If hate is reciprocated, then responsibility for the hatred is shared and the patient can feel better about their own hatred. Patients may behave aggressively or passive aggressively in order to provoke hatred in the other and this again creates an intrapersonal conflict for staff. Within forensic populations where the patient’s capacity for hatred may actually have led to the physical annihilation of another, the experience of being hated may be exceptionally painful to tolerate. g. hatred of female staff within a male population mainly convicted of rape and murder of female victims).

Working with these patients therefore involves the risk of assault. Within forensic services, staff often cope with the threat of violence by rationalising aggressive incidents as the acts of a ‘sick person’. Since personality disordered individuals can be difficult to construe as ‘sick’, their aggression may be more difficult to cope with, and Bowers (2002) found a perception that people with personality disorder may be more inclined to use a greater level of force than mentally ill patients. There is also a perception that people with personality disorder are more inclined to resort to instrumental aggression.

2007). Working with these clients is often a test of the staff member’s own ability to tolerate extremes of emotion. In particular, staff need to be able to manage not only the rapidly fluctuating mood but also the range of emotions that the patients struggle to tolerate – that is, those associated with vulnerability (in particular, fear, being hated and shame or humiliation) – without resorting to angry acting out as a means of coping. Fear A number of aspects of this work have the potential to induce fear in staff due to the risk to the physical or emotional integrity of the staff member.