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Letters to the Editor   |    
Dr. Horowitz Replies
Am J Psychiatry 2007;164:976-976.
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To The Editor: Dr. Boylan is correct in emphasizing the difference between adults and children in the therapy process in working through revenge fantasies that may follow traumatic experiences. No one can accurately distinguish veridical memory from fantasy memory, and children are even less able than they will be as adults at knowing the difference at the time of the experience and knowing the difference on later review. The child is less oriented to review and more oriented to completing a story in a future projecting way that seems to preserve personal safety. That is probably the first priority—to help them do this—in most cases.

As Dr. Boylan states, revenge fantasies, if and when present, are likely to find displaced targets, in play with an agentic self, have more than usual destructiveness, as well as influencing direct negative behavior toward people who are “safer” to attack than the actual aggressor. Unfortunately, the “safer” individual may be the child’s own self, which might be manifested through self-harming behaviors such as pulling out hair, picking off skin, or knocking the head.

When a child or adolescent displays play, fantasy, or interpersonal behavioral patterns that appear to enact revenge, it may be beneficial to encourage translation of the somatic actions into verbal statements. This may help to increase self-control and interpersonal regulation. This could be done through conversation with therapists or good caretakers. An example of such would be as follows: “I guess you are still pretty angry that you got beat up. I also might feel scared and then mad until I felt I was okay and safe again.” The point is not a catharsis in the old-fashioned sense of emotional venting, but the emphasis on the “okay and safe” concept of completing a reaction to traumatization.

+Dr. Horowitz’s disclosure accompanies the original article.




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