Comprehension and psychotherapy of antisocial-psychopathic personality disorder

Abstract

The article aims to highlight certain characteristics of a psychotherapeutic relation­ship with a patient with antisocial-psychopathic personality disorder. Working with such patients is a demanding task and the relationship is relatively unresearched as there is often only a limited clinical psychotherapeutic treatment. After a short histori­cal overview of research and understanding of this disorder, the article then presents a broader phenomenological overview of the knowledge and fundamental characteristi­cs of psychopathy through standardized international classification systems (DSM- V, ICD- 10) and the diagnostic assessment scale (R. Hare- PCL-R). Phenomenological descriptions of behaviour show a substantial lack in the structure of the superego, whi­le revealing a broad continuum of personal characteristics, ranging from pathological narcissism to distinct characteristics of psychopathy in its antisocial and heteroaggres­sive view of the surrounding world. By implementing what is known as the third topic model (Dejours, 1986), a psychodynamic understanding can be found of this disorder and the background of its defence and adaptive processes. With a shift in splitting into areas of the preconscious and repressed unconscious, the dynamic of non-neurotic di­sorders may explain some of the archaic defences which also appear in psychotherape­utic treatment between a therapist and patient in what is called a white relation. From the psychoanalytical point of view, the »third topic« model explains the function of the preconscious system as a »mediator« in experiencing oneself and consequently others (Benedik, 2000), which conceptually matches some of the latest research in the field of mentalization and the inadequate mentalizing capacity of thinking patterns in borderline personality disorder (Choi-Kain and Gunderson in Pažek, Roškar, Žvelc, 2016: 29). The central part of the article summarizes the work of Nancy McWilliams and other authors on the psychopathic personality structure with the emphasis on the therapist’s counter­-transference and the therapy itself. The final part presents an example of antisocial­-psychopathic personality disorder, including a description of the person’s life and their developmental characteristics.