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Extra info for Antisocial Personality Disorder - A Practitioner's Guide...

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The observing ego is that part of the therapist’s mind that observes the interaction between him or herself and the client. It floats freely and carefully observes the client’s words, facial expressions, tone, change of subjects, and body language. It also observes the same aspects in the therapist and his or her own thoughts and feelings about what is being communicated. This skill is of paramount importance in any psychodynamic therapy but particularly so with a client who has severe deficits in affect tolerance and verbal communication.

Any long-term issues are avoided here. If Frank continued therapy beyond the first phase, then the exploratory and restorative work of the second phase can begin. Here issues of the loss of his mother; the abuse perpetuated by his family; his abuse of others and the role that violence plays for him; issues of sexual molestation and sexual identity; addictions; emotional intimacy; development and maintenance of healthy interpersonal boundaries; development of a healthy superego (a working sense of guilt); reducing criminal behavior; affects of loss, shame, humiliation, etc.

In our case, Frank would have to be ready to risk that the therapist will not abandon or 24 ANTISOCIAL PERSONALITY DISORDER torture him, or be present but ineffectual. How the affects are contained by the therapist, processed with the client, and ultimately returned to him comprise the basic components of this model of therapy. II. What would you consider to be the clinical skills or attributes most essential to successful therapy in your approach? The most essential skill in approaching this client from a psychodynamic framework is the therapist’s use of an observing ego (Casement, 1985).

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