@article{ref1,
title="Portrait of a sadist as a young man",
journal="American journal of psychotherapy",
year="1987",
author="Boehnert, C. E.",
volume="41",
number="3",
pages="459-465",
abstract="Treatment of chronically violent patients poses problems for the therapist in a number of ways. Institutional demands, concern for one's personal safety, and psychotic transferences are common. This case details the treatment of one young violent offender.  VioLit summary:   OBJECTIVE: This article by Boehnert described the dilemmas inherent in the treatment of violent offenders within correctional facilities, especially the frequent regressions and episodes of acting out which these offenders often exhibited.  METHODOLOGY: The author employed a non-experimental design by reviewing one of his own case studies of a 17 year old white male, &quot;Henry&quot;, who was a violent offender. Treatment consisted of over 100 counseling sessions during the course of a year.  FINDINGS/DISCUSSION: Henry was raised by borderline retarded, extremely socially impoverished parents, within a family where sociopathy, chemical abuse, and violence were common. He had most recently been accused of the violent battery of a 5 year old. In the initial stages of counseling, Henry viewed it as a means to appease his sentencing judge. However, the author then described the three phases of treatment which suggested progress in Henry's recovery. The main characteristic of phase one was the vacillation between honesty and dishonesty; Henry was honest about his violent tendencies but continued to lie about his relationship with drugs as both a user and seller. At this phase, Henry was honest about his perception that every interaction was a potential threat; the environment was so threatening that in the course of a fight he found it advantageous to brutally beat his opponent, far after submission, so that onlookers would be less likely to attack Henry at a later date. Almost all of Henry's actions presupposed a need to defend himself by being aggressive towards others. While these explorations in phase one were honest, he continued to lie about other things and to use rational arguments to circumvent a particular point being made by the therapist. During phase two the explorations into Henry's perceptions of threat continued, but with this depth also came his fears that he would act out violently in order to avoid dealing with his pain. Shortly after this phase began, Henry did strike out against an officer and was placed in confinement; he felt threatened by his progress because it made him feel vulnerable and uncomfortable. Because of his distress all subsequent counseling sessions occurred where the two could be watched by security personnel through a glass wall. Disclosure continued at this level, but so did Henry's resistance, eventually leading to a 6 week depression and a violent episode followed by 21 days of solitary confinement. During the third and final phase of treatment the author gained more of Henry's trust by objecting to the harshness of Henry's solitary confinement. By siding with Henry and objecting to the decisions of security personnel, the author was seen as an ally. The author referred to this phase of treatment as investment, because Henry took a much more active role in the sessions and became more motivated to explore his issues. During the last four sessions the topic was the termination of their relationship, focusing on whether Henry would be safe enough to cry. During the last session Henry presented a drawing of a hand offering a rose to the onlooker, but did not cry. Although the various phases and the vacillating levels of progress seemed to lead to some progress in Henry's problems with violence and he was not accused in the subsequent two years of violent behavior, he was accused of fondling a young child.  AUTHOR'S RECOMMENDATIONS: The author encouraged a special awareness of the safety of the therapist when dealing with violent offenders. Caution was stressed especially when the offender appeared to be making progress because this advance was almost always marked by retreats as well. Finally, because there were several levels of problems, Henry's treatment may have been successful regarding his attitudes towards violence, but other issues such as sexuality or drugs may have persisted and, argued the author, should be addressed if comprehensive progress was the desired outcome.  (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)  KW  - Male Offender KW  - Male Violence KW  - Male Inmate KW  - Inmate Treatment KW  - Incarcerated KW  - Juvenile Male KW  - Juvenile Offender KW  - Juvenile Violence KW  - Juvenile Treatment KW  - Juvenile Inmate KW  - Correctional Institution Treatment KW  - Inmate Treatment KW  - Offender Treatment KW  - Case Studies KW  - Offender Counseling KW  - Sadism<p /> <p>Language: en</p>",
language="en",
issn="0002-9564",
doi="",
url="http://dx.doi.org/"
}