Autonomic countertransference: the psychopathic mind and the institution

This article examines the crucial role of countertransference in the diagnosis and treatment of those with a psychopathic personality structure. The disturbing emotions aroused in the therapist are evoked via the autonomic nervous system. Violence provokes a sympathetic reaction, perverse sexuality a parasympathetic response; in each case this is at largely unconscious level and thus all the more powerful. The impact on the therapeutic process is then examined both at an individual and an institutional level. My definition of a psychopath is "someone who brings out the worst in me".