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The robber who loves arranging flowers

The robber who loves arranging flowers. IAFP, Oxford, 26 March 2010 Anne van den Berg, Karel Oei. Patiënt P. Some data (1). 38 yrs. old Half Dutch (father), half Surinam (mother) Mother in the ' 70s and ' 80s a known popsinger Mother’s family large and complex

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The robber who loves arranging flowers

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  1. The robber who loves arranging flowers IAFP, Oxford, 26 March 2010 Anne van den Berg, Karel Oei

  2. Patiënt P. Some data (1) • 38 yrs. old • Half Dutch (father), half Surinam (mother) • Mother in the' 70s and' 80s a known popsinger • Mother’s family large and complex • Many offences: from 17th, mostly crimes against property. Jail in and out. Last one: hold-up with knife (threatening) cashier in supermarket. TBS. • Addiction: softdrugs and cocaine

  3. Patiënt P. Some data (2) • TBS =placement under a hospital order. • Admission date: 2004 - 2010 • Individual psychotherapy: 2006 – 2010 • WAIS IQ: average with a harmonic profile Verbal and Performal • PCL-R: high (36). Affective and interpersonal facets. • DSM IV: ASPD with narcissistic and borderline traits • Unescorted leave phase with reintegration ( half 2009)

  4. Important lifeevents • Failed abortion (in a pentecostal church milieu!) • Toddler regularly alone in Spain (4-6) • Unreliable parents (6-7) • Rejected and maltreated by stepparents (7-14) • Placed by parents in a juvenile center (16-18) • Only job: flowershop (18-19) • French Foreign Legion (21) • In love but betrayed (30)

  5. Song (lyrics and compositionby P)

  6. Themes of the song • Existence: I was a mistake • Attachment: family, sister, Amsterdam • Religious: demons, spirit • Mystique: French Foreign Legion (semperfi) • Identity: disturbed (2 cultures) • Negative feelings: hate, pain, lying, addictive • Positive feelings: love, protection, desire • Philosophy of life: don’t look back, future • Incestuous feelings Song and images are crumbled. Music and singing are more harmonious.

  7. Manners of communicationby P. • Very short and staccato sentences • Counter questions • Generalizations • Blaming • Controlled facial expression • Somatic suffering • Smiling at the start and the end of session • Avoiding intimate subjects Functioning from his alien self

  8. Themes of the TBS hospital • Very severe personality disorder • Not capable of having a long relationship • Very dangerous (high risk). Assessment instruments • Instrumental • Breaking of the rules in the hospital • Keeping the rules and the arrangements • Addicted • Not reliable

  9. Themes of the psychotherapist • Connecting with the psychological level of him (different modes) • Bridging the antitheses (title of presentation). No as a comment but as a consideration within myself • Making connections between the fragments in his life (autobiographical continuity). May be… • Let him look inside (reflective) • Emphasizing the hope

  10. Contrasts in title/in himself Robber ↔ Floral designer destructiveness constructiveness egocentric altruistic aggressiveness flower power bad feelings good feelings ugliness beauty swiftness patience hate hope No continuity in his self, borderline, alien parts

  11. Difficulties in realizingpsychotherapy? Patient: • Cognitive behavioral therapy (struggle) • Patient with equivalent, pretend and teleogical modes • Avoiding direct contact about his feelings • Doesn’t tolerate interference (control) • Doesn’t like obligations (control) Milieu: • Restrictive • Distance: therapist – head of the treatment unit

  12. MBT approach ? ImplicitExplicit • Nonconscious conscious • nonverbal verbal • perceived interpreted • unreflective reflective • mirroring explaining • Implicit techniques • Not the usual MBT techniques (stop, rewind) • Small reflections of own (good, wrong) thoughts • Empathy in terms of feelings like ‘annoying’ • Emphasizing voluntariness

  13. Resultsindividualpsychotherapy • Precisely in the appointments with me • Let see his face in between for a small talk • Some vulnerabilities • A little bit confidence in me • Life story completed (autobiographical continuity) • The last months more estrangement

  14. Happy end? • January 2010: Unescorted leave → holds up a supermarket with knife Why? Letter (end of February to me) • Disappointed in love (reflection in letter) • Addicted • Strong undercurrent feeling: ‘I am not allowed to exist’ • Revenge on the hospital: You will not succeed • Reaction on placing back into hospital and in his eyes the maltreatment by us. • Fear for society

  15. Conclusions for this patient et al. • MBT only possible in strong structure • MBT only possible in accepting structure • MBT in a more implicit than explicit way • Narratives show their full advantage in singing and music than with telling a story • There is an urge to tell his story but at the same time he can’t tell his story very well • A very defective fundamental feeling not to be allowed to exist. Profound destructiveness.

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