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Abuse is not an all-pervasive behavior. An abuser can be perfectly functional and non-abusive in his workplace relationships - but erupt with violence at home.
Abuse is an impulsive behavior and, to some degree, uncontrollable. The psychological roots of certain abusive conduct(like rage outbursts) are ambiguous. In malignant narcissists, rage can be the result of frustration and a perceived threat to fantasized grandiosity, omnipotence, or omniscience.
At any rate, abusive behavior patterns cannot be changed at will. They require behavior modification through intensive therapy sometimes coupled with medication.
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These treatment modalities are founded on the observation that insight induces emotions. Properly handled and targeted verbal cues are coupled with analyses of "mental tapes" (phrases we keep repeating in our head, such as "I am ugly", "I am afraid no one would like me", "I am incapable of doing this") of inner dialogues and narratives, and of learned behaviors. These are augmented with positive (and, rarely, negative) reinforcements. This is often sufficient to induce a cumulative emotional effect tantamount to healing.
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These postulate that cognition cannot influence emotion. They broach much deeper strata of the psyche. The exposure of these hidden layers induces a dynamic of healing.
Psychoanalysis therapy lets the patient transfer his past experience and superimpose it on the analyst who, in turn, interprets the material thus revealed to the patient.
In other types of psychodynamic therapy, the therapist provides a safe emotional and holding environment conducive to changes in the patient.
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Or Psychodynamic Therapy, Psychoanalytic Psychotherapy
This is an intensive psychotherapy based on psychoanalytic theory without free association (though it is sometimes used). Dynamic therapies are frequently used with "difficult" patients (suffering from all personality disorders - except the Avoidant personality disorder).
Dynamic therapies are eclectic, freely borrowing from other treatment modalities different modes of interpretation and other techniques. The material interpreted is not obtained only through free association or the recounting of dreams and the typical dynamic psychotherapist is a lot more active than the psychoanalyst.
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All the above-mentioned treatments are open-ended and subject to an agreement (a "pact") between the analyst and the analysand (i.e., patient or client). Both undertake to explore the client's problems no matter how long it takes.
Another common - though somewhat misleading - classification is expressive versus supportive therapies.
Expressive therapies seek to uncover (=make conscious) and resolve ("interpret away") - guided by knowledge gained during the therapeutic process - the patient's conflicts and his/her defenses and resistances. Insight thus modifies the patient's abusive behavior.
The supportive therapies are concerned with buttressing the Ego so that it can cope better and alone with external or internal pressures. They encourage the repression of conflicts and their attendant dysphorias and symptoms. Similarly, behaviorism makes no use of insight or interpretation and aims to modify behavior and to relieve symptoms.
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Abusers are usually problematic in group therapy. They immediately size up others as potential friends or potential foes (splitting). They idealize the former and devalue the latter.
Narcissistic abusers are individualists and uncooperative. They hold others in disdain and contempt. They feel humiliated and degraded when they are forced to collaborate with others in the healing process. They likely to fluctuate between feelings of superiority and outbreaks (acting outs) of rage and coercion.
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Views differ [Lowen, 1983].
Abuse is under-reported and healing over-stated. Abusers are intelligent actors and adept manipulators and therapists are often deceived by them. Add to that the shame and guilt the victim feels and society's unwillingness to discuss abuse issues openly - and clearly the phenomenon is little unknown.
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