When the murderous fantasy is fulfilled: Transference and countertransference in psychotherapy with patients who committed murder in a state of psychosis

• In Event: Homicide and violent crime: Risk factors and weapon use

Abstract

Research shows that, as compared to the general population, people with schizophrenia are at an increased risk of being convicted of murder. While research and theoretical debate regarding individual psychotherapy for those suffering from psychotic states exists, there is no specific frame of reference regarding transference and countertransference in patients that commit murder in a state of psychosis. The present study strives to fill this gap, by addressing the subjective experiences of both patients who committed murder while in a psychotic state, and of their therapists in long-term psychodynamic therapy. The study was conducted within a qualitative-phenomenological framework, using a purposeful sample. To trace the characteristics of transference and countertransference, we sampled therapist-patient pairs: 31 participants were interviewed, 17 patients and 14 therapists, including 15 therapist-patient dyads The patients that participated were all men, who were hospitalized in several psychiatric hospitals after having committed murder while in a psychotic state, and were therefore found not guilty of first-degree murder or imprisoned. The patients had been treated in psychodynamic psychotherapy, for at least a year. Study results showed four themes: Aggression and its place in the therapy; Projective identification, during which the therapists felt “attacks on linking” and experiences that they were "going crazy"; Transference and countertransference; Therapy as a possibility of repair. It was striking that the subject of aggression remained outside the therapeutic discourse. We suggest that this is because of the characteristics of the transference and countertransference, their intensity, and the nature of the way that murder limits the space for aggressive fantasies. The importance of the study is in deepening theoretical understanding regarding psychotherapy among this unique patient population which can help therapists in understanding unconscious dynamics between the therapist and patient, and increase the effectiveness of the therapy for the patients.

Authors

• Hanny Farkash, Bar ilan University

• Prof. Yael Idisis, Bar ilan University

• Prof. Sophie D. Walsh, Bar ilan University