Therapeutic Management of Violence (TMV)®

A multichannel approach to prevention and management of violence.
Best evidence based practice.
Foredrag presentert 25.10.07 på 5th European Congress in Clinical Psychiatry, Amsterdam, Nederland.

Therapeutic Management of Violence(TMV) – a multichannel approach to prevention and management of violence 

Oral paper presentation by:
E. Lovestad and M. Løvstad                                                                                                      
Lovestad School (Løvstadskolen), Gofjell, N-3790 HELLE, Norway.  
+47 35 98 75 75 (phone) +47 911 66 TMV (mobile)


Although rules and regulations within the health system in Norway state that staff have not only the right, but also a duty to restrain behavior which is potentially dangerous to oneself or others, alternatives to the use of force should be the option of choice. Health staff is thus required to take care of a person who is acting aggressively in an emergency situation, in a humane and least restrictive way. Methods to reduce and prevent restraint are legally, ethically and professional required at all levels.

On the other hand, staff feeling tense and insecure can easily appear as a threat to the patient and thereby provoke aggressive behavior. Hence, a sense of physical and psychological security is seen as necessary in order to develop a good atmosphere in the relationship between patients and staff.

To meet these demands, the program Therapeutic Management of Violence (TMV®) has been developed.  It is a nation-wide multichannel, practical approach to prevention and management of violence, experienced as a best-practice method over 30 years. Its best evidence based practice with multimodal interventions includes behavioral components, emotion-targeted components as well as cognitive components.

This paper presents the background of TMV, practical examples on the use of TMV, and how a supporting software tool has been used to document the effect of TMV in many institutions and hospitals in Norway over the last 8 years.

TMV has been developed as a practical method with training courses on pro-active prevention and solving of conflicts and aggressive behavior among clients and patients in institutions. The principal aim of the program is to help and protect the patient, at the same time meeting the staff’s need for psychological as well as physical security.  The program increases the understanding and awareness of how aggressive behaviour may escalate, and thereby how one may act pro-actively in such situations. TMV also includes psychological as well as physical techniques for the staff. Through these techniques one learns how to minimize the use of physical power, giving several alternatives to restraint, and thereby providing a more acceptable ethical solution to the problem. The method stress the importance of paying respect to the patient one is trying to help, as well as creating an attitude towards protection of persons who lack the ability to draw their own limits. TMV has been shaped from a service user perspective, also for maltreated children and youths with serious behavior problems, and is used at governmental level as the basis for new treatment programs for violent youths.

The guidelines of this unique method, which includes untraditional techniques, has been used with good results within the health sector, including institutions for mentally retarded, autism, dementia, ADHD, drug care, and units for violent/aggressive psychiatric patients. Also, the method has been applied with noticeable effect within schools, social security offices, service institutions and companies.

The paper elaborates further on how the education and training is conducted, including practical examples on how the principles of the method may be practiced on individual and institutional level after getting a detailed demonstration and training under skilled instruction.

Through the use of a software program it has been possible to document the effect of TMV, and how it shows significant effect on the staff in changing their behavior and attitudes towards the patients, thereby creating a calmer and more secure atmosphere. It also documents how TMV has helped staff to gain greater confidence and skills in preventing and handling difficult situations, as well as supporting and speeding up the effect of cognitive treatment programs on aggression and violence.

Full paper in pdf: