Abraham, K., 115, 131, 240, 252, 261
psychoanalytic technique and, 100
types of, 272
unwittingly encouraged by therapist, 99–100
Adatto, C. P., 261
addiction, 210
Adler, G., 299, 304, 305, 308, 311–312
adoption, 26–29
case material, 26–28
affect block, 271
affect hunger, 26–29
prognosis of children with, 29–30
psychodynamics, 32
treatment of children with extreme, 30–31
types of response to, 33–34
affectionless characters, 35–41
affectionless psychopathy, 4
affective factor of psychopathy, 199
affects, 16–19
aggression. See also specific topics
object seeking and, 139
aggression responses on Rorschach, 200
aggressive courage, 207. See also risk taking
aggressive impulses, 35–37
absence of ego-dystonic, 200
aggressive modes of narcissistic repair, 192–193
aggressiveness, 163
aggressor, identification with, 10–11, 193, 200
Aichhorn, A., 49n, 79, 85, 90, 92, 97, 103, 104, 109, 112, 115, 131, 265, 280
alcoholism, 210
Alexander, F., xi, xi, 92, 99, 112, 113, 156, 159, 339, 166, 169, 227, 237, 318, 335
anal-expulsive themes, 194
anal-passive stage, defense against regression to, 209
anger, in treatment, 270–271
animals, cruelty to, 16
antisocial behavior
aggressive vs. passive-parasitic, 191, 197, 317, 323–324. See also under psychopaths, types of
as Factor II of PCL-R, 199
as part of symptomatic neurosis, 330
antisocial character formation, 80
antisocial personality disorder, 323–327
psychodynamics, 333–335
sociodemographics, 196–197
antisocial tendency, 133
case material, 133–135
nature of, 135–137
treatment of, 143
antisocial types. See also psychopaths, types of
Kernberg’s range of, 190–191
anxiety, 57
drug therapy for, 276
inability to tolerate, 229
paranoid vs. depressive response to, 194
in therapist, 300
anxiety disorders, 8
anxious avoidant attachment, 4
arousal, 5–7
as-if qualities, 59, 75, 255. See also imposters
assessment. See diagnosis; testing and assessment
to animate vs. inanimate objects, 206n
aversion to, 163
capacity for, 185
defined, 4
dismissing, 4–5
attention deficit disorder (ADD), 5
authority, ambivalent attitude toward, 49
autoerotism, 233
avoidant strategy, 4–5
Bach-y-Rita, G., 278, 281, 309, 312
behavior disorders. See also specific disorders
psychopathic, 64
vs. psychopathy, 8
behavioral factor of psychopathy, 199
Bender, L., 58, 60, 67, 77, 84, 90
Berke, J. H., 18, 19, 173, 177
betrayal, feeling of, 250, 256
bisexual identification, 50
case material, 51
blushing, 210
borderline patients, 16
borderline personality disorder, 243
borderline personality organization, 13, 189
Bowlby, J., 3, 4, 7, 19, 20, 23, 84, 90, 173, 177
Bradford, J., 175, 176, 177, 178
Bromberg, W., 227, 237, 298, 312
Brontë, Ann, 284
“burning out” process, 277
Bursten, B., 174, 177, 243, 246, 249, 254, 256, 258, 261, 265, 280
“callous / unemotional” factor, 8
Cameron, N., 261
cannibalism, 9n
charisma, xi, 49, 159, 164, 209
child neglect, 9, 11, 65, 136–137, 142
Cleckley, H., 9, 20, 59, 60, 172, 178, 200, 202, 246, 261, 297, 312, 317, 320, 335
cognitions, 45, 49, 75. See also intellectual functioning; time; specific topics
collusion with psychopaths, 292–293
community settings, specialized therapeutic, 330
comorbidity, 197, 322. See also narcissistic personality(ies)
complementary personalities, 241–244
concern, capacity to experience, 311
conduct disordered children, 18–19
solitary-aggressive subtype, 18
confrontation, 326
conscience. See guilt; superego
control, need for
over analyst, 184
over objects, 229
Cooke, D., 11, 20, 21, 199, 202
countertransference, 185–187, 301–302, 304–308. See also psychopaths, responses aroused by; therapeutic nihilism
assumption of psychological complexity in patient, 187
of patient’s dangerousness, 173, 206
and self-deception, 186
as diagnostic tool, 326
early, 272
fear
of assault or harm, 185–186, 302–304
of being deceived, 105
feelings of invalidity and loss of identity, 305–306
hatred, 307
loss of professional identity, 186
countertransference problems, solutions to, 309–311
courage, aggressive, 207
craving personality, 245, 248–250, 255, 257, 259
creativity, 158
criminality
age and, 277
psychopathy and, 165–166
Cunanan, Andrew, 327
signs of, 173
death, fear of, 287
deception, 173–174, 246, 254, 326. See also manipulation
deceptive practices, 184
mature/neurotic vs. primitive, 17
Rorschach analysis of, 189n
delinquency
constitutional vs. environmental factors in, 90
Demera, Ferdinand, 123–125
denial, in therapist, 173, 186, 306
deniers, self-destructive, 310
dependency, 245
fear and avoidance of, 221–222, 230
lack of capacity for, 245
“dependent clingers,” 310
dependent transference, 218, 220–222
depression and depressive feelings, 194, 290, 299. See also sulking
experienced in treatment, 267–268, 275, 276
deprivation in childhood, emotional, 65, 136–137, 142
Derrick O’C., case of, 39–40
Deutsch, H., 58, 60, 74, 77, 125, 126, 131, 227, 237
devaluation, 12, 172–173, 186, 190, 194, 230, 293
developmental markers of psychopathy, 8
devouring. See incorporation
diagnosis, 188, 320. See also testing and assessment
differential, of personality disorders with antisocial features, 318, 320–330
Diagnostic and Statistical Manual of Mental Disorders (DSM), 195–198, 316–318, 316n
diagnostic frame, proposed, 319–322
dismissing attachment, 4–5
dominance-submission, 10, 12, 173, 185, 191, 193, 332
drive theory, 240–241
drug addiction, 210
drug intoxication, 57n
drug therapy, 275–277
DSM (Diagnostic and Statistical Manual of Mental Disorders), 195–198, 316–318, 316n
dyssocial reaction, 330
educational phase of therapy, preparatory, 103
ego, nonego vs. true, 128
ego development, disturbances in, 81–82
ego functioning, 45, 130. See also specific topics in narcissistic personality, 243
ego ideal, 125–128, 130–131, 217–218, 220. See also ideal object
ego psychology, 240–241
ego state, basic, 323
Eissler, K. R., 265, 280, 318, 335
eneuresis, 141
“entitled demanders,” 310
entitlement, 191
envy, 17, 173, 184, 190, 229–230, 236, 334
Erikson, E. H., 9, 20, 240, 261
erythrophobia, 210
ethical system of criminal psychopaths, 288, 289. See also morality
evil. See wickedness
exhibitionism. See phallic-exhibitionistic themes
exploitation, 229
Falstein, E., 113
family, treatment of entire, 111
family of origin, 257–258. See also parents
fantasies. See also omnipotent defenses and fantasy; phantasy
grandiose, 234
masturbation, 233
reunion, 247–248, 251, 254, 255, 257
fathers of psychopaths, 47–49
Fenichel, O., 95, 96, 113, 227, 237, 240, 261
fragmentation, 232
Freud, A., 20, 70, 77, 193, 203, 249, 250, 261
Freud, S., 46, 82, 90, 166, 169, 217, 226, 240–242, 249, 251, 261–262, 290, 296, 312, 318, 329, 335
Friedlander, K., 80, 82, 90, 166, 169
Frosch, J., 242, 243, 262, 302, 306, 312
frustration tolerance, 163
low, 229
Gabbard, G. O., 168n, 197, 203
Gacono, C. B., xi, xi, 10, 12, 13n, 17, 18, 21–22, 173, 178, 189, 189n, 199, 202, 203, 329n
Gecks, S., 3n
genotype, psychopathic, 197n
Gessell, I., 46n
Giovacchini, P. L., 306, 307, 310, 311, 312
Glueck, E. T., 58, 61, 331, 335
Goldfarb, W., 58, 61, 70–72, 78
grandiose fantasies, free floating vs. structured, 234
grandiose self, 10–12, 255, 259, 260, 332, 334. See also ideal object, identification with
grandiosity, 174, 194. See also omnipotent defenses and fantasy
gratification, ability to delay, 163, 229
gratitude, 291
greed, 139, 190, 229–230, 233, 235, 236
greediness, 139–141
Greenacre, P., x, xi, 92, 96, 113, 125, 128, 132, 227, 237, 255, 258, 262, 272, 280
avoidance of and defenses against, 230, 231, 233, 234, 236
development of, in therapy, 275, 277–278
in therapist, 304–305
Hare, R. D., 3, 5, 11, 20, 21, 172, 178, 187, 189, 198–199, 201n 203, 276n
Harrison, F., 294n
hatred
countertransference, 307
for primary love object, displaced, 287–288, 290
Hazelwood, R., 16, 16n, 20, 21, 176, 178
Healy, W., 58, 61, 92, 113, 318, 335
helplessness, feeling of, 220
in therapist, 304–305
Henderson, D. K., 59, 61, 158, 169, 191, 197, 203, 317, 323, 336
Hewitt, case of, 124–125
Hofer, M., 21
holographic man, 325
Holt, S., 16, 21, 177, 178, 193, 203, 333n
homosexual urges, and paranoia, 251
homosexuality, 207, 208, 232–234
passive surrender and, 209–212
hope, and lack of hope, 136
hospital setting. See also treatment, inpatient
exploitation in, 279
ideal object. See also ego ideal
identification with, 230. See also grandiose self
ideal self, 10
idealization, failure of, 333
idealized parent image, 259
idealizing transference, 184, 213, 217–222
ideals, 125–126
identification(s), 9, 10, 73, 95. See also malignant pseudoidentification
with aggressor, 10–11, 193, 200
bisexual, 50
introjective, 230
with phallus, 208
predatory, 10–12
with therapist, 213–214
identity, problem of, 267
imposters, 123, 126, 128, 130–131, 214
case material, 115–118
first phase of treatment, 118–120
second phase of treatment, 120–131
impulse control, 229
impulsiveness, 163
oral, 12
indifference to other people, 41
insight, lack of, 267
institutional care for psychopathic children, 67, 69, 77
institutions, children raised in, 65–67, 69–72, 77
intellectual functioning, 68–69, 72, 73. See also cognitions
internalization, 57, 259–260. See also identification(s)
interpersonal factor of psychopathy, 199
introjective identification, 230
introjects, persecutory superego, 193
Jacobson, E., 14, 15, 21, 248, 250–253, 256, 257, 262, 318, 328, 329, 336
jealousy, 18
Johnson, A. M., 113, 145, 153, 258, 262, 318, 336
Jones, Jim, 194–195
Kernberg, O. F., x, xi, 10, 11, 14, 15, 17, 21, 185, 189–191, 193, 203, 204, 240, 242, 245, 262–263, 311, 312, 315, 316, 318, 320, 322, 328, 329, 331, 332, 336
Kernberg, P., 323
Kirkegaard-Sorensen, L., 6, 20
Klein, M., 46, 61, 65, 78, 173, 178, 227, 237, 288–289, 296
Kohut, H., 184, 204, 242–244, 248, 260, 263
Koresh, David, 194–195
Korzybski, J., 204
Krafft-Ebing, R. von, 174, 178
language development, defect in, 75
Leaff, L., 173, 178, 298, 306, 312
libidinal impulses, 35–37
lie detection, 291
Lion, J. R., 173, 178, 267, 273, 275–276, 278, 280–281, 298–299, 303, 306, 307, 309, 312
lithium, 276
loss, 230
repressed, 289
loving, joy of, 9
loving relationships, inability to form and maintain, 40–41
Lowrey, L. G., 58, 61, 69–70, 78
malignant narcissism, 315–316, 327–328, 331, 334
malignant pseudoidentification, 184–185
Maltsberger, J., 303, 307, 313
manipulation, 173–174, 254. See also deception
defined, 246
in hospital setting, 279
of therapist, 266–270. See also therapist(s), attempts to corrupt
manipulative cycling, 184, 194, 224n
“manipulative help-rejecters,” 310
manipulative personality, 246–247, 254, 256, 258
manipulative type of narcissistic personality, 197
“mask of sanity,” 9
masturbation fantasies, 233
maternal narcissistic attachment to infant, 57
maternal (over)indulgence, 49–50, 129
maternal overprotection, 25
maternal rejection, 26
Mauritius, 6–7
medications, use of, 275–277
Meloy, J. R., xi, xi, 8, 10, 12, 13n, 16–18, 18n, 21, 22, 138n, 172–173, 175, 177, 178, 183, 184, 186, 189, 189n, 191, 193, 199, 201, 203, 204, 329n, 333n
Millon, T., 174, 179, 199, 204, 317, 336
mirroring, 256
narcissistic, 13n
mood swings, 75
moral justification of behavior, 193
moral outrage of others, indifference to, 194
morality, psychopaths and, 288, 289, 324–325
mother-child relationship, 80–81, 140. See also maternal love
murderers. See also Nazi SS killers; sexual murderers
serial, 193
narcissism, 11–12, 241–242. See also transference(s), narcissistic / selfobject
forms of, 259
infantile, 129
malignant, 315–316, 327–328, 331, 332, 334
pathological, 323
psychopathy vs. less severe forms of, 191
primary, 247
sexual, 233
narcissistic equilibrium, 12–13
narcissistic identification, 10
narcissistic injury, 209, 256–257. See also narcissistic repair
narcissistic libido, 217–218, 220
overflow of, 217
narcissistic mirroring, 13n
narcissistic needs, 297
narcissistic parents, 47–49, 49n, 129, 255
narcissistic personality(ies), 11, 12, 323
with antisocial behavior, 328
vs. borderline personality, 243
vs. complementary personalities, 241–244
families of origin, 257–258
object relations, 241–242, 323
psychopathy and, 190–195, 271, 315, 320, 324
types/subtypes
craving, paranoid, manipulative, and phallic, 244–260
oblivious vs. hypervigillant, 197
narcissistic rage, 248–249, 297
narcissistic relation to parents, 57–58
narcissistic repair, 244, 247–248. See also narcissistic injury
aggression and, 248–249
aggressive, 192–193
benign, 191–192
eliminative, 252–254
of the paranoid personality, 252
neediness, 245
neurological deficits, 11
neurotic characters, 156, 157, 318
neurotic conflicts, delinquent behavior rooted in, 82–83
neurotic personality disorders with antisocial features, 329
object choice, narcissistic vs. anaclitic, 241–242. See also transference(s), narcissistic/selfobject
object-love, 37–39. See also love
inhibition of, 37
object-related vs. narcissistic transference, 213–214
object relations, 68, 214, 229, 325. See also specific topics
internalized, 39–40, 232, 289, 332–334
of narcissistic personalities, 241–242, 323
search for painless freedom from, 160, 162
object relationships, 325. See also relationship(s)
complementary, 242
object seeking, and aggression, 139
object(s)
attachment to animate vs. inanimate, 206n
need for control over, 229
sadistic internal, 333
spoiling the good, 229, 235, 236
oedipal impulses, 235
Oedipus complex, 95
omnipotence in therapist, perception of, 220
omnipotent defenses and fantasy, 12–13, 230, 232–235, 259. See also grandiosity
omnipotent object, 259–260
oral incorporation. See incorporation, oral
oral rage, 184
oral sucking, fixation on, 55
orality, 247–250
Orgel, S. Z., 113
overindulgence, maternal, 49–50, 129
paranoia, 194–195, 276, 288. See also under anxiety
paranoid patients, 106, 250–251
families of origin, 257–258
paranoid personality, 245–246, 250–254, 256
paranoid-schizoid position, 237, 290
paranoid transference, 267, 331
parent-child relationship, 47–48
parents, 47–49. See also mother-child relationship
ambivalent attitude toward, 49
projective identification of antisocial impulses into child, 91–94, 96–102
passive-aggressiveness, 197–198, 245, 247
passive-parasitic psychopaths, 191, 197, 317, 323–324, 333–334
passive surrender, defense against, 209
PCL. See Psychopathy Checklist
and aggression, 208
penis-breast, 233
persecutory anxiety, 229–230, 233
persecutory superego introjects, 193
personality organization, psychopathy and, 189–190, 321, 322
personality types, classification of, 239–240, 260
phallic-exhibitionistic themes, 194, 209, 254–255
phallic-narcissistic character(s), 190, 197, 205–211, 247, 254–256, 260
family of origin, 258
physical appearance, 205–206
treatment, 211
polygraphs, 291n
polymorphous perversity, 43–44
Post, J., 334n
Powdermaker, F., 29, 34, 58, 61
predatory identifications, 10–12
predatory-prey dynamic, 173, 185
predatory violence, 190n
prisons, therapy in, 308
prognostic considerations, 330–331
projection, 235, 236. See also narcissistic repair, modes of, eliminative
of sadism onto psychopaths, 294
projective identification, 230–233, 293
prostitutes, psychopathic, 58
provocation, as treatment technique, 97
pseudoidentification. See malignant pseudo-identification
pseudologia fantastica, 322
psychoanalytic thought, evolution of, 240
psychopathic behavior disorders, 64
psychopathic genotype, 197n
psychopaths, 172–174. See also specific topics
adaptive abilities, 158–159, 163–164
alloplasticity, 200
behavioral characteristics, 43–45, 84
psychological foundation, 3–8
responses aroused by, 290–295
aggressive vs. passive-parasitic, 191, 197, 317, 323–324, 333–334
secondary (anxious) vs. primary (non-anxious), 7–8
psychopathy. See also antisocial personality
disorder; specific topics
affectionless, 4
definitions, 157, 172, 283, 317
search for painless freedom from object relations, 160, 162
psychodynamics, 166–169, 236–237. See also specific topics
terminology, 156, 160, 172, 317. See also DSM
theoretical concept of, 159–165
Psychopathy Checklist (PCL) and Psychopathy Checklist-Revised (PCL-R), 172, 198, 199–200
factor analysis, 199
psychosis, 12
psychotic level of personality organization, 189–190
Racker, H., 184, 204, 302, 313
rage
oral, 184
swamping of affection by, 38–40
in therapist, 307–308
Raine, A., 5–7, 11, 20, 22–23, 172, 179, 199, 204
Rapaport, D., 200, 204, 247, 263
rationalization. See moral justification of behavior
reality, sense of, 58
reality testing, 12
Reich, A., 186, 204, 243, 255, 263
Reich, W., 60, 61, 92, 113, 128, 132, 227, 237, 247, 256, 263
relationship(s), 68. See also object relationships
aversion to, 163
inability to form and maintain loving, 40–41
reunion fantasy, 247–248, 251, 254, 255, 257
revenge, desire for, 36–37, 270–271, 287–288, 291
rhythmic fluctuations in behavior, 75
risk taking, 255. See also courage
Robins, L. N., 195, 196, 204, 318, 336
Rogers, C. R., 147, 153, 174, 179
Rorschach findings, 13n
aggressive content, 200
defenses, 189n
PCL–R and, 199–200
transformation of benign percepts into predatory ones, 10
violent imagery, 18
Rosenfeld, H., 245, 252, 263, 318, 332, 336–337
sadism, 10, 15–16, 174–177. See also wickedness
sadistic behavior, 193
sadistic control, 185
sadistic internal objects, 333
sadistic personality disorder, 174
sadistic reactions aroused by psychopaths, 293, 294
sadistic superego precursors, 193, 332
sadomasochistic relationship with objects, 191. See also dominance-submission
Schafer, R., 9, 23, 188, 200, 204
schizophrenia, 58
pseudo-psychopathic, 315
schizotypy, 5–6
Schmideberg, M., 92, 113, 265, 281
self. See also grandiose self
lack of. See as-if personalities
“self-destructive deniers,” 310
self-disclosure of patient, illusory / distracting, 266
self-esteem, 323
low, 268. See also shame
self fragmentation, 232, 235, 242–244
self-other boundary, 242
self-other differentiation, 50–51, 255
self psychology, lln. See also Kohut; selfobjects
self-sufficiency. See also dependency illusion of, 271
selfobjects, 11–12. See also narcissistic libido; transference(s), narcissistic / selfobject parents treating their children as, 48, 49
semantic defect, 75
semantic dementia, 59
separation
in early childhood, 41
need for aggressive, 13n
separation anxiety, 7, 255, 287
separation-individuation, 255
sadistic vs. nonsadistic, 176
sexuality, 43–44
phallic-narcissistic character and, 207–209
sexually violent criminals, 14–15, 193
shame, 252, 253, 256–257, 324. See also self-esteem, low
splitting, 13–15, 230, 232, 235
spoiling the good object, 229, 235, 236
stalkers, 18n
stealing, 138–139. See also greed
initiation of, 97–98
Stoller, R. J., 322n
Stone, M., 174
Strack, S., 16, 21, 177, 178, 193, 203, 333n
stranger anxiety, 7
sublimation, 130
suicide, 326
superego, 60
abnormalities, 15–16
defects, 96, 104. See also superego lacunae
treatment of children and adolescents with, 102
development, 45–47, 65, 193, 277
internalization, 38
superego introjects, persecutory, 193
correspondence to defects in parents’ superego, 92, 98, 100
superego pathology, 323–324
superego precursors, 45–47
surprise, therapeutic use of, 219
Svendson, M., 113
Svrakic, D., 234n
symbiosis, 255, 287. See also reunion fantasy disengagement from mother-child, 256 violent, 13n
Szurek, S. A., 93, 113, 145, 153, 258, 262, 318, 336
Tenant of Wildfell Hall, The (Brontë), 284
testing and assessment, 201–202, 316n, 326. See also Psychopathy Checklist; Rorschach
therapeutic alliance and contract, 266, 270
illusory, 185
therapeutic modesty vs. omnipotence, 300
therapeutic nihilism, 185, 266, 275, 297–298
therapist(s). See also specific topics
attempts to corrupt, 108–110
feelings, 300–302. See also countertransference
manipulative false praise of, 266–267
motivations for treating psychopaths, 311
narcissistically invested in their capacity to heal and love, 173, 186, 304–305
outsmarting patient, 218–219, 221
qualities of successful, 279–280, 299–300
rejection of patient, 306
therapy. See also treatment; specific topics
general principles, 265, 272–273
dealing with anger and absences, 270–272
developing trust, 266–270
payment, 273–274
referrals, 274
by the mother, 140
progress in, 275–278
time, experience of the passage of, 146–150, 325
time concept, lack of / defect in, 66, 76
transference(s), 17, 184–185, 233, 332
behavioral expression of, 184
developed quickly, 213
displaced negative, 288
handling, 97
lack of capacity for, 127
narcissistic / selfobject, 184. See also idealizing transference
vs. (whole-)object–related, 213–214
treatment. See also therapy; specific topics
of aggressive vs. nonaggressive psychopaths, 275–276
indications and contraindications to psychodynamic, 188, 331–332
inpatient, 330–331. See also institutional care
magical expectations, 266
of mildly to moderately psychopathic patients, 187
vs. risk management, 187–188
treatment settings. See also hospital setting; prisons; treatment, inpatient special problems of, 308–309
truancy, 141
trust, developing therapeutic, 266–270
uncertainty, feeling of, 218
Vaillant, G., 17, 23, 298–300, 302, 313
van Ophuijsen, J. H. W., 83, 85, 90
violence, 277n. See also specific topics
predatory, 190n
violent imagery on Rorschach, 18
violent symbiosis, 13n
Warren, J., 16, 16n, 20, 21, 176, 178, 190n, 203
Wheelis, A., 150, 152, 153, 164, 169
wickedness, 171. See also sadism
Winnicott, D. W., 307, 309, 313
Wittels, F., 50n, 61, 227, 237
women
phallic-narcissistic, 207, 208, 247
relationships with, 207