Navigating a broken mind: Psychodynamic psychotherapy in private practice with a male who has committed a sexual offence

This article addresses the complex issues involved in treating individuals with psychotherapy who present with harmful sexual deviation and dysfunction, outside of a specialised institution. I argue that a psychodynamic understanding can assist the psychotherapist to engage with the internal and external worlds of such patients to enable effective intervention, while being mindful of the reality of the risks they pose to the community. An effective psychodynamically informed approach must traverse a complex terrain of internal and external reality between the patient and their context and how this may play out in an individual psychotherapy relationship or in a psychotherapy group matrix with vulnerable group members. This is a demanding and sensitive undertaking for any clinician. Psychodynamic and group analytic theory, mindful of complex and disturbing countertransference and periods of alarming acting out including self-harm, provides the psychotherapist with useful interpersonal tools, such as the management of the countertransference and an understanding of perversion to manage complex enactments during such high-risk work.