Psychodynamic perspectives on staff response to inpatient misdemeanour

Psychiatric inpatient misdemeanour, especially violence, is a common problem. The characteristics of such behaviour have been exhaustively examined in the literature, yet, outside specialist journals, there has been little discussion of how psychodynamic theory may help to understand rule-breaking and improve staff response to it. This paper aims to describe classical psychodynamic theory on the formation and function of the super-ego and how the countertransference of staff can be linked to parental models of control. There is particular discussion about the management of psychopaths, where rule breaking is a defining characteristic, and the merits of therapeutic community models of care. Finally, the traditional defences used by nursing staff to contain anxiety are discussed. The paper concludes that those traditional defences need to be replaced by systems that allow reflective understanding of patients' challenging behaviour and how staff respond. Copyright © 1998 Whurr Publishers Ltd.