In response to a request for references on psychotherapy of violent individuals, I am posting the following volumes that I think are very helpful & insightful:
Brett Kahr (Ed.) (2001). Forensic Psychotherapy and Psychopathology: Winnicottian Perspectives. Karnac.
Arthur Hyatt-Williams (1998). Cruelty, Violence, and Murder: Understanding the Criminal Mind. Jason Aronson.
Otto Kernberg (2004). Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship. Yale University Press.
Searles, H.F. (1979). Countertransference and Related Subjects: Selected Papers. New York : International Universities Press. (Searles has an excellent chapter on violent patients in this gem of a book).
Herbert Rosenfeld (1987). Impasse and Interpretation. Tavistock/Routledge.
Murray Cox (1992). Shakespeare Comes to Broadmoor: "The Actors Are Come Hither." The Performance of Tragedy in a Secure Psychiatric Hospital. Jessica Kingsley.
M. Cox & A. Theilgaard (1994). Shakespeare as Prompter: The Amending Imagination and the Therapeutic Process. Jessica Kingsley.
M. Cox & A. Theilgaard (1987). Mutative Metaphors in Psychotherapy: The Aeolian Mode. Tavistock Publications.
Rosine Jozef Perleberg (Ed.) ( 1999). Psychoanalytic Understanding of Violence and Suicide. Routledge.
Carl Goldberg (1996). Speaking with the Devil: Exploring Senseless Acts of Evil. Penguin Books.
J. Reid Meloy (1997). Violent Attachments. Jason Aronson.
Subject: Re: Violence & Psychotherapy/Pt. 2
Other volumes of import on the subject of psychotherapy & violence are:
Michael Eigen (2002). Rage. Wesleyan.
Karon, B.P., & Vandenbos, G.R. (1981). Psychotherapy of Schizophrenia: The Treatment of Choice. Northvale , NJ : Jason Aronson, Inc. (Bert has an excellent chapter in this volume on special issues in psychotherapy which includes homicide & suicide).
Jackson , M. (2001). Weathering the Storms: Psychotherapy for Psychosis. NY: Karnac.
Jackson , M. & Williams, P. (Eds.). (1994). Unimaginable Storms: A Search for Meaning in Psychosis. London : Karnac Books.
Sabo, A. N. & Havens, L. (Eds.) (2000). The Real World Guide to Psychotherapy Practice. Cambridge , MA : Harvard University Press.
Schulz, C. G. & Kilgalen, R. K. (1969).Case Studies in Schizophrenia. NY: Basic Books.
Serper, M. R. & Bergman, A. J. (2003). Psychotic Violence: Methods, Motives, Madness. Madison , CT : Psychosocial Press.
Thank you to Joe & Brooke for your supportive replies to my posting on my countertransference hate (I am not sure if I am getting all my emails on our listerve-so I may have missed some other reponses to my posting). I was feeling a significant amount of depressive anxiety/guilt (as well as some persecutory fears of retaliation) after my interaction with her. I have mixed feelings about continuing to work with her (as she has such strong ambivalence towards me). Part of me hopes she drops out but I would feel a loss if there were to happen. Below are some comments by Gaetano Benedetti on this issue of countertransference hate.
According to Benedetti (1987), there is a triple function of countertransference hate/aggression. First, it is restricted by libidinal feelings towards the patient and bearing the suffering caused by the patient's omnipotence of the persecutor and powerlessness of the victim. Second, the therapist must engage in integrating one's own negative, 'bad' parts of the self, therefore the patient is not the only one in the room feeling the full weight of the negative self- and object representations. And thirdly, this internal containment, transformation and integration by the therapist is introjected by the patient. Benedetti, after noting that we do not know how this destructiveness originates, whether in the biology, individual, family or culture, described this deeper contact as follows:
"During the contact with the psychotic patient, his destructiveness is experienced in all of its manifestations-raving, hallucination, splitting. These are always the perpetuation of an original destructiveness, the roots of which, for me, are at the base of the very psychosis, whether schizophrenic or depressive. Now, in the psychotherapy, we interpret this destructiveness in all of its tragic interactions...But no interpretation, however careful and intelligent, would ever have the power to induce the patient to dislodge himself once and for all from that destructive iceberg, to disidentify himself from his impulses, if there were not something fundamental which permitted a new knowledge of it. We expose ourselves to this, we undergo the impact, we share it. We accept feeling the impossibility of the accusations, the autistic wall, the coldness of the psychosis, the horror of the delusion, the boredom and terror of the void, the barrenness and inanity of so many sittings with the patient; we even run the risk of his being physically violent. And what is more, by exposing ourselves to his direct assaults, fortunately mostly verbal, we tragically introject his aggressivity, developing counteraggressive impulses which are still useful, very, from a therapeutic viewpoint, because they are bearers of a form of contact, because they are messengers of a dual reality...Well, in all of this, we have shared the seeds from which psychosis springs; and by not ceasing, in this state, to love our patient, we have proved to him the possibility of uniting and integrating good and bad objects, so that he may do this with us. That is to say, we have in a sense eliminated that frenzied terror of destructiveness that belongs to the realms of psychopathology and is a fount of its perpetuation...Aggressivity is transferred, above all, by our own internal transformation of it, not without a battle, and with the longing to be different. And the psychotic patient, in this light, becomes our teacher" (pp. 195-196).
Brian Koehler
