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Over five years, from 1919 to 1924, Freud dealt with masochism in three texts written in close proximity: “A Child Is Being Beaten,” Beyond the Pleasure Principle, and “The Economic Problem of Masochism.” Initially Freud explains masochism as incestuous fixation on the father and regression to pregenital, sadistic ways of loving. Subsequently he considers it primarily as subservient to the death drive. This paper starts from an idea present in two of the three texts, but not developed by Freud, in which he refers to the role that the “qualitative” element of rhythm could play in the occurrence of pleasure in masochism. By means of this element traumatic aspects of the primary relationship with the object could be stored as fantasies in the body. In any staged masochistic fantasies of being beaten or in masochistic perversion, the pleasure of pain would lie in the attempt to “dream” the trauma not only in the imagination but also, “aesthetically,” in the body.

The ways in which the analyst's desire for particular experiences with patients is inevitable and often leads to narcissistically based resistances are considered. Five propositions are examined: (1) that the analyst cannot help but have desires and want them recognized by the analysand; (2) that these desires frequently underwrite the analyst's theoretical beliefs and technical interventions; (3) that narcissistic desires and their influence are ubiquitous among practicing analysts; (4) that the patient is often on the lookout for the analyst's various agendas; and (5) that the patient often hopes the analyst will put his or her desire aside and listen so the patient can further his or her own interests. Lacan's concept of the “dual relation” is central to this discussion. The neo-Kleinian position on narcissistic resistances is explored, as is the idea of the “analytic third” as a potential solution to the problem they pose. An extended case description illustrates the main points.

Volumes have been written about the patient's love for the therapist, but there has been relatively little discussion of the therapist's love for the patient. In an attempt to create a theoretical and technical space for discussing the appropriateness and role of love in the therapeutic relationship, a revised concept of the therapeutic alliance is applied to provide technical guidelines and understanding of two kinds of love between patient and therapist, corresponding to two systems of self-esteem regulation: an open, reality-oriented system and a closed, sadomasochistic system organized according to omnipotent beliefs. Examples of the role of love through the phases of treatment illustrate the interrelationship of love and the accomplishment of therapeutic alliance tasks.

This paper traces the history of the therapeutic alliance concept, examining how it has been used and misused, at times elevated to a central position and at others rejected altogether. The loss of this concept created a vacuum in classical psychoanalysis that has been filled by rival theories. The continuing usefulness of looking at the treatment process through the lens of the therapeutic alliance, particularly in relation to the manifold difficulties of working with sadomasochistic pathology, is suggested. To this end, revisions of the theory of the therapeutic alliance are suggested to address some of the difficulties that have arisen in conceptualizing this aspect of the therapeutic relationship, and to provide an integrated dynamic model for working with patients at each phase of treatment. This revised model acknowledges the complexity of the domain and encompasses the multiple tasks, functions, partners, and treatment phases involved. The utility of the revised theory is illustrated in application to understanding the sadomasochistic, omnipotent resistances of a female patient through the phases of her analysis.

The role of perverse sexuality as an organizing influence in “multiple personality” is explored in this paper. Following a brief review of psychoanalytic thinking on sexual trauma and perversion, the author discusses his own views on dissociation and “multiple personality.” A clinical case is then presented in which transsexualism, homosexuality, and sadomasochistic heterosexual practices were manifested during altered ego states. Analysis of the transference revealed the centrality of sadomasochism in this patient. It is hypothesized that various perverse structures may be formed within these seemingly autonomous, amnestic states, in order to contain anxiety and encapsulate the aggression which resulted from early psychic trauma. Issues relating to diagnosis, counter-transference, reconstruction, and psychoanalytic technique are discussed also.If each, I told myself, could but be housed in separate identities, life would be relieved of all that was unbearable …Robert Louis StevensonThe Strange Case of Dr. Jekyll and Mr. Hyde

The development of a rageful sadomasochistic transference early in an analysis is presented. We describe key interventions that foster its resolution and offer a reconstruction of the patient's early life, focusing on difficulty in the rapprochement phase. We believe that the intense and difficult to manage sadomasochistic transference was linked to a repudiation of both preoedipal and oedipal triangulation, resulting in the perpetuation of a hostile dependent motherchild dyad and in the patient's unconscious belief that sadomasochistic interactions were the only means of establishing and maintaining a close relationship. THIS PAPER CONCERNS A RAGEFUL sadomasochistic transference which dominated the early stage of an analysis—an occurrence surprising to both analyst (B. J. Seelig) and supervisor (E. S. Person), since the patient had originally been diagnosed as a hysterical personality and was believed to be an almost ideal analytic patient. Only later did we discover that our patient, Miss T., had throughout her life invariably clung to a primary relationship considered by her to be the only meaningful one in her life, and characterized by a reciprocal victimvictimizer dynamic. For her, such a sadomasochistic interaction constituted the paradigm for any intimate relationship. Early on in the analysis she felt misunderstood and abused

Masochistic phenomena in adults are discussed as derivatives of conscious and/or unconscious fantasies. These masochistic fantasies are always associated with conscious and/or unconscious narcissistic and sadistic fantasies. These fantasies, like all fantasies in adults, are conceived of as compromise formations. After a selected review of the literature, analytic data are presented to highlight the clinical advantages of a contemporary elaboration of the structural hypothesis for the understanding of sadomasochistic and sadomasochistic phenomena.

This paper focuses on the process of working through in psychoanalysis. Reemphasis of the centrality of the empathic listening perspective and discovery of the selfobject transferences made it necessary to reconceptualize various aspects of the analytic process from the perspective of psychoanalytic self psychology. With the help of a clinical vignette, the paper illustrates the manner in which archaic defense organizations and newly developing psychic structures find a compromise solution in a transference symptom. Such symptoms can serve as nodal points in the process of working through; they represent a transitional phase between the old automatic responses to narcissistic injury and an increased capacity to use signal anxiety. The psychopathology that became illuminated in this process can be described phenomenologically as a self–defeating personality disorder.

A case is reported in which a young man for several years experienced his analysis primarily as a source of pain. Each new insight he achieved was an occasion for increased distress rather than liberation. Considerable analytic work elucidating motives for this negative therapeutic reaction produced no change in it. Eventually, it could be determined that the patient's need to suffer within the treatment relationship served a specific form of denial in fantasy that has not, to the author's knowledge, been described elsewhere. The importance of covert libidinal, object-preservative aims in such frustrating and destructive impasses is discussed, as well as the role of countertransference enactment.

The history of ideas about perversion is considered, along with an examination of whether the concept is clinically useful. Three cases of varying degrees of severity are presented, illustrating the clinical value of the concept in the analytic situation. All three cases are women, and the particular usefulness of the concept of perversion for women is noted. The place of aggression and the pleasure resulting from its expression are highlighted.

A very powerful form of preoedipal guilt stems from a sense of having damaged the life-giving parent with one's most basic needs. A related phenomenon is the child's sense that another subjectivity has deliberately chosen to give and sustain the child's life. This experience gives rise to a compelling mixture of awe, reverence, and obligation, a sense of guilt about being born, of debt concerning the gift of life . This sense of guilt and debt are part of every child's development. Depending on how conflicts surrounding them are negotiated, the child can come to feel either an appetite for living or a crushing sense of selfishness and unworthiness. Such forms of guilt and debt may lead not only to masochism generally, but to a particularly pernicious form of negative therapeutic reaction that can sabotage psychoanalytic work. A patient may feel, for instance, that a successful psychoanalysis is a selfish indulgence and an immoral betrayal of a sacred duty to rescue his or her parents from their misery. Guilt about being born and the sense of debt concerning the gift of life are linked to various developmental, psychodynamic, interpersonal, and cultural phenomena.

The psychoanalytic literature on altruism is sparse, although much has been written on this topic from a sociobiological perspective. Freud (1917) first described the concept in “Libido Theory and Narcissism.” In 1946 Anna Freud coined the term “altruistic surrender” to describe the psychodynamics of altruistic behavior in a group of inhibited individuals who were neurotically driven to do good for others. The usefulness and clinical applicability of this formulation, in conjunction with the frequent coexistence of masochism and altruism, encouraged psychoanalysts to regard all forms of altruism as having masochistic underpinnings. Since then, there has been a conflation of the two concepts in much of the analytic literature. This paper reexamines the psychoanalytic understanding of altruism and proposes an expansion of the concept to include a normal form. Five types of altruism are described: protoaltruism, generative altruism, conflicted altruism, pseudoaltruism, and psychotic altruism. Protoaltruism has biological roots and can be observed in animals. In humans, protoaltruism includes maternal and paternal nurturing and protectiveness. Generative altruism is the nonconflictual pleasure in fostering the success and/or welfare of another. Conflicted altruism is generative altruism that is drawn into conflict, but in which the pleasure and satisfaction of another (a proxy) is actually enjoyed. Pseudoaltruism originates in conflict and serves as a defensive cloak for underlying sadomasochism. Psychotic altruism is defined as the sometimes bizarre forms of caretaking behavior and associated self-denial seen in psychotic individuals, and often based on delusion. We consider Anna Freud's altruistic surrender to combine features of both conflict-laden altruism and pseudoaltruism. Two clinical illustrations are discussed.

Distinguishing perverse defenses from the concept of obligatory perversion allows perverse defenses to be examined in neurotic patients. Perverse defenses against reality, one's conflicts, and relationships with others are connected with affect intolerance, difficulty with analytic collaboration, and analytic impasse. Perverse defenses, including the cultivation of states of distraction, excitement, and pomposity, as well as perverse sadomasochistic relations with others, protect against the unbearable: intense affects, painful ideas, and loving, committed need of a valued, distinct person. Patients' perverse, vindictive refusal to be reasonable provokes perverse countertransference reactions whereby the analyst stands in judgmentally and critically for the seemingly absent demands of reason, morality, and analytic progress.

In the context of viewing the analytic setting as a "clinical laboratory" to study the nature of love relations, this paper starts by outlining the relationships of transference love, "normal" love, neurotic love, and oedipal love. After a description of the vicissitudes of transference love when patient and analyst are of the same sex and of opposite sex, developments of transference love regarding homosexual and heterosexual longings in neurotic and narcissistic pathology are considered. Countertransference reactions in response to transference love are explored next, with emphasis on conditions under which erotic countertransference may become particularly intense. In describing the technical management of erotic countertransference, the analyst's ability to explore his own feelings and fantasies without constraint is stressed. The usefulness of understanding the erotic countertransference in arriving at transference interpretations is illustrated by a clinical case of a female patient with a neurotic personality structure and predominantly masochistic conflicts.

Defense against recall of painful affect is proposed as a significant element in the complex entity of neurotic sadomasochism and symptom formation. This formulation requires that the fantasy of reversibility-what happened can be undone-be analyzed in the transference and predict, for the patient, a painful feeling of loss and rage. The structure and tenacity of the powerful resistance to this work has the regressive, anal nature of reversibility which is also seen in the sadomasochistic characteristic of self and object interchangeability. The perceived threat of loss may be understood as related to early object loss, either whole or partial, and is associated with a flawed body image. Because the formative circumstances lie deep within the patient's past, reuniting residual affect, historical event, and early wishes by means of reconstruction is the only means, of resolution. But, because it requires the relinquishment of the sustaining illusions of the sadomasochistic structure-omnipotentiality, omnipotence and bisexuality-the process will be experienced by the patient as intensely narcissistically dangerous. Vignettes from the analyses of two women illustrate the thesis and suggest the scope and direction of its clinical application.

This paper explores the relation of the delusion of omnipotence to masochism and suggests that this fantasy constitutes a major component of the resistance so prominent in work with masochistic patients. The connections among masochism, omnipotence, negative therapeutic reaction, and clinging to pain are discussed. The classical view has been that the failure of infantile omnipotence forces the child to turn to reality. Our experience with masochistic patients suggests that it is the real failure to achieve competent interactions with others that forces the child to turn to omnipotent solutions. The distinction is made between fantasies that enhance the real capacities of the self and those aimed at denying and transforming the pain and inadequacy of the mother–child relationship. The epigenetic transformations of omnipotent fantasies through all levels of development are described. The patient's need to protect the omnipotent fantasy is discussed in relation to resistance at each phase of analysis.

Sadomasochism, an ingredient of infantile sexuality, is an essential part of normal sexual functioning and love relations, and of the very nature of sexual excitement. Sadomasochistic elements are also present in all sexual perversions. Sadomasochism starts out as the potential for erotic masochism in both sexes, and represents a very early capacity to link aggression with the libidinal elements of sexual excitement. Sexual excitement may be considered a basic affect that overcomes primitive splitting of love and hatred. Erotic desire is a more mature form of sexual excitement. Psychoanalytic exploration makes it possible to uncover the unconscious components of sexual excitement: wishes for symbiotic fusion and for aggressive penetration and intermingling; bisexual identifications; the desire to transgress oedipal prohibitions and the secretiveness of the primal scene, and to violate the boundaries of a leasing and withholding object. The relation between these wishes and the development of erotic idealization processes in both sexes is explored in the context of a critical review of the pertinent psychoanalytic literature.

The author summarizes and develops some of her viewpoints on the perversions (outlined in several of the books and articles she has written. For her all the perversions, whatever their content, develop against an anal sadomasochistic backdrop. Their aim is to destroy reality. Reality, from a psychosexual perspective, may be defined as resulting from the existence of the father separating the mother and the child. This may be formulated in another way: reality is recognition of sexual and generational differences. Or, yet again: mother and father have a procreative sexuality, whereas the child does not. This leads to the idea that the destruction of reality is equivalent to destruction of the paternal universe. Clinical case illustrations are provided, one of which centers on the assassination of an old man who, besides representing a paternal oedipal image, also represents reality itself. This case illustrates in concrete form the murder of the father, and hence of reality, accomplished by the pervert when he eradicates the paternal dimension of psychosexuality by regressing to the anal sadomasochistic dimension.

Clinical material is presented from two patients where hypochondriacal symptoms were seen to be derivatives of unconscious fantasies of being beaten or tortured. The shift along the masochistic axis from these underlying fantasies to the conscious hypochondriacal symptoms is seen as subserving the important defensive purpose of reducing the patients' perception of their conscious guilt feelings.

In this paper, I propose a general classification of masochistic psychopathology and describe relations between this clinical domain and, other types of psychopathology. My main objective is to provide an outline relevant for diagnostic, prognostic, and treatment considerations of masochistic pathology. This includes descriptions of and relations among a wide variety of masochistic phenomena from the depressive-masochistic personality to extreme forms of self-de-structiveness. Ego organization, object relations, superego development, narcissistic organization, and polymorphous perverse infantile sexuality are considered as codeterminants of the levels and clinical features of masochistic pathology. Finally, the relations between masochistic pathology and negative therapeutic reactions are reexamined.

Psychoanalytic advances have led to refinement and reformulation of early models of female personality development. Masochism was taken as a point of departure for a study of the psychology of women and earlier hypotheses of a masochistic and inferior female psychic structure. Masochism is a residue of unresolved infantile conflict and is neither essentially feminine nor a valuable component of mature female function and character. Though the female might be more predisposed to masochism, there is no evidence of particular female pleasure in pain. It is important to distinguish between masochistic suffering as a goal in itself, and tolerance for a discomfort or deprivation in the service of the ego or ego ideal. Initial hypotheses of a diminished female libido, ego tendencies toward arrest and rigidity, relative inability to sublimate, and a deficient superego are incomplete and obsolete theoretical propositions. The female ego and superego are different from but not inferior to the male. Female development cannot be described in a simple reductionism and overgeneralization. Femininity cannot be predominantly derived from a primary masculinity, disappointed maleness, masochistic resignation to fantasied inferiority, or compensation for fantasied castration and narcissistic injury. Castration reactions and penis envy contribute to feminine character, but penis envy is not the major determinant of femininity. Penis envy variously impedes and fosters femininity but penis envy is more closely related to the girl's bisexual masculinity. The female Oedipus complex is central to feminine development, but has significant normative roots in primary and positive feminine identifications and individuation. Contemporary contributions to the psychology of women have emphasized concepts of gender and sexual identity, body image and self-representation, psychosexual response and empathic motherliness, etc. The female superego includes an ego ideal with feminine ideals and values and regulates feminine interests. The maternal ego ideal consolidates overdetermined maternal attitudes, guides the formation and integration of maternal attitudes, and directs the developmental achievement of "the ordinary devoted mother." Conflicts between the maternal ego ideal and infanticidal impulses are ubiquitous and clinically significant. Current theoretical amendments conceptualize mature female autonomy, pride, and self-esteem. Female creativity may be exemplified in many and new forms in addition to motherhood. The capacity to sublimate and to foster sublimation in children is a prerequisite for normal motherhood. Femininity evolves under the influence of parents and culture, with unique developmental challenges and transformations, and a universal psychobiological core linked to functions and roles that should be neither idealized nor devalued.

This paper summarizes the major strengths and weaknesses of current psychiatric nosology, and then discusses various forms of masochistic behavior as one illustration of how psychoanalysis can contribute to the continuing evolution of psychiatric nosology. Masochistic behavior is separated into behavior in which there is a predominantly conscious link between pleasure and pain, and behavior in which that link is predominantly unconscious. Both categories are further separated into normal and pathological forms. The current diagnostic category of dysthymic disorder is then discussed, with consideration given to the contribution that psychoanalysis can make toward the clarification and delineation of this heterogeneous diagnostic category.

This paper explores the ontogeny of fear of humiliation, conceived of as an important organizing affect-laden fantasy in certain narcissistic personality disorders. The influence of the pleasure of the parental object in sadistically humiliating is emphasized in the overdetermined genesis of this fear. While, in elaboration of Loewenstein's (1957) and Eidelberg's (1959) contributions, "seduction of the humiliator" is a fundamental defensive process observed in masochistic characters, identification with the humiliator is a sadonarcissistic defense observed in work with certain narcissistic personality disorders. The countertransference potential to enjoy humiliating such analysands, as well as the defensive functions of fear to humiliation, are noted.

The role of therapeutic strategy within psychoanalytic technique is described. An antistrategic bias inherent in certain aspects of the “classical” technique is explored in relation to the historical development of psychoanalysis. Clinical expertise, which includes the making of strategic or tactical choices, is relegated to the “unofficial,” due in part to this negative bias impeding the study of technical differences in favor of general agreement about a theory of technique that may differ considerably from actual clinical work. A case is presented that illustrates strategic choices in the management of a severe character resistance in a supervised analysis. Some consequences of a negative bias against therapeutic strategy as it relates to psychoanalytic training is described.

In this paper, I have presented the assumption that some symptom pictures such as attachment to pain, the masochistic character, the negative therapeutic reaction, a basic depressive response, and anhedonia are rooted in a prevalence of organismic distress during the symbiotic phase. Neuroscientists taught us that early experiences are associated with the neuronal structuring of the developing brain, which then affects concurrent or subsequent reactions. In particular I followed Ginsburg's (1982) assumption of a neuronally, genetically given aggressive drive potential which influences and is influenced by early experiences, and which can interact with other gene potentials. In some patients aggressive drive components contributed to a less than harmonious basic core associated with failure of the early infant/mother interaction. Unpleasure prevailed during the symbiotic phase; aggressive energies predominated and enmeshed with the neuronal encoding, the early structuralization in both the neurophysiological and psychological meaning. Thus, the structuring of the function of internalization and the emerging self-object experience were disturbed from early on. This then continued to foster a proclivity for unstable (fusion and) diminished neutralization tendencies. As biological discharge phenomena evolve into vague psychological awareness, such an infant does not attain a sense of well-being, but rather attains a sense of "not-well-being" (Joffe and Sandler, 1965) which remains continuous or can be triggered--kindled--by any reactivating constellation, and the object is experienced as a source of unpleasure. This is in line with Mahler's bad mother and bad self-introjects. Primary narcissism has not evolved well or, said differently, is invested more with aggressive than with libidinal cathexis and is in an unfortunate association or balance with primary masochism. Aggressive drive components subsequently color fantasies, readiness for and severity of conflicts. The aggressivization of self-feelings and of the function of internalization with its influence on--and exacerbation of--the rapprochement crisis is traced into later symptomatology. The basic pathology as described in this paper then compounds the oedipally derived problems.

The study of the legend of Tristan and Iseult in terms of the multiple fantasies it might express adds to our understanding of the psychology of love. In a previous paper (1975), I delineated, via allusion to the Tristan legend, the romantic-erotic conditions sometimes involved in creativity. In this one, I have approached the question of love from the other direction and have tried to delineate the creative-adaptive conditions required for integrating the experiences of loving and being in love. The "High tale of love and death," the Liebestod fantasy realized, is still with us, but the happier ending may be a realistic, viable alternative.