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In the aftermath of the recent episodes of school shootings, the most notorious being the massacre at Columbine High School in Colorado, increased media and medical attention has been focused on violent children. The panel's chair, Judith Chused, reminded the audience that beginning with the seminal work of August Aichhorn, adolescents and younger children who demonstrate dangerous and violent behaviors have long been of interest to psychoanalysts. Chused briefly described her experiences treating young patients who manifest their psychological distress via substance abuse, promiscuity, antisocial behaviors, and physical violence. She stressed the difficulties of forging a working/therapeutic alliance with patients whose narcissistic vulnerabilities and history of insecure attachments impel action and not introspection, and whose psychic equilibrium is threatened by the emergence of libidinal longings within the transference.
Particular countertransference reactions stimulated by these patients—e.g., the therapist's anxiety about the patient's safety outside the office (which might threaten confidentiality), or anxiety about therapist and/or patient safety within the sessions (which might threaten the analyst's abstinent posture)—were described by Chused. She stressed the importance of establishing clear limits and boundaries to ensure an ambience conducive to analytic work and the development of analyzable transferences. The centrality of limits and boundaries to the successful treatment of these children was a point stressed by each of the panelists.
Before introducing the presenters, Chused outlined some of the important biological, psychological, and environmental factors that contribute to a patient's propensity for violent behavior. She stressed the