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This is an important and interesting contribution to the development of our understanding of offender patients. It is number three in a series, Forensic Focus, edited by Murray Cox. This volume offers the experience of psychoanalytic psychotherapists working with a wide range of problems, largely within the NHS. The chapters are individual, though the contributors (all female) were part of a study group run by the editors.
In Part I, the editors in their foreword briefly outline the history and development of forensic psychiatry and psychotherapy, and include a chapter on the assessment of offender patients. Some of the issues raised in management and treatment are developed further in a chapter by Dr C. Taylor.
In Part II contributors discuss a wide range of cases and topics. Presentations are individual and of a high standard. There is liberal use of case vignettes which ‘come alive’ for the reader. Included are incest, violent and non-violent offending, murder, abuse, perversions, fraud and other problematic behaviours, rooted in the bleak and damaged internal worlds of the patients. Certain themes recur: the pain of this sort of work for the patient, the therapist and others; the need for careful understanding of transference and countertransference, and for personal therapy, supervision, and a supportive network. These measures may help mitigate and contain the splits and conflicts driven by, and mirroring, the damaged internal worlds of the patients. The contributors, whilst acknowledging the pain and struggle, manage to convey their ability to hang on to some hope.