The Ailment

T. F. Main

  • This classic paper was written by Tom Main in 1957. Main, who worked at the Cassell Hospital in Richmond, South West London, for 30 years, set up a twice-weekly work discussion group after a number of staff began to show signs of stress. Its purpose was to make a retrospective study of those patients whose treatment could be considered a serious failure. What emerged was that each of these individuals had managed to form a “special” relationship with a member of staff. Over time, the group came to recognise how this had happened, and to understand better the evasions and distortions in their team working that had led to this situation developing.

The difficult patient

Hinshelwood RD

  • In this paper, Hinshelwood (Professor of Psychoanalysis at the Centre for Psycho-analytic Studies, University of Essex) argues that staff dealing with “difficult patients” retreat from their inevitable but uncomfortable emotional responses into an objectified stance that can mask their significance. He explores how, in fact, these feelings can provide important information about such patients, if we can face up to thinking about them.

The dreaded and dreading patient and therapist

Carine Minne

  • Chapter by Carine Minne in Psychic Assaults and Frightened Clinicians: Countertransference in Forensic Settings edired by John Gordon and Gabriel Kirtchuk.

The Future of Quality in Healthcare Provision and the role of the Peer ReviewProcess: Quality Networks

Gilluley, P., Tucker, S., & Hillier, B.

  • In this paper the authors discuss the history, motivation and policy development behind the quality agenda in healthcare, and summarise the challenges and current work on developing quality standards and indicators. They review the development of the principle of peer review of services and finally, they use the example of the Quality Network for Forensic Mental Health Services to explain how the Quality Network concept can be used to benchmark quality on a national level and lead to improvements in services.

The inpatient treatment of personality-disordered offenders: multidisciplinary successes and tensions

Taylor, C

  • This article was published in the International Journal of Applied Psychoanalytic Studies 12(2): 122-133.

    It is available through the Wiley Online Library.


The Mask of Sanity

Hervey Cleckley, M.D, Emily, S. Cleckley

  • The Mask of Sanity was written by a physician called Hervey Cleckley, and was first published in 1941. It is a classic text describing Cleckley’s clinical observations from interviews he undertook with prison inmates who were considered to be psychopaths. The “mask” he refers to in the title is the semblance of normality, even charm, he believed these individuals were able to assume, despite their fundamental lack of inner emotions.

The Psychotic Wavelength: A Psychoanalytic Perspective for Psychiatry

Richard Lucas

  • The Psychotic Wavelength provides a psychoanalytical framework for clinicians to use in everyday general psychiatric practice and discusses how psychoanalytic ideas can be of great value when used in the treatment of seriously disturbed and disturbing psychiatric patients with psychoses, including both schizophrenia and the affective disorders. 

The Response Aroused by the Psychopath

Neville Symington

  • What do we mean by 'psychopath'? We need to know this before we can understand the response which he arouses. The term 'psychopath' or 'psychopathic' covers a wide range of observable phenomena but there is one common denominator: the overriding determination to attain certain goals, and these by flouting the values which the society holds sacred. This was a point made succinctly by Edward Glover (1960): 'Moral obliquity is in fact the hallmark of the psychopaths who engage the attention of the courts.'

The Therapeutic Milieu Under Fire: Security and Insecurity in Forensic Mental Health

John Adlam

  • This book offers fresh, original and stimulating approaches to engagement with individuals who have been multiply excluded from society and who present challenges to traditional psychiatric models of assessment and treatment. 

The Violent True Believer as a "Lone Wolf" - Psychoanalytic Perspectives on Terrorism

Meloy, J.R. & Yakeley, J.

  • The existing research on lone wolf terrorists and case experience are reviewed and interpreted through the lens of psychoanalytic theory.

Toxic Couples: The Psychology of Domestic Violence

Anna Motz

  • Domestic violence is a major public health concern, affecting millions worldwide. It is underreported, often devastating and sometimes ends in murder. In Toxic Couples: The Psychology of Domestic Violence, Anna Motz integrates psychological and criminological data with clinical illustrations and discussion of current high-profile cases.

Treating the untreatable: The evolution of a psychoanalytically informed service for antisocial personality disorder

Jessica Yakeley

  • Jessica Yakeley's article appears in Contemporary Developments in Adult and Young Adult Therapy: The Work of Tavistock and Portman Clinics: Vol 1.


Treatment continuity in discontinuous worlds

Carine Minne

  • This chapter by Carine Minne appears in Contemporary Developments in Adult and Young Adult Therapy: The Work of the Tavistock and Portman Clinics: Volume 1 edited by Alessandra Lemma.

Understanding Dunblane and other massacres: forensic studies of homicide, paedophilia and anorexia - an extended book review

Celia Taylor

  • This extended book review appears in Psychodynamic Practice 20 (2): 164-169. 

Understanding self-injury: Psychoanalytical approaches to understanding self-injury

Richard Curen and Pauline Heslop

  • This chapter by Richard Curen and Pauline Heslop on psychoanalytical approaches to understanding self-injury can be found in the book: Understanding and Working with People with Learning Disabilities Who Self-injure edited by Pauline Heslop and Andrew Lovell. Adopting a predominantly psychological approach, the book provides carers with up-to-date information and resources to provide appropriately individualised care to people with learning disabilities who self-injure.

Understanding violence: Does psychoanalytic thinking matter?

Meloy, J.R. & Yakeley, J.

  • A coherent psychoanalytic theory of violence has been hindered by the very few psychoanalysts who have actually worked with violent patients, by political allegiance to certain psychoanalytic schools of thought, a naïve belief that all violence is typically not intentional, but rather a problem of impulse control, and the lack of understanding of recent neurobiological findings concerning aggression. Although intensive psychoanalytic treatment is usually not appropriate for violent individuals, the authors assert that a comprehensive understanding of violent behavior from a psychoanalytic perspective is of relevance for all mental health practitioners interested in the nature of human aggression. 

Use of the HoNOS-LD in identifying domains of change

Hillier, B., Wright, L. & Hassiotis, A.


    The aim of the work was to analyse clinical outcome indicator data from the Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) in adults with intellectual disability admitted to mental health wards during a 19-month period; and to identify clinically relevant domains of change associated with in-patient admission. 

Violence to body and mind: treating patients who have killed

Carine Minne

  • This is a chapter in Agression: From Fantasy to Action edited by Paul Williams.

Violence to body and mind: treating patients who have killed

Carine Minne

  • This chapter by Carine Minne appears in the book Aggression: From Fantasy to Action. The book is a result of the 2nd International Psychoanalytic Conference: "Aggression: From Fantasy to Action", held in May 2010.

Violence to body and mind; infanticide or suicide

Carine Minne

  • Chapter in Relating to Self-Harm and Suicide edited by Briggs, Lemma and Crouch.

Violence, abuse and disabled people: learning-disabled adults and children

Richard Curen and Valerie Sinason

  • Richard Curen and Valerie Sinason's chapter on Violence, abuse and disabled people: learning-disabled adults and children appears in 'Domestic and Sexual Violence and Abuse: Tackling the health and mental health effects' edited by Catherine Itzen, Ann Taket and Sarah Barter-Godfrey.

Violence: Reflections on our Deadliest Epidemic

James Gilligan

  • Part of the Forensic Focus series, James Gilligan focuses on how feelings of shame cause violent and vengeful behaviour, argues that conventional punitive legal and penal systems which are based on notions of justice and retribution perpetuate violent behaviour. This ground-breaking book is a read for everyone touched by violence, all those who are working to prevent it and its consequences.

What About Me? The Struggle for Identity in a Market-based Society

Paul Verhaeghe

  • According to current thinking, anyone who fails to succeed must have something wrong with them. The pressure to achieve and be happy is taking a heavy toll, resulting in a warped view of the self, disorientation, and despair. People are lonelier than ever before. Today's pay-for-performance mentality is turning institutions such as schools, universities, and hospitals into businesses - even individuals are being made to think of themselves as one-person enterprises. Love is increasingly hard to find, and we struggle to lead meaningful lives. In *What about Me?*, Paul Verhaeghe's main concern is how social change has led to this psychic crisis and altered the way we think about ourselves.

Working with violence - a contemporary psychoanalytic approach

Jessica Yakeley

  • It has become an urgent priority to tackle the problem of violence. But in an age preoccupied with public protection and risk, violent behaviour is more likely to provoke a punitive response than any attempt to understand and address its root causes. 

    Drawing on the field of psychoanalysis and the expanding discipline of forensic psychotherapy, this book offers a strong conceptual framework for understanding the motivations and dynamics that underlie violent behaviour in adults. 

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