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Colin Simsarian, MA, MS
Correspondence: csimsarian@paloaltou.edu
Brenda Hammond, MS
Correspondence: bhammond@paloaltou.edu
Holly M. McGrath, BA
Correspondence: hmcgrath@paloaltou.edu
Christopher G. AhnAllen, PhD, ABSMIP
Board Certified in Serious Mental Illness Psychology
Correspondence: cahnallen@bwh.harvard.edu
Phillip M. Kleespies, PhD, ABPP
Board Certified in Clinical Psychology
Correspondence: kleespies@aol.com
Bruce Bongar, PhD, ABPP
Board Certified in Couple and Family Psychology
Correspondence: bbongar@paloaltou.edu