Pinned Against the Ropes
Book ticketsOrganised by:
British Psychoanalytical Society (incorporating the Institute of Psychoanalysis)
Description
Therapeutic Relationships in Forensic and Adult Mental Health Settings
Pinned Against the Ropers: Managing Violence and Risk in Community Settings
Delivered Online via Zoom
Recording available for 1 week to all registered participants
This lecture is aimed at nurses, psychiatrists, psychologists, occupational therapists, social workers and other mental health practitioners.
Marcus Evans (Psychoanalyst, Registered Mental Health Nurse), Lisa Conlan (Consultant Psychiatrist, Psychoanalyst), Dr Ronald Doctor (Consultant Psychiatrist, Psychoanalyst),Chaired by Olive Burke (Psychoanalyst)
This online event explores the growing pressure on community mental health and forensic services in assessing and managing violence in the community.
Balancing respect for patient autonomy with the duty of care presents an ongoing clinical challenge—especially when psychosis or entrenched personality structures lead individuals to deny their need for support. Feelings of shame or humiliation around dependency can provoke defensive withdrawal, making even well-intentioned care feel intrusive or persecutory. As a result, patients often reject services precisely when engagement is most crucial. Risk can escalate rapidly if these reactions are misunderstood or avoided—whether out of fear of confrontation or an overcorrection toward preserving autonomy. In such moments, thoughtful engagement in the face of resistance is not simply persistence; it is a clinical imperative.
Violence risk assessment is never an exact science. Risk is dynamic and can shift suddenly, especially in community contexts where contact with patients is limited. Staff are often under immense pressure to make finely balanced decisions, typically with incomplete information and under emotionally charged conditions. What kinds of structures best support clinicians in navigating these conflicts—between the risk of overreach and the danger of inaction? The anxiety surrounding such decisions can impair clinical judgment, leading to either excessive caution or unwarranted deference to autonomy. Yet responsibility for these decisions cannot be deferred. Paradoxically, avoiding action in the name of independence may undermine the very care and safety that ethical practice is meant to protect.