Editors:
ISSN 1025-9740
Welcome to this bumper New Year edition of the revamped IAFP newsletter. Chris and I are delighted to be taking on the job of editing the newsletter and invite you to submit contributions, comments, correspondence etc. This edition is large by way of catching up on the news and changes that have been going on in IAFP over the last year or so, but we hope to keep up a lively involvement of IAFP members in the newsletter and have plans to develop some other regular features such as a correspondence column and a book review section (read on for more information). We also welcome contributions in languages other than English.
In this edition we have tried to provide an introduction to IAFP
by way of autobiographical notes from members of the executive
council and information about the running of IAFP. A number of
positions on the council are up for reelection and some must change
according to the constitution so as you read this you should be
thinking about whether you should be standing or whether someone
you know should be nominated. Precise details will be in the next
Newsletter. The business meeting at the Conference in Ulm (26th-28th
April, 1996, see below) will address these and other issues about
the methods and directions of the IAFP but start thinking now.
Also in this issue we give information about the best ways to
contact us and to submit articles and letters. But first, a note
from the President about the origins of IAFP and how to join.
Jo-anne Carlyle & Chris Evans
The International Association for Forensic Psychotherapy was founded in Leuven, Belgium in 1991 to promote and encourage professionals working psychotherapeutically with offenders. It also aims to promote education and encourage research in this area.
If you are not a member and are keen to join, or if you are a member whose dues have lapsed, then you can renew your affiliation by contacting Jan Cosby or Tegwyn Williams at the address below:
Caswell Clinic,The first task performed after assuming office was the installation of Estela Welldon as Honorary President for Life of our Association. The decision was taken unanimously by the membership and greeted with warm applause. The honour was richly deserved. Estela not only laid the foundation for our Association by the now legendary European Conferences at the Portman Clinic, but she also transformed this worthy enterprise in 1991 in Leuven into the founding of the Association. International Conferences were held in 1992 and 1993 in London, in 1994 in the Hague and this year in Glasgow. All during that time she gave inspiring leadership to our fledgling organisation. We can all be congratulated that her manifold talents can be retained by her new position because we need them!
Our Association faces in the coming years the vital task of consolidating the important gains made in the first four years. There is an enthusiastic, well motivated membership from all over the world. The Annual Meetings are well attended with a hard core of faithful participants. The scientific discussion is of high quality and all areas of psychotherapeutic endeavour are presented.
All these good things should, however, not lead to complacency. On the contrary, a firm basis should now be constructed from which the Association can safely chart its future course. That is the immediate task ahead of us.
In practice, this means that first of all there should be a firm administrative base in the Association. Following the approved proposals of our newly reappointed Secretary General in the Annual Business Meeting in Glasgow, it is with considerable pleasure that now can be announced the appointment of Mrs. Jan Cosby as Administrator of the Association. The appointment was made during a working visit to the Secretary's office in the Caswell Clinic in Bridgend, mid-Glamorgan in Wales. Mrs. Cosby works under the leadership of our Secretary General, will be in charge of all the administrative work of the Association and will serve as a central information point for the membership.
The Fifth International Conference will now definitely be held from April 26 until April 28, 1996, in Ulm, Germany. The Chairman of the Organising Committee, Dr Friedemann Pfäfflin, has already started preparations. The title of the Conference will be: "Freedom and Coercion: Forensic Psychotherapy under Scrutiny"!
Future conference sites:
1997 London
1998 Denmark
Prof. Bart N. W. de Smit, July 1995
Many old members will know a little about the people currently serving on the executive council, particularly as a number of them are founder members of IAFP, or have been involved in the organisation from its infancy. However, we thought that it would be useful to welcome new members by doing some introductions.
Bart de Smit, England
Estela Welldon, England
Tegwyn Williams, Wales
Christopher Cordess, England
Friedemann Pfäfflin, Germany
Peter Gottlieb, Denmark
Abe Halpern, USA
John Young, USA
Stephen Freiberg, Australia
Ingrid Thompson, Canada
Enda Dooley, Ireland
Sandra Grant, England
Some of these positions are up for re-election so if you feel like getting more involved in the organisation, now is your chance.
Bart de Smit
Prof. Dr. Bart N.W. de Smit is Emeritus Professor of Forensic Psychiatry of the Vrije University of Amsterdam and former Psychiatric Advisor of the Ministry of Justice in the Netherlands. Since his retirement he has lived in London. He is a founding member of the IAFP and was chairman of the organising committee of the 1994 Congress of the IAFP in the Hague, Netherlands. Currently he is President of the IAFP and was inaugurated as such in May of 1995 for a two year period.
His hope for IAFP is that it will continue to develop as a sophisticated professional international body aimed at the clinical and research identity of forensic psychotherapy within the context of the criminal justice system.
Estela Welldon
Estela Welldon was the founder of the International Association for Forensic Psychotherapy in 1991 and is President for life. She designed the first course on Forensic Psychotherapy and is its Course Director. The Course was initially run under the auspices of the British Postgraduate Medical Foundation, and now leads to a University College, London (University of London) Diploma. She is a pioneer in the application of Group Analysis and Social and Sexual Deviancy and is the author of Mother, Madonna, Whore. Through the IAFP she would very much like to realise the fair treatment of offenders world-wide, with preventative action based on the psychodynamic understanding of delinquent criminal behaviour, and the ending of the institutionalisation of perversion.
Tegwyn Williams
I work as a Consultant Forensic Psychiatrist in a newly established secure unit in South Wales dealing mostly with the severely mentally ill offender and, after a period of training at the Portman Clinic, consider myself to be an educated amateur in Forensic Psychotherapy. I was a founder member of the Association and have been secretary since 1992. I would like the Association to be at the forefront of developing and evaluating therapeutic strategies with mentally abnormal offenders in all settings including prisons, hospitals and the community. To this end I would like to encourage the Association to multi professional and multi agency membership and ownership of the necessary skills both to work with this client group and develop an organisation such as ours.
Christopher Cordess
Dr Christopher Cordess has been Consultant Forensic Psychiatrist in London, since 1986, and is an associate member of the British Psychoanalytical Society. He has published chapters and papers on Forensic Psychiatry and is co-editor (with Murray Cox) of Forensic Psychiatry: Crime, Psychodynamics and the Offender Patient, published by Jessica Kingsley Publishers.
Friedmann Pfäfflin
PD Dr. med. Friedmann Pfäfflin, Psychiatrist and Psychoanalyst. 1978-1992 Dept. of Sex Research, Psychiatric University Clinic, Hamburg. Since 1992, Dept. of Psychotherapy, Ulm University, Ulm. Head of workunit Forensic Psychotherapy. Hopes for IAFP in 1996: A good annual conference April 26-28, 1996 in Ulm with a great audience and an emphasis on research to structure future work in this important field.
Peter Gottlieb
I work as the head consultant for a forensic psychiatric unit with 60 beds and 60 outpatients, offering psychiatric services for the most seriously disturbed criminal and psychiatric patients from Copenhagen with Court mandated orders of treatment.
By now I have some 10 years of practice in the evaluation for the courts and treatment of offender patients.
My background of dynamic training - obtained mainly in group therapy - is a great help in clinical as well as administrative matters.
I find it important that the IAFP will be able to keep and strengthen the link to general psychotherapy and at the same time further develop and outline the forensic specialty. I hope to be able to host the 1998 conference in Copenhagen appropriately.
John L Young
Dr Young is an attending psychiatrist at the Whiting Forensic Institute, a maximum security facility under the mental health department of the state of Connecticut. He is also an associate clinical professor of psychiatry at Yale University School of Medicine. He primarily works directly with insanity acquittees and collaborates on related clinical research. His broader interests include issues that involve religion as well as law and psychiatry.
My major hope for the IAFP is that it continue to foster excellence in education, research and practice of forensic psychotherapy by encouraging collaboration and fellowship.
Stephen Freiberg
Dr. Stephen Freiberg is a consultant psychiatrist and psychotherapist working in Sydney, Australia. He did his psychiatry and forensic psychiatry training in Sydney while working with the Prison Medical Service of New South Wales for many years.
He completed his senior registrar training with a dissertation on individual psychotherapy with male prisoners. He is a founding member of the IAFP and has been on the International Advisory Council of the IAFP for several years.
He currently works in full-time private practice in Sydney. He is also on the International Editorial Board of the American Journal of Psychotherapy.
Ingrid Thompson
Ingrid Thompson, Ph.D. (Cantab.). I am a professor at the McGill School of Social Work, McGill University where I teach courses in clinical criminology, and child sexual abuse. For many years I have also been at the McGill Clinic in Forensic Psychiatry, an out-patient service for adult offenders and the first of its kind in Canada. At the clinic I do research, see patients and conduct clinical supervision of social work students. I was very pleased when the IAFP was formed as I felt it would respond to an important and unmet need for practitioners doing clinical work with offenders; namely to meet and discuss the issues that arise from working with this particular population. I see the IAFP as an important resource to provide support for forensic clinicians and to develop the field to its fullest potential.
Enda Dooley
Presently Director of Prison Medical Services in the republic of Ireland. Trained in Forensic Psychiatry at the Maudsley Hospital and was Consultant at Broadmoor Hospital prior to taking up present position in 1990. I am particularly interested in therapeutic strategies aimed at addressing the problem of personality disorder in the prison situation. Given the legal and professional ambivalence over the issue of personality disorder (related violent or criminal behaviour) and its management it is likely that this group will be increasingly incarcerated in prison. I would like to see IAFP giving consideration to theoretical and practical aspects of the management of this group, in particular the matter of recognised standards of therapist competence.
Sandra Grant
Dr Sandra Grant has been a Consultant Psychotherapist since 1979, and over this period has been influential nationally in developing the specialty via the Royal College of Psychiatrists and Joint Committee on Higher Psychiatric Training. She has served on the Council for the Association for Psychoanalytical Psychotherapy in the NHS and is a training analyst with the Scottish Association of Psychoanalytical Psychotherapists. Over the last five years she has become involved in management, currently holding the post of Clinical Director of Adult Community Mental Health Services across Glasgow. This has fostered her interest in psychotherapeutic work with a more disturbed client group. She would hopefully see the IAFP continue to provide a professional forum for learning and to lobby the development of the specialty. Her main goal would be to increase the shared learning with those working within the criminal justice system at all levels.
As we said in the editorial, some posts are now up for election,
contested or uncontested, with or without re-election as an option.
Precise details are available from: Tegwyn Williams,
IAFP Secretary,
Caswell Clinic,
Glanrhyd Hospital,
Bridgend,
mid-Glamorgan,
CF31 4LN
UK
'fax: (0|44) 1656 662157
The full information will be published in the next issue of the
Newsletter prior to the conference in Ulm. Which brings us nicely
to the next item.
The conference has been organised by Friedmann Pfäfflin and Reinmar du Bois and will be held with the hospitality of the Forensic Psychotherapy Section in the Department of Psychotherapy in the University of Ulm. The title of the conference is:
International Association for Forensic Psychotherapy
5th Annual Meeting
April 26-28, 1996
Chairs:
We have heard a rumour that the "Theatre of Reflections" successful performance of Thursday's Child in London, starring IAFP member and dramatherapist, Jessica Williams-Saunders, may be coming to Ulm. We'll Keep you informed!
The ATC is an organisation offering resources and support to staff of all levels and disciplines working in therapeutic communities, using a therapeutic community approach or attempting to develop a therapeutic environment. The membership advantages include:
According to the Autumn 1995 issue of the A.T.C. newsletter, the A.T.C. is having a membership drive and is willing to send interested people a free copy of the Newsletter together with information on the A.T.C. and a membership application form.
The contact information is:
A.T.C. Office,There's more information about the ATC including the journal contents
and full text of the newsletter on the Internet at the address
shown on the left of this page. There's more about the Internet
and the IAFP's presence on it in an article on page 14, but now,
from next year's conference to last year's conference.
Chris Evans
There was a very successful annual conference in Glasgow in May, in the beautiful setting of the Burrell Collection in Pollock Park. The theme of the meeting was Violence and Death. The conference consolidated the range of the interests of the association with a symposium on research and a symposium on the Arts Psychotherapies. We hope to publish the text of the founder's lectures in the Newsletter and are delighted to print Pat Galley's fascinating lecture below. This paper was particularly innovative in its bridging of Attachment theory and classical analytic understandings of severe psychopathology. Read on.....
It is obvious that the final outcome of violence is death, but today, I want to examine the connection between the fear of death as the ultimate innate anxiety, causing both severe psychopathology and violent, destructive behaviour.
Freud gave a somewhat secondary place to the self preservative instincts in terms of the origins of anxiety and the development of psycho-pathology. In his concept of the death instinct however, he implicitly acknowledges something which he had earlier denied, namely that individuals have an innate knowledge of death. The Nirvana principle, which he held explains the death instinct, is a kind of psychic entropy, a sense of inertia at the thought of the effort required to transcend a full lifespan. Such an inertia would be impossible without the awareness of a span of life to be traversed, so in postulating the death instinct Freud accepted that human beings have, at some level, a knowledge that their life will terminate. However, as you know, Freud saw the origins of aggression as a conflict between the life and death instincts and the fear of death plays little part in his thinking except, rather half heartedly, in his later formulation of signal anxiety.
Melanie Klein's position was more complex for, although she postulates that the main source of anxiety is a fear of aggression and annihilation of the ego from within, this aggression is essentially linked with frustration, separation anxiety and unconscious envy. Separation anxiety must of course be connected with the fear of death within the individual since, particularly at early stages of development, the presence of the mother to feed and love the infant is essential for its survival and early sustained neglect leads to death. The psychic consequences of this reality is peculiarly absent in the writings of psycho analysts, with the exception of Bowlby who connected anxiety primarily with over long separation and deprivation. He failed however, to develop a satisfactory psychotherapeutic working model based on his ideas based on extensive observation of children's behaviour.
I have become increasingly inclined to the view that the instinct of self preservation represented by the flight and fight response common to most animals, has in humans a mental representation that is central to the development of psycho pathology of all kinds, including psychosis and destructive, violent behaviour.
Having had a traditional Kleinian training, I was particularly interested in Bion's views on linking, both his concept of projective identification as a means of communication, and his theories on thinking. Some years ago I noticed that a patient of mine, who was both traumatised and very envious, appeared to make attacks on his own linking functions as well as those of the object. For instance, he had strong negative therapeutic reactions if he noticed anything that might gratify or reward him and he seemed to hate my efforts to be on the lookout for ways of understanding him. He was rather violent in the clinical situation and anything that stuck out, such as light switches, the handle on the lavatory or handles on doors, evoked his violence so that he was constantly smashing and breaking them. I eventually had to give up treating him in my consulting room at home. I saw him for a while at the Portman Clinic. One of his first acts of demolition there was to put his foot under the mantle of a rather lovely old fireplace and heave it off from his position on the couch. From an analysis of this type of behaviour and of his dreams, I postulated a function of his ego that I termed prospective linking. This term described his own ego's first step in the linking process with his object which he constantly needed to attack. At that time linking functions of the self derived in Kleinian theory from an introjective identification of the good object. Bion saw the linking functions of the primitive self as due to a successful introjective identification with the primitive breast or penis. Over the years I have come to reject this point of view since it fails to explain how introjective identification, if it be the primary form of linking, can get started in the first place. If the mechanism is dependent on itself for its own initial functioning then it would never become established.
I also find it unsatisfactory to postulate omnipotent phantasy as a basis for the development of mental health and ego integration. Prospective activity, that is searching for the object of need, is clearly an innate drive which develops into complex learned patterns of behaviour in the initiation of dependent and interdependent activity. It represents a specific form of instinctual linking activity which has a mental representation in primary fantasy.
From clinical studies I have identified three such basic linking functions which are, I suggest, present innately both in the infant and in the nurturing environment as biological real requirements. The nurturing environment will be mainly the mother but include important paternal functions as well. In my view the infant's dependency needs are represented by specific serial requirements of attachment to the mother and that these specific requirements have to be reflected by parallel ones in the mother herself. Successful reciprocal linking activity will establish a knowledge of an independent self in a safe dependent relationship with a caring object and I have called this process primary identification.
Primary identification from this standpoint, reflects Kohut's work on the discovery of the self. However in my model it also establishes a conceptual internal duality of a self in a dependent relationship with a dependable separate object. The link between the two is experienced as essential. and vital. It forms the basis for love and beauty. When it is threatened then the most intense anxiety of death from within is the result.
Successful completion of primary identification of self and object lays the foundation for a capacity to develop a repertoire of symbols that combine as secondary phantasies. These reinforce independence by developing links with the external world but carry in health the vital internal dependent link. They lead eventually to the capacity for conscious imagination and for cognitive thinking. I follow Segal in her views on symbol formation, in which she points out that symbols, which form the basis for thinking and imagination, construct a link between the self and the object so that separateness is a sine qua non for their formation. She suggested that the obliteration of the difference between self and other caused by projective identification results in a failure in normal symbol formation and produces concrete symbolic equivalents of a kind found in psychotic thinking. This view of course is incompatible with Bion's theories on the development of thinking, which rely on a form of projective identification in which the infant utilises the mother's capacity for managing anxiety and for thinking in the absence of its own equivalent capacity.
It is quite untenable to use the same mechanism to explain the development of thought disorder on the one hand and the development of normal thinking on the other. Donald Meltzer, a follower of Bion's ideas, tried to marry the two points of view in a later paper, evoking the notion of a "sticky" or "non sticky" type of projective identification, the first producing concrete symbols the second obeying Bion's ideas. This type of tampering with theories in an endeavour to get around inherent contradictions is really not legitimate and only gives psycho analytic theory making a bad name. Segal has addressed the contradiction more thoughtfully. She seems to feel she can incorporate Bion's use of the mechanism as a normal stage in the development of symbols by suggesting this can occur within a mental space in the object experienced as a container. She nevertheless is clearly uneasy at the loss of the self caused by the confusion of identity that projective identification by definition indicates. Her thinking, to my mind, does not really resolve the contradiction.
I have examined this contradiction in more detail elsewhere, but I mention it now because it seems to me that the enormous importance of projective identification as a core pathology in so much mental ill health has been considerably weakened by its use as an essential mechanism for the development of healthy functions, so that the distinction between pathological and non pathological states of mind has become very blurred. In fact Bion's theories on projective identification are a logical extension of Klein's idea that introjective identification forms the basis for early ego coherence. Both projective and introjective identification are of course omnipotent phantasies and in following Segal I would argue that it is not possible to have a secondary fantasy, omnipotent or otherwise, until the self has been discovered and conceptualised as a separate entity in the same way as Bion visualised the good object being conceptualised through progressive realisations of a caring breast.
Within my model of development, three vital functions have to operate sequentially and reciprocally between the infant and the nurturing environment for the primary identification of the dependent self and dependable other to be conceptualised.
The first of these functions, prospective linking, I have already mentioned. It can be seen behaviourally in early infancy when babies turn their heads searching for the breast and in mothers who become alert and wakeful, even from deep sleep, at the first stirrings of the child wanting to be held and fed long before it begins crying. Prospective linking is therefore importantly connected with sight and sound and, when successful, results in a self which is optimistic, explorative, curious and alert. When damaged or impoverished then impotence, voyeurism, exhibitionism, a fear of evil eyes, a dread of being seen or a sense of a meaningless existence are some of the resultants.
The second linking function I term holding on. In the infant it is represented by oral grasping and sucking of the nipple, by the grasp reflex and behaviour such as holding out both arms to be lifted and held. In the mother and father, it is reflected in the need to pick up and hold the and, of course, to place the nipple in its mouth. Holding functions give a sense of a psychic and physical skin, the importance of which was stressed by Esther Bick in her work with psychotic patients. It helps establish the sense of separateness, which prospective function presages and confirms the optimism of prospective activity by defining the self and its boundaries and confirming the reality of the dependable object. When it fails, then body image suffers in direct proportion to the severity of the deprivation. There is a lack of belief in the coherence of the self which either feels fragmented or trapped within another object. The rage and fear connected with a poverty in holding on functions can lead to a need to break and enter objects psychologically or actually, with fantasies of violent penetration or their equivalents in such criminal behaviours as rape, burglary and violent assault.
The final linking function in my series, I call substantive linking. This involves the exchange of warmth, of love and nourishment, both physical and emotional. It results in a realisation of the self and the object as full of goodness and dependency as a blissful exchange of good things. Both the reduction in anxiety and the sense of fulfilment that substantive linking brings to both parties confirms and re-confirms at each experience the most profound sense of goodness in inter-dependent relating and the uniqueness of oneself and others. Its disruption will result in a belief in the badness and valuelessness of the self and others or, at worst, a complete failure in a sense of humanity. The awful feelings of emptiness and impoverishment that lie behind the manic defences of so many criminals often mean that they cannot value their own or others' lives. The killing or maiming of others or the senseless destruction of their own bodies and brains with alcohol and drugs often reflects the severe failure of substantive experiences. I have treated criminals who experience themselves as animal-like, or full of violent fire that threatens to consume them and others. They have a poor capacity to dream but their nights are full of images of blood, mutilation or fierce flames.
The complete failure in all the series of linking functions will result in a primitive autism, in which the self will fail to be conceptualised and will remain in a state of confusion with the failed nurturing object. No secondary fantasies can result from this situation so the self is not only lacking in awareness of its own identity but has no capacity to develop secondary phantasies, and cannot therefore use defences to manage fear and frustration, cannot, for instance, split or use projective identification and will remain trapped in a state of near death, confusion, terror and rage. If the nurturing environment continues to fail for long enough then an autistic child will result. More commonly, however, the mother will begin to function better, perhaps after a period of post natal depression or early difficulties, and then primary linking can begin. However, if the delay has been sufficiently prolonged then the primary autistic state of mind will be split from the rest of the ego, directly the self has been conceptualised by the arrival of healthier linking functions. There is insufficient time to look at the various consequences of this, but I have become increasingly interested in the discovery of such areas of encapsulated primitive autism, which represent a vulnerability to catastrophe, both psychologically and behaviourally in individuals who may otherwise appear normal. The failure of the encapsulation will result in violent catastrophic behaviour if the ego is overwhelmed by the autistic anxiety. If the more healthy ego can preserve secondary fantasy then a psychotic state of mind with progressive splitting and projective identification or flights into grandiose manic phantasy will result. The sudden eruption of homicidal violence in some depressive states or the escalation of sadism or mutilatory behaviour in previously fairly passive sexual deviants are two examples of the eruption of encapsulated areas of primary autism.
The fear and violence of these states of mind represents, in my view, the ultimate anxiety that lies at the root of all psychopathology, namely that the self will not come properly alive or, secondary to that, will fail to sustain itself as an independent entity in a safe internal relationship with a life sustaining object. There are two sources of failure in early linking which lead to the primary anxiety of death. The first is failure on the part of the environment, and the second weakness is in the instinct for attachment in the self due to some innate deficit in dependent functions. The latter, which results in a poverty of linking activity on the part of the infant represents the death instinct as described by Freud and Klein. It is not therefore an instinct at all but the absence of instinctual components in essential areas of the drive for attachment and dependency. It leads to fear, envy, hatred or violence and is always terribly difficult to distinguish from failures on the part of the environment. In fact of course passive activity in the infant will lead inevitably to the lack of response in the mother who is liable to confuse the infant's passivity for contentment. It may be that some cot deaths result from such deficits.
The effects on secondary fantasy of varying degrees of failure in the reciprocal linking functions result from deficits in primary identification and produce a whole range of aberrations in secondary phantasies. In analytic work, both with offenders and non offenders, I am on the lookout for fantasies which indicate problems in specific linking functions and try to analyse them accordingly. Connections between criminal destructive behaviour and historical trauma can be discovered in the transference in some detail by keeping in mind this process of early linking, of discovery of the self and the good object and the consequences of the failure of these early functions of attachment. I have been particularly interested in trying to understand disorders of thought in terms of the success or failure in the early linking activity. Patients' inability to use logical connectives or inability to conceptualise an existential quantifier can often be understood in terms of specific failures in the three functions that complete the process of primary identification.
If one considers the prolonged and crippling effect of severe post traumatic stress disorder in adults, then one can begin to understand much more convincingly why the psychopathology connected with early life threatening experiences is so intractable. Such life threatening experiences need not be violent or actively abusive, although indeed they may be, but simply threaten the infant's endeavours to establish itself in its own life so that the closeness of death will invade the inchoate self before it has even developed a capacity to buffer such trauma by using its own imagination. It always seems strange to me how infants and children are expected to get over things without any fuss. Of course, it is only recently that the effects of life threatening experiences in adults have been taken seriously, and seen as capable of leading to mental disorder. For a long time post traumatic stress disorder had been equated with some kind of moral weakness. The fear that universally results from severe life threatening or cruel experiences can give us some picture of what the early self must be up against when encountering neglect, abuse or outright violence within an environment in which it is entirely unable to escape and in which its desperate need for caring attachment can be so appallingly denied.
I thought I would end with a clinical example to give a bit more meaning to what I am conscious is a very theoretical paper. It comes from a young man, miserable and socially paralysed, exhibiting what many physicians would diagnose as a depressive illness in a massively over controlled personality.
Highly intelligent, but almost incapable of social relating, he lived in a world of fear of others and a sense of self depreciation and unaccountable violence within himself. His mother, a dilettante psychotic absorbed in fashionable fads, undoubtedly responded in a strange way to his infantile needs. His father, an academic priest, wallowing in narcissistic self righteousness, was remote and shadowy and his disturbed sisters vindictive and mocking. For a long time in analysis he was silent, apologetic and almost devoid of associations, but gradually his confusion and fear began to emerge. They were finally conveyed more fully in a dream in which he experienced himself as trapped in a kind of dome shaped structure from which, nevertheless, he could see around him. What he saw was a ghastly scene in which some Japanese soldiers appeared to be skinning a woman alive and drinking her blood. As he watched however, he thought perhaps it was the other way around and that the woman was doing it to the soldiers. I won't attempt to bring his associations, but I believe this was a glimpse of his encapsulated autistic self trapped inside the object, looking for a dependable object but seeing only a confused situation in which holding on had become a skinning alive and substantive functions the antithesis of a healthy reality, a death ridden drinking of the vital blood. This patient became much more confident after we reached this point in analysis. He has been able to re-enter University and begin to relate tentatively to others. He has begun to feel less violent, less inhibited and less depressed. I believe he carried the potential for suicide or homicide or some catastrophic piece of behaviour in which his fear, violence and confusion could have erupted in the way one sees, too late, in so many tragic forensic cases.
Behind most violent behaviour lies a fear of self annihilation, through the loss of the primary dependent internal relationship with its life sustaining properties. Life sustaining internal relationships and the increasing atrocities of the High Street, or those horrors in Rwanda or Yugoslavia may seem far removed, but such violence, the appalling rape and pillage, owe more to a fear of annihilation of the self than to any essential badness within undamaged human nature.
Pat Gallwey, April 1995
We are happy to put brief notes about other meetings/conferences etc. that may be of interest to members. Send us your views of events that you have been to.
Groups: Buenos Aires
There was a successful three day Symposium on Group Work and Forensic
Psychotherapy, organised by Estela Welldon, at the 12th Congress
of the International Association of Group Psychotherapy in Buenos
Aires this summer. It included papers in the following areas:
the forensic patient: recognition and voluntary group treatment;
secure units, group treatments and new patterns; training and
research - the European perspective.
Estela Welldon
Groups & systems: Tromsø
Also, Chris and I presented a paper at the 21st International Congress on Law and Mental Health in Tromsø, on "Containing containers: psychodynamics of therapy in secure institutions" which was well received. Although the conference was primarily psychiatric, we had chance to make some good contact with psychotherapists and researchers from Scandinavia and Norway in particular.
Denmark
Peter Gottlieb sent the following about the Danish Association of Forensic Psychiatry:
In May 1995 the Danish Association of Forensic Psychiatry for the first time in its 5 year old history devoted its annual meeting to the subject of forensic psychotherapy. An audience of some 50 psychiatrists attentively listened to the views of Patrick Gallwey on the importance of a solid and resourceful framework if therapeutic work is to be performed at all.
The other presenters were Danish. Psychologist Lars Sorensen presented a theoretical frame for long term therapy of chronically mentally ill offender patients. Senior Registrar Trine Arngrim shared her heavily learnt experience on group therapy with forensic psychiatric inpatients. The group has existed for about one year as a slow open group with about 5 or 6 participants and conducted according to Foulkesian principles. It is still very much alive. Finally, psychologist Birgitte Brun reported on her own therapeutic practice with difficult inpatients at St. Hans Hospital, stressing the necessity of providing a room for the therapy and at the same time be faithful to the interdisciplinary solidarity and teamwork.
In the discussion it was concludingly argued that apart from the
concern of the patients, also the duties of forensic psychiatrists
towards society do necessitate a dynamically therapeutic approach.
Peter Gottlieb
Britain
The Royal College of Psychiatry has recently accepted the training of Forensic Psycho-therapy and posts of Senior Registrars will spend 2 years in Forensic Psychiatry and 2 years in Psychotherapy. The Portman Clinic was the first to implement such a training.
Dr Sheilagh Davies put forward to the Royal College of Psychiatrists
a proposal for the inclusion of a Section on Forensic Psychotherapy,
as a new discipline for the Millennium. This was accepted and
will be presented at the winter meeting in January 1996.
Estela Welldon
Diploma in Forensic Psychotherapy - Portman Clinic/University College London
In January 1989 the first formal discussions of a course in Forensic Psychotherapy took place in London. The group consisted of representatives of the Portman Clinic; psychoanalysts; child, adolescent and forensic psychiatrists and Dr Estela Welldon. The original course of one years duration started in October 1990, leading to a Certificate in Forensic Psychotherapy. This subsequently became Year I of a two year part time Diploma Course - initially awarded this status by the British Postgraduate Medical Foundation and now by University College Medical School, London.
The course provides special experience in psychotherapeutic work with offenders but does not, in itself, constitute a basic psychotherapy training. The target population for the course is all professionals working with offenders in hospitals; special hospitals; secure units; prisons; probation offices; courts; and the community. This may include people from a range of core professional backgrounds: psychologists; psychiatrists; nurses; social workers and other social service professionals; occupational therapists; arts psychotherapists; probation officers; counsellors; and psychotherapists.
The course structure includes small group supervision; interdisciplinary discussion of practice in a variety of work settings; reading and lectures on theoretical and clinical topics; and personal experience in psychoanalytical psychotherapy.
The syllabus requires an understanding of basic developmental and psychodynamic theories and concepts of individual, group and family psychotherapies and their adaptation to the forensic field. It includes an understanding of basic psychoanalytic techniques, adapted to psychotherapy and to the forensic patient within the community, residential hospital, or prison service establishments. The use of personal therapy as a means of enhancing candidates' abilities to offer therapy is also emphasised.
There is continuous written and supervisory assessment as well as examination by dissertation at the end of each year. Progression from Year I to Year II is not automatic, and students are required to have demonstrated a commitment to the work; an ability to engage patients; an adequate academic standard; a capacity for insight in self assessment; as well as a commitment to personal therapy. Progression to Year II is then by competition.
There was a successful meeting of the Alumni of the Portman Certificate and Diploma in Forensic Psychotherapy. There were a number of papers with plenty of time for thought provoking discussion and also time to meet other Alumni and staff teaching on the course. Speakers from the staff on the course included: Elif Gurisik; Rob Hale; David Morgan and Estela Welldon, and from the Alumni: Jo-anne Carlyle; and Jeremy Resnick.
Complete copies of the background and course prospectus for the
Diploma and the Course Director's report to the Advisory Group
(4th July 1995) are available on the Internet (see overleaf) or
by contacting Estela Welldon at the Portman Clinic:
8 Fitzjohn's Avenue,
London
NW3 5NA
UK
'phone: [+44|1] 171-794 8262
'fax: [+44|1] 171-431 8825
Estela Welldon
Italy
The Department of Psychology of the University of Bologna with
Dr Luisa Brunori at its head, is in the process of founding a
sister course to the Portman Clinic Diploma in Forensic Psychotherapy,
commencing October 1995.
Estela Welldon
Why put the IAFP newsletter and information about the IAFP on the Internet? What does it mean?
The Internet is a collection of interconnected computers. The robust underlying design is basically that all computers pass on any message that isn't for them. The Internet arose from the fear that military communications would be destroyed by radio-frequency pulses from nuclear weapons in a nuclear war. A sprawling web of many military and academic computers obeying the basic rule to pass one messages was thought more likely to survive than strengthening of purely miliatry connections.
The military and educational sectors cohabited surprisingly highly successfully largely by pretending to "mutual invisibility". However, the commercial sector has recently joined these publicity shy lovers with the recognition that the Internet provides wide and cheap access to your data. This "data" can be text, numbers, graphics or any combination of these - anything you can create by putting together zeros and ones according to an agreed code. (Maths theory suggests that there is nothing we can comprehend that can't be represented this way.)
The new military, academic and commercial ménage a trois has flourished with the addition to existing codes and protocols of a code, "HyperText Markup Language", and a protocol which enables computers to exchange this. This development allows me to put this newsletter on a computer in St. George's and make it visible anywhere on the Internet.
This has led to a profusion of information being put on this "World Wide Web". Academics have put up things for other academics. Things I've mounted include the newsletters of: the Society for Psychotherapy Research (UK); the European Council on Eating Disorders; the Association of Therapeutic Communities; and the Cassel Hospital. The military have put up large collections of free software. (The "make-yourself-look-damn-useful-when-they-do-see-you-so-they'll-be-more-likely-to-turn-a-blind-eye-to-evidence-of-your-less-useful-side" exception that I think reinforces my general "mutual invisibility" rule.) Most recently, the commercial sector have put up advertising for a fraction of the cost of any other advertising medium.
What's forensically interesting is that some people, seeing an opportunity, mounted pornographic material and others flocked to look at this and a new porn industry was launched. The apparent anonymity and cheapness revealed some trends: a review notes that someone being prosecuted in the States found that a picture he initially described as depicting "oral sex" was accessed much more often when he changed the description to "choking oral sex". Depictions of bestiality and paedophilia also flourished. Although the actual traffic, as a proportion of that on the Internet, was minute, it is clear that the Internet revealed a very prevalent interest (at least among a broadly male, computer-oriented population) in sado-masochistic and other "perverse" sexuality. This probably doesn't much surprise forensic psychotherapists and it suggests to me that it is timely to have a Forensic Psychotherapy presence on the Internet.
After a while conventional media noticed what was happening and became concerned about the absence of the "top shelf" classification. (It occurs to me this may be a peculiarly British thing: in this country "soft" porn is restricted to the top shelves in newsagents as it is believed firstly that this puts it out of reach of children, and secondly, and perhaps more fantastically, that elieved it makes it less likely to offend non-purchasors. People realised that on the Internet pornographic material would be accessible to any child with an Internet connection and minimal keyboard skills. It was also noticed that increasing numbers of children had Internet access through their school. Once the issue was recognised it also became clear that it would be difficult to police and legislate this with the methods developed for other media.
I hope that mounting the newsletter on the net, minus any bits
that are clearly for the eyes of members only, will help to publicise
the discipline. The address or "URL" of the newsletter
and other IAFP material is to the right of this article. Spread
it around! My existing material gets about 400 visits a week so
this can be a good way to publicise an issue or an organisation.
I'll keep you posted on how this develops.
Chris Evans
We are keen to start a lively book review column in the newsletter. However, we thought that it was important to reflect the fact that IAFP operates at the interface of a number of disciplines: law; psychotherapy; forensic psychology. What we would like to do then is to get seminal books in the field reviewed by a number of people so that we can publish a lawyers view a psychotherapists and also someone from the field of forensic psychology/psychiatry. Suggestions for suitable books welcomed. One of the obvious ones is the recently published tome: "Forensic Psychotherapy: Crime, Psychodynamics and the Offender Patient" Edited By Chris Cordess and Murray Cox. We already have a psychotherapist who has agreed to review it - are there any lawyers or non-psychotherapist forensic practitioners out there, who could provide us with a complementary review? We are trying to get review copies, but can't promise them yet.
Submit articles in your native tongue but our preferred format please!
IAFP is an international organisation and we want to foster this as much as possible by being able to accept contributions in languages other than English and American (they are different after all). Where possible we would try and get submissions translated and have the possibility of getting short articles and letters translated from the Scandinavian languages; Spanish; French; Italian; Welsh; and German. We would of course publish in the original as well. Anybody prepared to help with translation (including the above languages) would be welcomed - please contact us at the address or numbers above.
We've split the access so Email, 'phone & 'fax come to my technology and snailmail goes to the Tavistock for respectability (!). We have no secretarial support so we want to minimise retyping so please 'fax things aligned as straight as possible and in as large a font as possible (14 pt is good) so my computer may be able to recognise the text. Please don't use italics for large pieces of text. If you can supply things by Email or on PC compatible diskette that would be hugely appreciated.
Information for contributors
We are very keen to encourage members to contribute letters, articles, ideas, comments etc. to the newsletter. However, we do this in our own time and do not have secretarial back up, so it would be very helpful if contributions could be submitted in the following ways:
The ideal is Email to the address below. The next best is for things to be sent as Word for Windows or ASCII (that's "DOS text" or "text" in most word processors' options for formats in which to save things). Preferably on a DOS formatted 3½" diskette. Modern Macs should offer the option to format a diskette in DOS format and to save to it. Failing that the best thing is clean, unfolded typescript, double spaced and using a single spaced font (e.g. "courier" or "gothic") if you have a choice. (Yes, that's the sort of font that looks horrid to the eye in these pampered days of fancy word processors. It looks horrible to us now but it's fine for scanning and optical character recognition.) Use a large font, say 12 point, if you have the choice.
Please send them to:
Jo-anne Carlyle
Clinical Psychologist in
Psychoanalytical Psychotherapy
Adult Department
Tavistock Clinic
120 Belsize Lane
LONDON
W3 5BA
U.K.
or to:
Chris Evans
Senior Lecturer in Psychotherapy Psychotherapy Section
St. George's Hospital Medical School Cranmer Terrace
LONDON
SW17 0RE
U.K.
Tel/'fax: (0|44) 181 725 2540
E-Mail: C.Evans@sghms.ac.uk
We are running at the moment with a title of IAFP Newsletter. We are happy to continue as this, but wondered if you wanted an alternative name for the newsletter. Any suggestions will be published and if it seems that people are keen for a new name, then we'll put it to the vote - perhaps at a future conference?
Through Gill McGauley, IAFP has commissioned some professional proposals for possible logos. It has been suggested that the choice be put to the popular vote. The logos are shown in small below and large overleaf so you can judge how they look for different purposes. To vote just tear off the final page and mark your favourite in some unequivocal way and send it to Jan Cosby at the address on that sheet.
Thanks to the sterling (no that was not meant to be a joke about the "Euro" - though it would make conference organisation and collection of dues easier) efforts of Tegwyn Williams who commissioned Rob Buck (Graphic designer and Illustrator), we have a series of designs to choose from for the IAFP logo. The name will be corrected to I.A.forF.P. in the final versions. Voting will probably take place at the conference in Ulm, but if you are not going to be able to make it and want to register a vote, send it to Jan Cosby or Tegwyn Williams at:
Caswell Clinic,
HAPPY NEW YEAR!