On patients who explode: surviving petrifying psychotherapeutic experiences

Although most of our patients will enter the consulting room quite quietly, often in a depressive state, having contained their sadistic impulses, a tiny fraction of those with whom we work will attack us in a variety of chilling ways. In this article, the author describes in detail two particularly terrifying clinical experiences in which a patient either threatened to kill him or actually sullied his consulting room with bodily fluids. Drawing upon his psychotherapeutic encounters not only with intellectually disabled patients and forensic patients but, also, with those who presented as ordinary “normal-neurotics”, the author considers the phenomenology of these “bomb”-like explosions and explains how he attempted to maintain a classical psychoanalytical focus of understanding, which consisted of a careful scrutiny of the countertransference and a firm commitment to the interpretation of unconscious material, whilst under attack. Furthermore, he examines the essential role of speaking with experienced colleagues who will provide essential supervision or assistance during these challenging chapters of clinical practice. The author also considers the many ways in which “bombs” can be hurled not only by the more obviously dangerous or disturbed individuals but, also, with surprising frequency, by those with no criminal history whatsoever, who, upon first encounter, often present as reasonably healthy.

Europe in the aftermath of the refugee crisis: the effect on forensic psychotherapy

After World War II Germany has repeatedly suffered waves of immigration. With eighteen to twenty per cent of the entire German population now being of foreign descent, it is puzzling that public opinion widely ignores the impact of migration on Germany’s national destiny and identity. As forensic therapists we routinely apply a set of assumptions and routines, by which we address internal and external culture conflicts of migrants. Each wave has challenged the justice system and the legislature, and forensic therapists are used to working around legal boundaries to safeguard that migrants receive treatment and are not deported. The uniqueness of the present wave of migration lies in the overwhelmingly high numbers of arrivals in a very short time span, many of whom were traumatised unaccompanied male minors with ill-informed expectations. Europe in its entirety has seen the breakdown of existing structures for receiving and accommodating refugees alongside a surge of solidarity, but also with some alarming loss of empathy. Public bias against migration is beginning to impinge on our forensic work, as we deal with migrants, whose difficult life situation has had a bearing on their criminal behaviour, while forensic assessments determine whether they are going to be deported or not. We as forensic therapists are therefore caught in a professional dilemma whichever way we turn.

Fuses igniting in the consulting room

This article on fuses igniting in the consulting room is entirely based on clinical experiences without reference to any theoretical positions. Three clinical vignettes will be described to illustrate situations when the therapist realised there was a sudden unexpected rise in “temperature” of a patient’s mind and/or in her own mind, and why this may have occurred. A fuse was lit but was it a slow or a quick one? A slow match is a very slow-burning fuse presenting only a small glowing tip whereas a quick match is one, which once ignited, burns at top speed. I will relate this ignition to the possibility of premature interpretations, or a failure to realise how anxious the patient was in the presence of the terrifying object–therapist and also, unexpected situations arising during and outside of sessions. I will describe how these situations unfolded during sessions and how, upon reflection, these could have been diffused differently. The emphasis will be on how best to maintain a psychoanalytic stance but also how to clinically judge when a session must be terminated in order to protect patient and therapist from exploding “bombs” inadvertently ignited by patient, therapist, or external events. The importance of supervision and consultation with colleagues will be stressed.

Deprivation and delinquency in the adolescent forensic patient

Drawing upon Donald Winnicott’s classic paper, “Delinquency as a Sign of Hope”, the author has underscored the importance of recognising the role of emotional loss in the aetiology and treatment of adolescent forensic patients, and she has elucidated how this particular psychoanalytical lens can assist psychotherapists to work more effectively with deprivational trauma. The author has also described her experience as both a field social worker and as a forensic psychotherapist, and has shared moving clinical material with great clarity and generosity, demonstrating the value of incorporating Winnicott’s insights into the forensic consulting room. In particular, the author has examined how the patient can use the psychotherapist as an understanding object who can help to counteract earlier deprivations.

"Gendercide—Gender Divide": reflections on organising a conference... and then moving it online

This is a personal reflection on the experience of organising, postponing, and then reorganising an international conference online during a pandemic. It considers the very real elements of the external chaos, suffering, and confusion which were held in mind throughout the conference planning and delivery, as we also navigated different time zones and constantly changing advice regarding Covid-19. It is about how we transformed our initial feelings of frustration, disappointment, and loss into the drive to keep as much of our original plan alive, and, in the process, how the first IAFP conference with a large group and live simultaneous translation was created online.

The repudiation of femininity

Freud, in 1937, put forward the idea that the repudiation of femininity and the death instinct were factors contributing to the resistance to recovery in psychoanalysis, stimulating much contentious debate. I will illustrate how these ideas have been modified and expanded as both the repudiation of femininity and the death instinct are linked by their envy of the receptive dependence on the good object which lead to a feeling of humiliation and shame in both males and females. When the death instinct is formulated as an anti-life instinct the relationship with envy becomes clearer, the two may indeed turn out to be different aspects of the same thing. In this article I will use clinical material to try to show how the process of negotiating this receptive attitude by repudiating femininity in favour of phallic omnipotence is enacted with perverse behaviour and violence and how, with the help of analysis, the patient may be able to modify their destructive behaviour.

The experience of domestic violence survivors in the US family courts: gender bias in the court

There is a significant body of research on gender bias against women in the family courts. During the Covid-19 pandemic, battered women's vulnerability to domestic violence increased on a global level as women experienced a significant increase in the severity of abuse. The problems of gender bias and the treatment of battered women and their children have a long history of human rights' abuses. In particular, battered mothers have been the focus of gender-biased theories of parental alienation, used as a defence against claims of abuse and child maltreatment, despite a lack of empirical validity and acceptance. Additionally, the family courts in the United States are closed to the public and as a result there is a lack of transparency and accountability. A large-scale national study revealed that many supporting mental health professionals who provide custody evaluations lack a formal graduate education in domestic violence and child maltreatment. Furthermore, legislative presumptions that favour joint legal custody in custody decisions and requirements of co-parenting, fail to take into consideration the long-term public health risks of such chronic traumatic exposure. Finally, this article will address needed systemic reforms that include increased transparency, longterm court-monitoring, and supporting mental health professionals with formal graduate education in trauma, child development, and abuse, to promote resilience in vulnerable families.