Taubner, S; Fonagy, P; Bateman, A; Rabung, S; (2017) Psychodynamic treatment of violence and aggression – empirical evidence and new approaches. In: Sturmey, P, (ed.) The Wiley Handbook of Violence and Aggression. Wiley-Blackwell: London, UK.

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Abstract

The basic assumption of psychoanalytic clinical concepts leads to a quite unique stance, in which violent symptoms – even the most cruel or irrational behavior – are considered to be meaningful in terms of assuming a vital function of regulating the self or interpersonal relationships. The hidden (or, rather, not superficially obvious) meaning of symptoms can be understood in terms of the individual’s personal history, unconscious conflict, or structural impairment incurred in the course of psychological adaptation to environmental demands which the individual aims to cope with within the limits of his/her constitutional capacities and social resources. In this chapter we will describe psychoanalytic and psychodynamic treatment approaches to violence and aggression that follow the idea that violence is not tied to a specific diagnosis, and but consider it as a symptom on its own with quite diverse clinical contexts, meanings, and etiologies. At the same time, violence is regarded to have a common phenomenological core and situational trigger that is an unbearable affective state or the perceived danger of self-fragmentation. The violent act in that sense is regarded as a way of coping with unbearable affect and to protect the individual from the fragmentation of the self. Psychoanalytic therapy has been intended for the treatment of neurotic patients but has since then widened constantly its scope and evolved into a vast application for different patients and settings. Two major branches within psychoanalytic/psychodynamic therapies can be differentiated: one is the more classical insight-orientated approach and the other is aiming more to enhance personality functioning. Both approaches would aim to share the putative meaning of violent acts with the patient within the context of an affective and significant therapeutic relationship, and to make use of the problems that arise within this relationship to facilitate this process. We will illustrate that there is rather a lack of studies supporting the effectiveness of more classically insight-oriented psychodynamic approaches to the treatment of violent patients; however, we hope to show that there are promising developments in the field for psychodynamically inspired interventions that address underlying functional impairment in addition to, or even eschewing, the insight-oriented approach. Thus, we will argue that for psychodynamic models to be helpful, specific adaptations to generic treatment models are needed to meet the special needs of this target group.

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