ISTDP with violent offenders

“I´m working with men who batter their wives and am trying to motivate perpetrators to change their behavior and to seek therapy. I am trying to create a brief intervention method (no more than 15 minutes) that social workers, police and others can use to assess and motivate batterers to seek treatment. Motivational Interviewing is one method. But I would like to base the method on ISTDP. I imagine that working with projections is essential. Any thoughts would be helpful.” Thanks for this very interesting and important question.
First of all, while we can assess, for instance, somatization in about fifteen to thirty minutes, we cannot usually help a batterer see his defense, see that it hurts him, and motivate him to seek therapy in fifteen minutes. So if we leave this kind of unreasonable time limit to the side, let’s take a look at how to help this kind of patient.
First of all, to motivate this group we first have to find out if it is a problem for them and, if so, why it is a problem. Often these patients deny that their impulsivity is a problem. As in motivational interviewing, we will spend our time mirroring his denial and splitting until he can bear the rise of feelings that will allow him to admit that this is a problem. This process can take some time and requires patience on the part of the therapist.
Pt: I don’t have a problem. [denial]
Th: Wonderful. [mirror denial]
Pt: So what do you want? [projection]
Th: Nothing. I’m just wondering what the problem is you would like me to help you with. [block projection]
Pt: I don’t have one. [denial]
Th: So a man without a problem finds himself in a therapist’s office. [mirror contradiction between his words and actions]
Pt: The probation officer said I need to come here. [projection]
Th: Since I can’t help him, I have to ask you what the problem is. [block projection]
Pt: Everything is going well. [denial]
Th: You’re a lucky man. [mirror denial]
Pt: [fidgets] Well I don’t have a problem I can’t handle. [Beginning acknowledgement of a problem with denial of a need for help]
Th: That’s the best position to be in: to have a problem and know how to handle it. [mirror denial]
As a result of this process of mirroring denial and splitting while blocking projection, over time many of these patients will eventually admit to a problem.
Next, draw his attention to the price of the defense for HIM:
“What impact does it have on you when she fears you rather than loves you?” “What impact does it have on you when your son/daughter is afraid of you?” “What impact does it have on you when you have departed from your strongest self?”
“What impact does it have on you when you let the rage be in charge instead of you being in charge of the rage?”
“Would you like to be the one with the power instead of the rage taking the power away from you?”
You could also deactivate the gratification of losing control.
“I get the sense that it feels like a relief to let it out, but would it be fair to say that the rage gets its way but then leaves you to pay the price?”
“Do you notice how the rage is happy that it got its way, but then you are the one who gets punished? You must be angry at how the rage tricks you and sets you up this way.”
Help the perpetrator see how the impulse does not solve his problems but creates them, and remove the gratification he receives for his impulsivity.
Then you can mobilize his will to the therapeutic task:
“Would you like me to help you regain your power, so the power is in you rather than the rage taking the power away from you?”
“Would you like me to help you become in charge, so the rage is no longer in charge of you?”
“Would you like me to help you become more powerful, even more powerful than the impulse? Is that the kind of power you would like your children to admire?”
Thus, once he has agreed there is a problem, and that it is a problem for him, we can begin therapy.
Usually, people with this kind of impulse problem really have a projection problem. They feel powerful mixed feelings. As a result of splitting, they feel only split-off rage and no love toward their spouse. Since the spouse is now viewed as “all-bad”, there is no guilt or anxiety to inhibit the impulse. So the perpetrator directs all his rage at the all-bad projection he has placed on his spouse.
In the therapy, we will need to build his capacity to bear feelings inside him so he doesn’t project those feelings outside of him onto others, where he beats those feelings and projections. This process of building the capacity to bear feelings inside without projecting them outside is called restructuring the resistance system of projection.
Hopefully, this gives you a place to start.

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