Date of Award


Level of Access Assigned by Author

Campus-Only Dissertation

Degree Name

Doctor of Philosophy (PhD)


Counselor Education


Dorothy Breen

Second Committee Member

John Maddaus

Third Committee Member

Sandy Caron


The purpose of this study was to examine the etiology and cultural underpinnings of adolescent violence as collective case study analysis of three inter-related groups: psychiatrically hospitalized rural adolescents, their parent/guardian, and various hospital staff. Violence among adolescents is a serious societal issue that has had varying degrees academic study. I have chosen to build upon the pioneering work of Arthur Kleinman (1978, 1980, 1988) who developed an explanatory model of illness prototype that attempted to improve patient – provider communication and alignment of treatment goals and mutually desired outcomes. Using an explanatory models of violence instead of illness paradigm first adapted from Kleinman’s work by Pall Biering (2001, 2007), I explored the varying perspectives of these groups in an attempt to better understand this phenomenon from a qualitative perspective, a methodology that has not been commonly utilized (Slovak & Singer, 2002). Through multiple in-depth interviews, I sought to uncover underlying themes and insights related to adolescence violence and aggression from those who have employed it, those who have lived with its manifestations, and those who have treated these youth behind this violent behavior. The major theme of this study clearly established that psychiatrically hospitalized adolescent violence in this cohort had primary roots in extensive maltreatment. Candid revelations depicted extensive abuse often beginning in infancy that included physical, sexual, and emotional abuse and profound neglect. A second theme revealed almost all adolescents carried a strong shame-based identity and a damaged sense of self. Thirdly, many adolescents utilized a defensive violence shield to protect them from perceived or imagined threats due to extensive hypervigilance, dangerous impulsivity, and poor affect regulation. Finally, a prosocial theme emerged with many adolescents demonstrating the traits of compassion and forgiveness, even to those who may have harmed them. Recommendations included greater utilization of multi-disciplinary trauma informed systems of care and adoption of a Developmental Trauma Disorder Diagnosis. I hope that this research may eventually help improve treatment strategies and outcomes for psychiatrically hospitalized adolescents. In employing a qualitative strategy, I also wanted to provide an honest voice for an often disenfranchised and misunderstood population.