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Only then will Frank be able to internalize these changes, build boundaries for himself, and be able to locate and respect those of others. 13. Would you want to involve significant others in the treatment? Would you use out-of-session work (homework) with this patient? What homework would you use? Significant others could be involved in the treatment if Frank felt it would be helpful. However, Frank must be the one to decide. A client with a history of severe trauma will experience the therapist’s unilateral decision to add people to the therapy as a boundary violation.
Relational concepts in psychoanalysis: An integration. Cambridge, MA: Harvard University Press. , & Fine, B. ). (1990). Psychoanalytic terms and concepts. New Haven, CT: American Psychoanalytic Association and Yale University Press. 46 ANTISOCIAL PERSONALITY DISORDER Morrison, Andrew P. (1989). Shame: The underside of narcissism. Hillsdale, NJ: Analytic Press. Roth, Loren H. ). (1987). Clinical treatment of the violent person. New York: Guilford. Russell, Paul L. (1998). The role of paradox in the repetition compulsion.
The purpose of acting out is to discharge intolerable affect. The treatment model indicates that Frank’s acting-out behavior derives primarily from a weak ego (impulsivity) and the need to reduce humiliation, feel in control, and keep people at a distance. If Frank had a relationship with his therapist where he felt accepted, his need to reduce humiliation would subsequently decrease. If he felt respected by his therapist, he would feel more in control to be able to set therapeutic distance where he needed.