further explain PTSD resulting from terrorism and other traumas, lets now
discuss the behavioral psychodynamics of a victim held captive. Understanding
these dynamics is essential for the effective treatment of hostages, perhaps in
a skyjack situation. A task I am sure you hope that you will never have to undertake.
Heres a case study where a question of ethical self-determination became
involved for a therapist when his client, a detective, was sympathizing with his
captors and pathological transference occurred.
off-duty detective, James, was captured when he interrupted a robbery. When the
robbers learned he was a detective, two of the gunmen shouted they were going
to kill him. Then they placed a bag over his head and made him kneel down. The
detective later stated, I was glad it was going to be in the head, because
I thought it would be quick. Instead, he heard the robbers discuss him and
then leave. He wasnt shot.
pathological transference, months later, one of the robbers was caught. James
visited the man many times. A close relationship developed and the detective told
the robber, If you need me, Im there for you, because you were there
for me at the time. When the second robber was caught, the detective told
his superior, Chief, this guy has really changed, and went out and
bought lunch for the second robber. The third robber is still at large. The detective
fantasizes, in therapy sessions, conversations he has with the third robber: James
will say, Listen Otis, what went down, went down; turn yourself in. Believe
me Ill work with you. Im not looking for revenge.
yourself if James... were your client, ethically, would you define this as pathological
transference or not. Or, is this a case of ethical patient self-determination
and autonomy? Studies indicate that pathological transference only occurs when
someone threatens a persons life, deliberates, and then does not harm him.
The victim, as in the case of James, doesnt dwell on the threat, but rather
the feeling that the criminal let him live.
Pathological transference usually
does not occur when the criminal harms the victim. What are your feelings on this
point of ethics: pathological transference, patient self-determination, or both?
Pathological transference is consistently found in individuals
held hostage by criminal terrorists. As you know, hostage victims are essentially
instrumental victims. That is, they are used and exploited by their captors as
leverage to force a third party (the family, police, or the government) to accede
to the captors demands. The captors threaten extreme violence to the victim,
primarily in their communications to the third party, if their demands are not
met. This suggests to the victim that the terrorists will not harm him, if the
third party gives in to the captors demands.
The key to transference... here
is the terrorists use of the victim as leverage. This leverage sets the
groundwork for intense pathological transference. The transference is both accelerated
and heightened when the hostage has already been psychologically traumatized by
treating victims of violent crime, my colleagues and I have found the following four intervention techniques to be most effective. See how these compare with
your current practice. As you listen to these four you might think about how they
relate to the Ethical Principles of respecting your clients self-determination
4 Intervention Techniques for Victims of Violent Crime
Intervention #1. Restoring power to victims early
on by asking permission to interview them: For example, to restore a feeling of
power to the victim of violent crime, I ask, Is this a good time to talk
to you? or Do you mind if I ask you some questions? Have you
found, like I have, that asking permission like this diminishes the one-up position
held by the therapist...similar to the one-up power position of the clients
former captor or assailant.
Intervention #2. Reducing isolation by providing nurturing behavior, thus diminishing the experience of the hostile
environment to which the victim was subjected. Of course, a nurturing environment
is key in a therapeutic relationship, but I find I need to increase my self-awareness
of my body language and voice tone, especially so as to provide a positive open
space but not infringe on the traumatized clients space.
#3. When treating a victim of violent crime, diminishing the helpless, hopeless
feelings of the client by giving him or her the experience of determining his
present and future behavior in terms of space and time. I foster this by asking
permission, for example, to cross the room to get my note pad by saying, Is
it okay if I go to my desk to get a pad for you to write this information down?
Intervention #4. Reducing the feelings of being subjected to the dominant
behavior of the captor by identifying yourself to the clients satisfaction.
As you know, fully identify yourself, especially at your first meeting, and explaining
to your clients satisfaction, for example, the agency you represent can
be a key in building trust.
The preceding four interventions are based on undoing and
reversing the factors that can bring about traumatic psychological infantilism.
By psychological infantilism, I mean the rescuers must remember that the sudden
release of the victims usually causes an acute phase of crying, clinging, and
submissive behavior. The victims still are in the grips of traumatic infantilism.
Using methods like those interventions described above to help nurture and restore
power are crucial to prevent the rescuers from causing even more injury to the
survivor. Also, you may have found it is important to allow the survivor privacy
without isolation. The basic ethical principles of genuineness, honesty, and sincerity
are, of course, applied here.
Thus, the two components of pathological
transference and traumatic psychological infantilism form the crucial elements in this transference to the captor.
Peer-Reviewed Journal Article References:
Carsky, M. (2020). How treatment arrangements enhance transference analysis in transference-focused psychotherapy. Psychoanalytic Psychology. Advance online publication.
DeTore, N. R., Gottlieb, J. D., & Mueser, K. T. (2021). Prevalence and correlates of PTSD in first episode psychosis: Findings from the RAISE-ETP study. Psychological Services, 18(2), 147–153.
Eagle, G., Benn, M., Fletcher, T., & Sibisi, H. (2013). Engaging with intergroup prejudice in victims of violent crime/attack. Peace and Conflict: Journal of Peace Psychology, 19(3), 240–252.
Hasselle, A. J., Howell, K. H., Bottomley, J., Sheddan, H. C., Capers, J. M., & Miller-Graff, L. E. (2020). Barriers to intervention engagement among women experiencing intimate partner violence proximal to pregnancy. Psychology of Violence, 10(3), 290–299.
Krahé, B., & Busching, R. (2015). Breaking the vicious cycle of media violence use and aggression: A test of intervention effects over 30 months. Psychology of Violence, 5(2), 217–226.
Shubs, C. H. (2008). Transference issues concerning victims of violent crime and other traumatic incidents of adulthood. Psychoanalytic Psychology, 25(1), 122–141.
Stuart, G. L., McGeary, J., Shorey, R. C., & Knopik, V. S. (2016). Genetics moderate alcohol and intimate partner violence treatment outcomes in a randomized controlled trial of hazardous drinking men in batterer intervention programs: A preliminary investigation. Journal of Consulting and Clinical Psychology, 84(7), 592–598.
Online Continuing Education QUESTION
4: What are the two crucial elements of transference to the captor for individuals
held hostage by criminal terrorists? To select and enter your answer go to .