Coercion as part of a psychoanalytically based therapy: Case report on the treatment of a forensic outpatient

Abstract

This paper presents the four-year forensic outpatient treatment of a male patient in his mid-30s who was diagnosed with a schizoaffective disorder and had previously been held on unlimited detention due to several assaults. At the beginning, several coercive measures had to be taken. Over time, both the therapeutic alliance and the patient's psychic structure improved remarkably. The patient explained at the end of therapy that, despite being forced into treatment, he also felt recognized and held while he had been in deep distress. Several explanations of how coercion and the therapeutic process may correlate are discussed: essentially, the complex and dialectical relationships between inner and outer reality, therapeutic space, and social structures are reflected. Cautiously but consistently introducing outer reality as well as validating the patient's realistic perceptions contributed to strengthening his ego functions.