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Dr. Peter Fonagy on Therapy for Violent Men

PsychAlive5:10

Transcription

I was trained as a psychoanalyst working with violent young men, but I realized very quickly that if I was just going to survive, let alone help anybody, I just want to live. I had to unlearn most of the things that I'd learned because trying to give these people insight was probably a very, very dangerous thing, not for them, for me, because they were just going to beat me up.

And what I realized was more important than anything else is to be present for them, close to them as a human being, to be very aware when I triggered their attachment system and to respond to that by moving back away rather than moving even closer. So, you know, when a person starts shouting at you and you are a well-trained psychotherapist, you say things like, "I think you're feeling very angry with me." And the person might say, "Because I'm bloody angry with you, very, very angry with me all the time." You're kind of soothing them, you're stroking them, you know.

Now, if you are, if you behave like that with young men whose violence, their anger very quickly turns into physical assault, but actually what you have to be able to do is to be able to say things like, "But, you know, you shout at me like that, I can't think. Do you really not want me to think about what you're saying? I mean, I don't mind, but if you shout, I can't think." The point being that you present yourself, your mind, your experience of them, close up and force them to see you for what you are. Then you've got to do that very consistently, all, you know, every time, particularly when you see that you have actually made the person feel bad in some way or made them feel uncomfortable.

The next, the first thing you've got to do, you own up to it. "Look, I don't know what I said, but like, just, um, I know that I've done something wrong here. I said something I shouldn't have said. Can you help me? Because that, you know, I'm really, I'm not thinking very clearly at the moment. Then I just kind of kick. So, can you help me a bit? You know, well, what did I say? What was it?" You know, the point being not that it's very important that I kind of beat myself over the head with my own incompetence, but that it forces the person to think, "Well, now, what was it that upset me about what he said?" And when they become reflective like that, they become a lot less dangerous.

The other thing that I found enormously helpful was humor. If you, if you don't have kind of fairly good footwork and duck at the appropriate moment, it's, it's a dangerous job. And very often, particularly self-facing humor, not to matter the other person's expense, but you make your own expense is actually quite helpful because humor is another one of those things that actually forces a person, mentally, to see the point of a joke. You have to see what kind of psychological particularity that person is in.

So, being simple, not ever trying to see very much, it was actually complicated, but focusing on mental states in the here and now. And that combination of non-being, non-threatening, being really genuinely interested in the person's state of mind makes them feel a little bit more reliably that they are a person whose thoughts and feelings matter. And once they start respecting their own thoughts and feelings, they inherently start respecting those of others as well.