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Article   |    
The Role of Fantasies, Countertransference, and Psychological Defenses in Patient Violence
William R. Dubin
Psychiatric Services 1989; doi:
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The author thanks Marie Horn for her help in manuscript preparation.

Philadelphia Psychiatric Center, Ford Road and Monument Avenue, Philadelphia, Pennsylvania 19131 Temple University School of Medicine

1989 by the American Psychiatric Association

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Abstract

Over the past decade the management of aggression on psychiatric units has generally focused on pharmacologic and physical interventions rather than on psycho-dynamic concerns. The author reviews the dynamics of violence and discusses how clinical staffs fantasies, countertransferences, and psychological defenses may interact to trigger patient aggression. Interventions that address these issues with staff include developing a cohesive treatment team in which clinical staff can express their feelings without the need to explore the psychodynamic underpinnings, having clinical leaders maintain a strong presence on the unit to serve as role models, and providing regular inservice training.

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