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This practical little handbook about working with dangerous and violent patients, including those who have killed, addresses a most particular area of work. It focuses on the problem of the feelings engendered in clinicians by such a difficult patient group and how to manage those feelings. It is a book that focuses on countertransference, recognizing it, processing it and then making use of it. Without this facility there would be, as sadly there have been in the past, many more casualties and disasters, repeating of trauma and professional indiscretions. Working with these patients can be dangerous and the close following and awareness of countertransference is the best protection. The patient and staff groups described come from our high secure and medium secure hospitals.
The book begins with a Foreword by Brett Kahr that, using historical examples, acknowledges the dangers. However, I found his argument over-optimistic and curiously circular. He reminds us that forensic psychoanalytic psychotherapy is not new and that (by another name) it predates the foundation of the Portman Clinic, the NHS clinic that first offered teaching in this field. Citing Freud, Marie Bonaparte, Melanie Klein and others who were concerned about violence and criminality in our culture, he goes on to give a comprehensive account of how the field has developed and concludes that there is a growing body of expertise which could, in time, eradicate serious criminality. This over-optimism is not helpful.
Hinshelwood's Foreword then brings us back to something more grounded. He welcomes this volume which acknowledges the human problems of caring for those who are dangerous but not before ‘fastening his seat-belt’, for, as he says: ‘There are people so desperate that they are willing to commit terrible crimes to get their message across and there are carers so assaulted that they must put safety before care’ (p. xix). I am not sure that those committing the crimes have as much choice as he impl