Psychopathology: Theory and Practice

The Psychodynamics of Personality Disorder, Sadism and Destructiveness in the Countertransference

This presentation describes some concepts underpinning forensic psychotherapy, including a theory of a triangular dynamic between patient, psychotherapist and society that was developed by Dr Estela Welldon. The talk explores the countertransference in relation to personality disorder, and how challenging this can be for the clinician, arousing such responses as collusion, disbelief and condemnation and also stirring our own sadism via projective identification. He considers how even the most apparently insane violence has meaning inside the mind of the person who commits it. This is explored in relation to two cases in which the violence erupted through a fragile narcissistic structure that had been attempting to hold the self together. This concept of a narcissistic organization of the mind, which arises when there is a failure of containment in infancy, is discussed as a means of understanding this fracturing of psychic defenses.