Psychodynamic approaches to violence

SUMMARYThe assessment and management of violent behaviour in mentally disordered patients are no longer the sole domain of forensic psychiatrists, but are increasingly part of the day-to-day work of all psychiatrists and mental health professionals. Violence risk assessment has become a huge industry, and although the importance of dynamic, as well as actuarial, risk factors is now recognised, a more systematic approach exploring the psychodynamics in the aetiology, assessment and treatment of violent behaviour is often lacking. In this article I revisit some of the key psychodynamic principles and concepts relevant to an understanding of violence, summarising the historical contributions of key psychoanalytic writers on violence and aggression, and exploring the ideas of more contemporary writers working in the field of forensic psychotherapy. A psychodynamic framework for working with violent patients is introduced, focusing on the setting and containment, specific therapeutic interventions and monitoring countertransference reactions.LEARNING OBJECTIVES•Understand historical and contemporary psychoanalytic theories of the aetiology of aggression and violence•Utilise a psychodynamic framework for working with violent patients and offenders•Understand the use of countertransference in the risk assessment and treatment of violenceDECLARATION OF INTERESTNone.