Working With Persons Who Have Been Violent:

Attachment, Transference and Countertransference

Lisa Firestone, PhD and Robert Kinscherff, PhD, JD, instructors

Attachment research has revolutionized our understanding of human development, our internal worlds, and the consequences of development gone awry. No other empirically-based theory tells us more about how we become who we are – and how to change who we have become.   Research has also increasingly revealed the ways in which childhood adversities mediated by experiences with caregivers have neurodevelopmental consequences which can yield resiliencies can also create vulnerabilities to physically and sexually violent conduct.

Research demonstrates that a therapist’s attachment style is predictive of client outcomes and many psychotherapy outcome research studies use changes in attachment status. In addition, research shows that when people—therapists and clients--fail to make sense of their past, they find themselves repeatedly reliving and recreating old disappointments, betrayals  and wounds over and over again. When these dynamics occur in work with clients with histories of violence, they can render psychotherapeutic intervention ineffective or even toxic.

This workshop views clinical work with persons with histories of significant violence through the lens of attachment. Attachment style is the medium through which both conscious (“reactions”) and unconscious psychological processes are engaged and sometimes behaviorally enacted by both the client (“transference”) and/or the therapist (“countertransference”). Clinical work with persons who have engaged in physical and/or sexual violence which has resulted in severe injury or death to others can understandably precipitate both intense reactions and powerful transference-countertransference dynamics. These can seriously derail therapeutic processes in a variety of ways if not recognized or addressed.  In particular, dynamics involving rejection, shame, humiliation, fear or revenge commonly arise in work with these persons.

This workshop draws upon the latest in attachment and neurodevelopmental research as well as scholarship on transference and countertransference dynamics to provide participants with the tools to: (a) identify and articulate reactions and transference-countertransference dynamics; (b)describe their origins and course of common reactions; (c) help clients with histories of violence—who have commonly also been victims of violence—to integrate their emotions and resolve insecure or chaotic attachment patterns; and (d) diminish their risk of future violence by targeting effective treatment. The workshop utilizes clinical case material, guided writing exercises, and other experiential learning processes to provide participants with information and skills essential for the successful treatment of persons with histories of violence.

Learning Objectives

• Explain how child attachment patterns continue to affect people throughout their lives.

• Describe through the lenses of neurobiology and attachment how violence may emerge developmentally particularly among children who have been victimized and are insecurely or chaotically attached.

• Describe common conscious reactions and unconscious processes and enactments on the part of both clients (“transference”) and professionals (“countertransference”) during clinical work with persons with histories of serious violence.

• Explain how a patient with a history of physical and/or sexual violence can—through psychotherapeutic interventions—develop secure attachment in adulthood.

• Identify techniques to help clients who have been violent integrate their emotions, understand the origins and dynamics of violence in their lives, and develop a coherent narrative for their life that reduces the risk of future violence.

• Discuss the critical importance of helping clients who have been violent to resolve their own trauma histories and integrate the impact of their violence to others.

Program Code: ATC6 
6 CE Credits
Location: William James College, Newton

Lisa Firestone, PhD, is a clinical psychologist and Director of Research and Education at The Glendon Association. She is involved in clinical training and research on suicide and violence, resulting in the development of the Firestone Assessment of Self-destructive Thoughts (FAST), the (FASI) and the Firestone Assessment of Violent Thoughts (FAVT), published by PAR Publications. She is co-author of The Self under Siege, Conquer Your Critical Inner Voice, Creating a Life of Meaning and Compassion and Sex and Love in Intimate Relationships. Dr. Firestone is a highly regarded workshop facilitator in the topics of suicide, violence and family relations.

Robert Kinscherff, PhD, Esq., is a forensic and clinical psychologist and an attorney who has been at MSPP since 1999. He is Associate Vice President for Community Engagement with oversight of key service-providing programs including the Freedman Center, Brenner Center, and PATHWAYS.  He is also Teaching Faculty for the Doctoral Clinical Psychology Program and for the Doctoral School Psychology Program.  He was instrumental in establishing the doctoral Concentration in Forensic Psychology and the doctoral Concentration in Children and Families of Adversity and Resilience (CFAR).  Dr. Kinscherff is also Faculty at the Center for Law, Brain and Behavior at Massachusetts General Hospital and Senior Associate for the National Center for Mental Health and Juvenile Justice.  During 2015-16 he will be a part-time Senior Fellow in Law and Neuroscience at the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School.  He is a member of the Massachusetts Governor's Juvenile Justice Advisory Committee and the Special Commission on Sexual Offender Recidivism.  Dr. Kinscherff has previously served as Assistant Commissioner for Forensic Mental Health (MA Department of Mental Health), Director of Juvenile Court Clinic Services (MA Trial Court), and Director of Adult Forensic Services (Psychiatry and Law Program, Massachusetts General Hospital). For over a decade, he taught classes at the intersection of law and psychology at Boston University Law School. For the American Psychological Association, he is a current member of the Board of Professional Affairs, and has served as Chair of the APA Gun Violence Policy Review Task Force, a past two-term Chair of the Ethics Committee (EC), Chair of the Committee on Legal Issues (COLI) and Member of the Committee on Professional Practices and Standards (COPPS). He is a past member of the Editorial Board for the Society on Terrorism Research and has been an invited participant on APA, FBI and RAND Corporation working groups involving the intersection of ethics, behavioral sciences, law enforcement and national security. His research and professional practice areas include ethical and professional practice issues in clinical and forensic mental health practice, violence risk assessment and management, juvenile and adult sexual offenders, serious delinquency and juvenile homicide, aggressive and sexually problematic behaviors among youth and adults with developmental or mental disorders, and severe and unusual forms of child maltreatment. He teaches and consults nationally and internationally.