Psychotherapy in a Special Hospital: Learning Difficulty and Violence (From A Practical Guide to Forensic Psychotherapy, P 115-120, 1997, Estela V Welldon and Cleo Van Velsen, eds. -- See NCJ-168168)

• NCJ Number: 168183
• Author(s): J Carlyle
• Date Published: 1997
• Length: 6 pages
• Sale Source: Jessica Kingsley Publishers
• Publication Type: Training (Aid/Material)
• Language: English
• Country: United Kingdom

Annotation

This paper describes the psychotherapy of a woman with learning difficulties who was violent in the sessions.

Abstract

The case illustrates some of the tensions of doing psychotherapy at the interface of mental handicap, violence, and large institutions. The interface issues include the function of violence as a distance regulator, the role of the psychotherapist in a secure psychiatric institution, and what it means to be therapeutic. The therapeutic work involved the Group Analytic idea of "dynamic administration" (Foulkes 1975) and the psychoanalytic concept of understanding difficulties in thinking in the presence of pain, both related to abuse and to deprivation (Sinason 1986; Tustin 1987). "Dynamic administration" refers to the attention given by the therapist to the setting in which therapy occurs and the attempts to provide a safe and predictable environment. The therapist sought to provide a context in which the patient's violent and destructive behavior could be understood. The therapist tried a number of ways to avoid being kicked in the sessions while maintaining communication in the room. Eventually, the therapist decided to move the session to the patient's ward and to conduct the sessions sitting side-by- side at a round table. After the move to the ward, they met in a room sometimes used by the staff. Over the course of the therapy, the patient's behavior did improve; staff attitudes toward her changed somewhat, and she was subsequently discharged to conditions of lower security.