Self-Defeating Aggression and the Need for Rough-and-Tumble Play in Adult Analysis

The belligerent patient poses a challenge to psychoanalysts. In working with an aggressive young man, I describe how I use rough-and-tumble play to meet his verbal assaults, downregulate his emotions, and create space for mentalization. Directing and redirecting his hostility led to new relational possibilities and his enhanced capacity for self-reflection. I discuss the implications for the use of rough-and-tumble play with certain patients to develop mutuality, deepen interpretive work, and enhance their reflective functioning.