Psychologists are frequently called upon to evaluate individuals who threaten violence toward intimates. Guidelines for such an evaluation focus on utilizing clinical-descriptive and actuarial parameters. The author presents a psychoanalytic object-relations perspective as a framework for integrating these domains of information. A psychoanalytic understanding of development and the therapeutic encounter, coupled with clinical and actuarial data, provide the diagnostician with an understanding of the significance of the patient’s personal history, as well as helping to identify significant psychostructural deficits and action-tendencies. Clinical data, therapist-patient interaction and psychological testing results are integrated and used to go beyond formulating a descriptive diagnosis. The patient’s internal structure, including the following constituents are discerned: degree of self-object differentiation; level of self-integration; defensive operations; capacity to manage narcissistic injury and the consequent shame-rage cycle; subtle deficits in sense of reality. A case is detailed of a 32-year-old woman whose violent potential was identified three weeks before she shot her husband.
Category: Professional WritingsBy Richard Lettieri
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