Motiveless malignity: Problems in the psychotherapy of psychopathic patients

Summary — English:

Alvarez explores the differences between the inner worlds of neurotic, borderline, and psychopathic patients, focusing on their distinct forms of destructiveness. She distinguishes neurotic anger, the intense vengeful hatred of paranoid borderline patients, and the seemingly cold attachment to violence in psychopathic patients. The paper examines the emotional difficulties that can arise in psychotherapy with psychopathic patients, including their limited access to emotional connection. Alvarez emphasizes the importance of understanding the patient’s internal world rather than relying solely on diagnostic categories. She highlights the therapist’s need to recognize the specific emotional state of the patient and adapt therapeutic interventions accordingly.