Management of violent patients in a psychiatry walk-in clinic

The authors discuss a systems approach for managing violent psychiatric outpatients. Multiple care-giving and brief, as needed visits within an outpatient walk-in clinic setting can provide empathic care for those violent patients who become too threatened by the intimacy of individual therapy, and who often reject treatment. The walk-in clinic can provide the violent patient and his therapist sufficient "distance" from each other, so that excessive transference and countertransference reactions--which can lead to acting out and violence--are diluted. Case vignettes illustrate how the walk-in clinic can treat violent patients falling under a variety of diagnoses, and prepare them for eventual acceptance of more traditional therapies. This approach may assist community clinics who are increasingly involved in the treatment of violent patients.