A Sadomasochistic Transference - Beth J. Seelig, MD

1991). Journal of the American Psychoanalytic Association, 39:965-965
A Sadomasochistic Transference: Its Relation
to Distortions in the Rapprochement Subphase
Beth J. Seelig, M.D. and Ethel S. Person, M.D.
ABSTRACT
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
—————————————
Dr. Seelig is Assistant Professor of Psychiatry, Emory University School of Medicine;
Supervising and Training Analyst, Emory University Psychoanalytic Institute. Dr. Person
is Supervising and Training Analyst, Columbia University Center for Psychoanalytic
Training and Research; Professor of Clinical Psychiatry, Columbia University College of
Physicians and Surgeons.
We thank Drs. Arnold Cooper, Gerald I. Fogel, and Michael H. Stone, and the late Dr.
Robert S. Liebert for their valuable comments on an earlier version of this paper.
Accepted for publication April 30, 1990.
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by the analyst, and accordingly felt entitled to be rageful in return (Coen, 1988);
she became intensely angry, accusatory, guilty and guilt-provoking. These feelings
did not prompt her to leave analysis, but seemed to enmesh her in an intensely

painful relationship, leading to an analysis that, in its opening phases, was
agonizing for the patient and, at times, for the analyst as well.
We shall present some detailed verbatim excerpts from the early analytic
material to convey the nature of the transference in which Miss T. was
alternatively angry at the analyst or at herself (sometimes at both) and the
difficulties this presented to the analyst's attempt to maintain an analytic stance.
We shall then draw attention to some key interventions that fostered resolution of
this aspect of the transference.
In the course of struggling to intervene in and interpret the transference, we
arrived at a reconstruction of the patient's early development. Her sadomasochistic
pathology (and the transference that derived from it) appeared to be the outcome
of an early and ongoing distortion in the mother-child bond, with concomitant
failure to achieve normative preoedipal and oedipal triangulation. We shall present
clinical material that led us to this reconstruction, focusing on the developmental
epoch during which rapprochement and preoedipal triangulation occur—more or
less successfully. The tentative nature of Miss T.'s preoedipal triangulation
appeared to be the result not only of her sadomasochistic entanglement with her
mother, but also of the way she perceived her mother as actively interfering in her
relationship with her father, and a corresponding feeling that her father quickly
withdrew from any potential struggle with her mother. As might be anticipated and
as is evident in the clinical material, Miss T.'s oedipal longings (both historically
and in their contemporary editions) were embeded in a sticky pregenital matrix in
which the quest for intimacy with more than one person was experienced as
strictly forbidden, and intimacy with one person was compromised by
sadomasochistic distortions.
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We believe that our reconstruction confirms and extends formulations by
Stolorow (1975) and Cooper (1985), (1988) on the preoedipal determinants of
sadomasochistic and narcissistic-masochistic character pathology. We shall focus
on those factors that militate against the patient's "escape" from the pathological
dyad to refuge with a third party. In addition, we shall emphasize how
sadomasochism sometimes may be invoked as the only viable means of
establishing and preserving a sense of mutuality, and here we shall draw on some
theoretical constructions of Stern (1985) and Benjamin (1989).
Background
Miss T. was psychologically minded and highly intelligent. She was
diagnosed as having a hysterical character with depressive and phobic features.
Once in analysis, however, she quickly developed an intense sadomasochistic
transference regression, demonstrating borderline structural features (as described

y Kernberg, 1984) that had not been apparent in the initial evaluation—so much
so that at times we questioned the validity of the initial neurotic diagnosis. It was
only after some of the intense pregenital material was worked through in the
transference that Miss T. presented a more classically neurotic picture, at which
time the familiar oedipal dynamics manifest in the evaluative consultations could
be productively analyzed.
A slender, attractive, slightly boyish-looking twenty-two-year-old college
senior who was living with her boyfriend, E., Miss T. began analysis to "resolve
conflicts which I have about myself." When asked to elaborate, she went on to say,
"I am not sure what I want to do careerwise and I feel that I am afraid to live up to
my full potential."
Her problems, as she experienced them, first manifested themselves in college
in academic underachievement, in her inability to commit to a course of study
commensurate with her gifts, and in increasing anxiety. In part this anxiety was
said to
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have been alleviated by her love relationship with E., a relationship presented as a
mutually rewarding one, based on concordant interests and satisfying sex. She
reported that she had close and enduring friendships and a variety of interests. Her
ongoing problems seemed to be restricted to her academic life, where her
performance had been hampered by such severe anxiety that her whole experience
of college was "painful."
Miss T. was a middle child with two older sisters and a younger brother, and
she had always felt like the "superfluous girl." Her father was a social worker who
worked long hours and her mother was a chronically depressed housewife, a
highly intelligent woman whom Miss T. saw as having sacrificed her own
ambitions to live in her husband's shadow.
Miss T.'s relationship with her mother was tempestuous, both close and
argumentative, but she felt remote from her intellectual, authoritarian father. She
was described in her family as the embodiment of the little girl in the nursery
rhyme who "When she was good … was very, very good, but when she was bad
… was horrid." Painfully envious of all her siblings, she felt she was the only one
who did not have a special place in the family. Miss T. reported that her two older
sisters were valued because they were very beautiful, but as the not especially
attractive third sister, she felt that she was little more than the byproduct of her
parents' efforts to have a son. Nonetheless she described an uneventful
developmental course, with the ability to function well both socially and
academically. But her envy of her siblings, especially of her brother, continued

unabated, fueled by their ability to perform well academically with ease and to
chart "appropriate" career goals.
Miss T.'s union with E., which had seemed to be evidence of her ability to
form a mature heterosexual bond, was later shown to be essentially asexual, what
we would call pseudoheterosexual, and beset with anger and mutual
recriminations. In contrast, she had developed a different way of relating to people
with whom she was only moderately close: with such friends, she was always
"good." She had the feeling, however, that the
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way she was in relation to these friends was somehow not really authentic.
Initially, her protestations of being "really" a nasty person despite being a good
friend were incompletely understood as the expression of an overly severe
superego in a neurotic patient. Later, we came to understand them as part of a
masochistic and narcissistic defensive structure.
Treatment
Although we are not reporting material from sessions in which the
transference rage was in abeyance, Miss T., the little girl who "when she was good
… was very, very good and when she was bad … was horrid," had many calm
sessions in which she was able to behave as a "very good" patient.
In her first dream, reported during the second couch session, Miss T. arrived
for a session at the wrong time. Finding her analyst with another patient, she was
about to leave, when a male analyst offered to "make it up" with her. She was on
the verge of accepting the offer when it occurred to her that this would be
"ridiculous," and she left. She then found herself in an elevator with a woman who
was laughing at her for being stupid, and she became furious. When asked to
associate to the idea of having a male analyst offer to "make it up," she said she
had felt disappointed that she had been referred to a female analyst, because she
felt that women really could not do work as good as that of men. She thought,
however, that having a woman analyst might help her overcome feelings of
inferiority associated with her femaleness.
In retrospect, Miss T.'s initial dream presaged the trajectory of the
transference. She wished to be able to turn to a third person (the male analyst of
the dream, or her father) to help her to extricate herself from her hostile-dependent
tie to her mother and to feel better (be less burdened by the image of herself as the
bad little girl), but in the dream, as later in the transference, she could not allow
herself to accept what was offered. The offer was "ridiculous." Feeling derision
toward
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herself, she immediately projected that feeling onto a mother surrogate, the
derisive woman (mother/analyst) with whom she was in the elevator (claustrum).
It is this image, of being stuck with a condescending maternal figure, with its
concomitant affects of bitterness and rage, which erupted into the transference and
required immediate attention, taking precedence over the seemingly manifest
issues of penis envy and oedipal conflict which in fact could be addressed only
much later in the analysis.
By the nineteenth session, Miss T. was overtly angry at the analyst. She
started the session crying silently and then began to talk slowly about her sadness
at having left a part-time job in which she had felt capable and accepted by coworkers
and superiors alike.
Miss T.:
It's all over, so that's that. On my way here I was feeling sad and good; I
really accomplished something. I did a good job, now I'm just sad.
Analyst:
What do you make of that?
Miss T.:
It's easier to talk about feeling sad [Three minute silence (crying)]. I
don't see what's the good of talking right now. It's not going to change
anything. You're not going to say anything. Why bother? I don't
understand anything from other days. Why should I now?
Analyst:
You sound reproachful that you haven't learned much about yourself yet.
Miss T.:
It's just making me angry—lying here like a food. I'm wasting time just
lying here. You never just answer a question. It's always "What does it
mean to you?" [pause]. If I leave here angry, I'll go home and have a
fight with E. I guarantee it.
In fact, that was exactly what Miss T. did; she went home and provoked an
argument with her boyfriend. When the acting out was interpreted, she agreed that
she was fighting with
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E. because of her rage at the analyst and she used this to "prove" that the analysis
was harmful rather than helpful. This anger was not only not resolved, but
continued to escalate in the early months of the analysis.

Miss T. easily felt betrayed when the person with whom she was involved did
not live up to her expectations. For example, her initial treatment fee had been set
at a reduced rate, with an agreement to increase it when Miss T. got a job after
graduation. When she succeeded, the fee was increased, and Miss T. became
furious, feeling that the amount of the increase meant that the analyst had lulled
her into a false sense of security and had now betrayed her trust.
It might be asked why, when Miss T. was already angry, we elected to
increase the fee as had been agreed initially. We believed that not to raise the fee
would have been to "fail" Miss T. in another way. Had she felt that her analyst was
coerced either by a sense of her fragility or by a fear of her anger, her own
conviction of being too sick, or else intolerable would have been confirmed. Miss
T. had felt that during her entire life she had never made the right choice, and she
attempted to maneuver the analyst into feeling the same way.
Miss T.:
[Walks in avoiding looking at the analyst; lies down]. I'm just here to tell
you how upset you've made me. I knocked down my dresser yesterday.
I'm furious! I don't know what I'll do. Maybe I'll put my hand through a
window. Now I'm covered under Blue Cross.
Analyst:
You're describing a situation in which your suffering will show and you'll
get someone other than me to help you.
Miss T.:
Yeah and you don't… How do I get a new analyst? Tell me that! There's
nothing sick about thinking that you should care! This analysis can't
work, why not forget it and get someone else? I'm still as crazy as I was!
How can your ears take this yelling?
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Analyst:
You think that if you yell until my ears hurt, that you are making me
suffer just as you do. We are together in suffering.
Miss T.:
[Yelling at the top of her voice] I do want you to suffer because you don't
care! You fucked me up! I'd rather be dead! Maybe I will do something.
After my suicide, you can analyze that!
Attempts to explore either the suicidal fantasies themselves or her resort to
suicidal fantasies as a message to the analyst were met by angry silence. The
following day, Miss T. accused the analyst of having caused her sore throat

(because she had yelled so much). Miss T. taunted the analyst by saying she would
just have to live with the uncertainty of whether or not she would kill herself, and
if the analyst tried to hospitalize her, she knew exactly what to say and how to act
so that she would never be admitted. She gloated over this fantasy in which the
analyst looked like a fool in front of the psychiatric resident in charge of
admissions. Retaining an analytic stance in the face of this intense aggression was
difficult, and led on a few occasions to failures of empathy which further fueled
the patient's rage. At times the thought crossed the analyst's mind that life would
be easier if Miss T. would go ahead and kill herself (a complementary
countertransference position as described by Racker, 1957).
During this time, as Miss T. continued to heap vituperations on the analyst
and to act out her rage with her boyfriend at home, she behaved appropriately at
work and became a valued employee. She accused the analyst of secret amusement
because she was certain that the analyst knew that she (Miss T.) was unable to
leave the analysis no matter how badly she was being abused. The analyst pointed
out that while Miss T. was accusing her analyst of getting secret pleasure out of
Miss T.'s suffering, Miss T. was in fact secretly enjoying berating the analyst and
feeling morally superior to her. This was rejected, as were other interventions, as
an effort to "turn everything around and make
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me [Miss T.] feel crazy." At the end of one of these furious hours, she stated, "I
don't think it'll be a good analysis, but there's no choice, so we'll sit here in this
battle for years and years."
It should be repeated that these rageful sessions did not represent the entire
analysis during this period. Intermittently, Miss T. would talk calmly about her
work or social activities, as if the rage did not exist. The analyst became aware of
a countertransferential reluctance to disturb this calm, sometimes feeling as if she
and the patient were together in the eye of a hurricane. When the storm resumed,
the analyst found herself wishing that Miss T. would leave and go torture some
other analyst—for instance, her supervisor.
Miss T. had an extreme need to have every perception validated. When this
need was not met, she could not allow herself even to hear what the analyst said. If
the analyst did not seem to agree with her every perception, then either she or the
analyst had to be "crazy," i.e., totally out of touch with reality. It was this aspect of
the transference that had to be addressed before any further work could be done.
However, it was extremely difficult to subject this attitude to analytic scrutiny,
since to do so meant to present Miss T. with a viewpoint other than her own, an
intervention she experienced as an attack on the core of her being.

The first observation to make an inroad into the patient's rageful insistence on
unanimity was the analyst's (oft-expressed) statement that she (Miss T.) felt the
analyst failed to understand her in a fundamental way. This statement was itself
extremely difficult for Miss T. to hear and accept because when the analyst said,
"you feel that I don't understand you," Miss T. interpreted this to mean, "You feel
that I don't understand you, but I do; your feeling that I don't is wrong." Gradually,
over some months, the analyst was able to point out that her sense of being
misunderstood served as a source of secret gratification (just as for the
masochistic-narcissistic patients Cooper [1988] described, "being disappointed or
refused becomes the
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preferred mode of narcissistic assertion" [p. 128].) Gradually, Miss T. became able
to scrutinize her own behavior for longer periods of time, without diverting the
focus by angry accusations directed at the analyst.
Although she was unable to utilize clarifications, let alone interpretations,
during her rages, Miss T. slowly came to acknowledge, during her calm periods,
the truth of the observation that she had radically different perceptions of people
depending on whether she was calm or in an affective storm. She began to see that
these strikingly differing perceptions of the analyst and of other people were part
and parcel of her different perceptions of herself. When she was angry, she hated
her analyst and believed the analyst to be evil while she herself was good. When
she was not angry, she liked and sometimes even loved the analyst and thought
herself a bad patient, but when she became angry again the affectionate feelings
made her feel like a fool who had been duped by false promises. As these elements
of the transference became clearer to Miss T., she began to feel that she and the
analyst could be allies in an attempt to understand the terrifying rage and the sense
of desolation she had struggled with her entire life and which were now activated
in the transference.
Session 177
Miss T.:
I had a terrible day and a terrible night. I don't know what I can do to
get someone to believe it, I spent two hours crying and hitting myself. It's
not normal … I just want to die … I really hurt. No one understands
what's so terrible. No one can help. If speaking English doesn't work, so
I'll do something.
Analyst:
What were you thinking of when you hit yourself?
Miss T.:

I wanted to die. There was no one to talk to. No one is listening to me.
Normal people don't hit themselves. If
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I speak rationally, people think I am rational. I'm not. This is not normal!
Analyst:
It's clear that it isn't normal for you to hit yourself and to feel like killing
yourself when you feel unheard and alone, but it seems that you feel very
strongly that only actions will really get through to me.
Miss T.:
That's so.
Analyst:
You're also frightened to analyze what all this means.
Miss T.:
I'm afraid you'll show me terrible things. I know you're trying to be
consistent, to always be there, to understand, and I know it in a different
tone of voice, even though I can't say it in another way.
As the patient consolidated a measure of trust in the analyst, her outbursts of
rage shifted to her personal life. The relationship with E., which had seemed at the
outset to signify achievement of mature heterosexuality, soon took on quite a
different coloration. Miss T. began complaining bitterly about E., claiming he only
thought about himself and his own needs and was never concerned with her needs.
As E. planned a trip to visit his parents without her, she felt rejected and rageful
that he was going when she could not accompany him because she didn't have the
price of a ticket.
Just prior to E.'s departure, they had a fight in which he threatened to leave
her. She reported feeling calmer and stated that she was glad as soon as he was
gone. Then she reported a dream:
There are two things going on. I went to the place where I work [a temporary
job], but I was supposed to be doing laundry. It never got accomplished. I
kept losing it. Also I was on roller skates. I was trying to stand up and I
couldn't. Other
people were watching.
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She associated, "It's just like my life; I can't get on my feet and nobody is
helping." She went on to talk about the fact that she was a much worse driver
when E. was with her in the car and that when she skied with him, she always fell
down. When she skis with her mother, her mother is the one who falls, and she the
one who stays upright. By the end of the session she was screaming hysterically
that she was always rejected and that she could not stand it anymore.
Perhaps it was the growing therapeutic alliance that allowed Miss T. to reveal
the largely asexual nature of her relationship with E. and to subsequently
"discover" a pile of homosexual magazines hidden in his closet. When confronted,
E. admitted to having a secret homosexual life. Their relationship became
progressively stormier and lasted only a short while longer. As it turned out, this
relationship appears to have cloaked a reenactment of Miss T.'s relationship with
her mother (with Miss T. alternately cast in the role of her younger self or of her
mother under a manifestly heterosexual disguise). When she left E., it was to live
alone for the first time in her life. (It was not until much later, when the intense
early mother-child material had been worked through in the transference, that she
was able to form another relationship with a man that included more than just
sporadic sexuality.)
With her acceptance (albeit tenuous) of her analyst as an ally, the "terrible
things" she suffered began to be recounted in the analysis rather than enacted.
Session 224 followed a session in which she had talked about a man living next
door to her in her new building, who had put a welcoming note under her door,
inviting her to drop by. She had been suspicious and frightened and had not
responded to the note. She also felt very guilty over her "unfriendly" behavior as
she thought he was probably a nice person who was only trying to be friendly.
When the analyst pointed out the excessively punitive character of her selfdirected
recriminations, she became angry.
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Session 224
Miss T.:
The reason I got so upset yesterday was that I don't agree that you can
explain every behavior as if it's all O.K. Some things are not O.K. I don't
believe in making up excuses that justify me, especially at other people's
expense [pause]. Obviously, you are going to take my side, it's the only
side you hear. You'll act as if you don't care about right and wrong and
as if everything is acceptable, and it isn't! [cries silently].
Analyst:
What's scary about the idea that I'd be on your side?

Miss T.:
You don't know that anything that I say is true and you can't possibly
know. There aren't excuses for everything … [crying convulsively].
Analyst:
You are torturing yourself for making a mistake that you feel you cannot
undo.
Miss T.:
[calmer] Do you have any Kleenex?
Analyst:
[handing her the tissue box] Sure, here.
Miss T.:
Thank you [pause]. You're acting like I could do something to change it,
and I don't know if I can.
The extremely painful guilt Miss T. suffered as self-inflicted punishment for
her "impolite" behavior was overdetermined. She viewed her rejection of her
neighbor as a serious crime, essentially murder, and her feelings toward him were
in fact murderous. At this point it was not clear to the analyst if the neighbor who
was there "before" her represented a sibling rival, a potentially threatening
romantic object, or a potential source of phallic aggression. The guilty pain she
experienced
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over her "rude" behavior was a partial expiation for her aggression, but she also
raged against the analyst, suspecting the analyst of fostering her isolation.
When the analyst tried to direct her attention to the excessive nature of the
pain as a first step in the analysis of this incident, Miss T. accused her of being
either a liar, who pretended to feel that anything was alright while being secretly
judgmental, or else of being a fool. Unconsciously, she had taken the analyst's
intervention ("You are being excessively self-punitive") to mean that the analyst,
like her mother, would prefer that Miss T. not become involved with a man, that
she remain in an exclusive relationship with the analyst (mother). (When she had
broken up with E., she had been suspicious that the analyst might be happy that
she no longer had a man.)
Nonetheless, an alliance had finally been forged which would allow these and
other issues to be examined. In asking for and accepting a tissue for the first time
in the analysis, Miss t. made the analyst vividly aware of her new ability to accept
something from her. This was especially poignant, as the tissue box had always
been present on a small table next to the couch. Miss T. had been unable to notice

it, asking "Do you have any Kleenex?" The analysis continued to have stormy
times, but they became briefer and could be subjected to analytic scrutiny.
Some New Memories and Psychodynamic
Formulations
When Miss T said, "I don't think it'll be a good analysis, but there's no choice,
so we'll stay in this battle for years and years," she was making a transference
statement that appears to have been related to a failure in the rapprochement
subphase of the separation-individuation process (as described by Mahler et al.,
1975). Unable to fully separate, she was alternately rageful and repentant. This
"battle" was the only mode of intimate relating she knew. The intense hostiledependent
bond with the analyst and the repudiation of the possibility of
triangulation had been presaged in the initial dream, in which she rejected the offer
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"to make it up" made by the male analyst. The reedition in the transference of the
hostile-dependent bond had to be analyzed before she could go on to deal with
oedipal triadic issues. (It is worth noting that Miss T.'s negative oedipal
transference contributed to the paranoid quality of her transference regression.)
As interpretation and working through of this transference paradigm
progressed, Miss T. began to recall previously repressed or ignored historical
material and to question relatives about events in her early life. Her mother had
reacted to evidence that Miss T. was left-handed, as was her next older sister, with
the belief that her less than one-year-old baby daughter was showing precocious
sibling rivalry. Mother felt that the baby's lefthandness was somehow a
manifestation of her effort to "compete" with her sister! When Miss T. began to
read at age four, this achievement was labeled as bad because it was "too early,"
another proof that the child was trying to outdo her sisters. This material was not
mentioned until well into the analysis. She had not mentioned it as she had
actually believed she had "made herself" left-handed in an effort to compete, and
that her mother was probably right when she accused her of learning to read at
"too early" an age. Not until the analyst expressed surprise when she mentioned
these ideas did Miss T. first start to question them consciously. They had been
presented by the mother as fact, and Miss T. had been unable to utilize any other
viewpoint to help her discredit her mother's views.
Retrospectively, it appears that Miss T.'s early development had been
disrupted by a pathological bond with her mother, in which she felt the latter both
torpedoed her initiative (sense of agency) and lacked interest in her inner life.
Yet this was not a simple case in which a daughter felt rejected or criticized
by her mother; she also felt her mother simultaneously bound her to her and tried

to distance her from her siblings and her father. Although, for a long time, the
patient complained she had no special place in the family, she,
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in fact, described how she was her mother's phobic partner. Miss T. felt her mother
used her in order to quiet her own anxiety. She recollected that mother was
frightened to go to the basement to do the laundry and needed her to go along.
Miss T. related her adult hate of doing the laundry to the fear her mother had of the
basement. She described being bewildered by mother's insistence that she stay
with her in the basement, and angry at not being allowed to go and play.
Initially, Miss T. experienced the analysis as claustrophobic and controlling,
like doing laundry with her mother. When Miss T. was older, she had to make
telephone calls for her mother, since talking on the telephone made mother too
anxious. The mother-daughter roles appeared to be reversed, with the child being
called upon to calm the neurotic anxieties of the mother. In some ways, then,
despite her demands, Miss T. unconsciously felt like her mother's chosen child, so
long as she denied her own autonomous wishes, and "read" her mother's needs
without any real expectation that her own subjective life was of concern to her
mother. Being chosen for the special position of phobic partner was not initially
recognized as being a source of gratification; this pleasure could only be
acknowledged unconsciously after the analysis was well underway. (Miss T. never
fantasized or theorized as to why she was the child so chosen.)
While predominantly compliant, Miss T. intermittently raged at her mother,
creating the first of her intense sadomasochistic bonds. She recollected intense
battles with her mother in which she attempted to "prove" to her mother that she
had been totally unwanted, or that she was "supposed to" be a boy. Mother battled
with her over these issues, always insisting that she loved all of her children
equally, though Miss T. remained unconvinced.
The question naturally arises as to why Miss T. was unable to extricate herself
from the tie to her mother, which she regarded as so damaging to herself. A child is
often able to mobilize an in-depth bond to a third party as a way out of a
"pathological" dyad. We believe several mechanisms acted to
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perpetuate Miss T.'s hostile-dependent bond with her mother. From the child's
point of view, as Fairbairn (1952) astutely remarked: "it is better to be a sinner in a
world ruled by God than to live in a world ruled by the Devil" (pp. 66–67). Miss
T., who regarded herself as a bad little girl, conceived the hope that her mother
(and later the analyst) would turn out to be benevolent if only she could reform

and give up being bad. When she periodically found the courage to assert herself
against mother (or analyst), this assertion took the form of raging tirades, which
were later used as confirmation of her sense of badness. Another mechanism was
critical in locking in her pathological tie to her mother: this was the narcissistic
pleasure Miss T. took in feeling essential to the mother even if only as her phobic
partner. Since she suffered from severe envy of all three siblings, any aspect of her
relationship that gave her pride of first place—whether as mother's victim or
phobic partner—was experienced as essential to her specialness.
As Miss T. recalled it, mother interfered actively with any of her early efforts
to form an attachment either to father or to her siblings, thus thwarting her
attempts to extricate herself. She despaired of father as he was of no help, failing
to intervene and thereby offering no alternative to the pathological motherdaughter
bond. A new memory retrieved in the course of the analysis suggests the
way in which triangulation was thwarted by Miss T.'s mother, a disruption father
allowed. When Miss T. was four years old, her father took her on a rollercoaster.
She sat on his lap and was thrilled by the experience. Upon their return home,
however, when she ran to tell her mother about the exciting ride with Daddy, her
mother went into a rage with her for having allowed her father to do such a
dangerous thing. The affective valence of the experience was shifted 180 degrees:
from pleasurable, erotically tinged excitement, to guilty humiliation-laden
depression and suppressed rage. In this memory, father also failed her; he said
nothing at all in response to his wife's scathing attack on their daughter. To turn to
such a father to "make it up" would indeed be "ridiculous"
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(it was the patient's longing for paternal rescue and her hopelessness at achieving
it that were presaged in her initial dream). Her mother's message, as Miss T.
interpreted it, was that she should be of one mind with her mother and also that
she should not form a separate relationship with her father, as such a relationship
would imperil the life-sustaining mother-daughter bond.
In the analysis, Miss T. expected to be misunderstood, even while
vociferously demanding that her analyst be an "analytic mirror." In essence, she
was demanding that the analyst provide her with that empathic understanding of
which she had felt deprived. When she perceived any failure of empathy on the
part of her analyst, she felt entitled to unleash her intense aggression. However,
when she thought that the analyst did indeed validate her account of events, she
berated her for being so easily duped. The ease of regression and the intensity of
the transference, which at times seemed to overwhelm Miss T.'s small remnant of
observing ego, appeared to be related both to her distorted relationship with her
mother and the resultant instability of the oedipal configuration. This instability
manifested itself in a rapid shift from oedipal issues and object relations to

primitive dyadic maternal-infant issues, along with concomitant primitive
defensive operations and intense, unmodulated affect states. Such shifting
transference patterns are described by Kernberg (1984), (1988b) in his extensive
work on character pathology.
The intense, sticky, sadomasochistic tie to the analyst was a recreation in the
transference of the perversion of intimacy that had been established between Miss
T. and her mother. Neither could disengage from the struggle with the other. In the
transference, Miss T. expressed this dilemma very clearly when she said "there's
no choice … we'll sit in this battle for years and years." In struggling with this
difficult transference, we came to the conclusion that Miss T.'s inability to let go of
the painful bond had multiple determinants: the erotization of her suffering, the
narcissistic gratification of being special, the
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ego enhancement of a fluctuating identification with the aggressor, an inhibition
(or repudiation) of preoedipal and oedipal triangulation, and the sense of intimacy
(though distorted) generated in the sadomasochistic exchange. In the course of
working through these issues, Miss T. also came to understand her guilty selftorture
(alternating with her sense of victimization) as being the price she paid for
her sadistic counterattack, her own participation in psychically abusing others as
she experienced them abusing her. With this new understanding she became able
to engage in the analytic process without the previous agony of being either the
suffering victim or the guilty victimizer.
Discussion
Distortions in the Mother-Child Dyad as a precursor of
Sadomasochism
Zetzel (1968) in her classic paper, "The So-Called Good Hysteric," describes
the variations in degrees of psychopathology in characterologically hysterical
patients. In this paper, she uses the same rhyme about the little girl who was
alternatively very good and very bad to describe the "not-so-good hysteric" as
Miss T.'s mother had used in describing her daughter. Originally seen as a hysteric,
Miss T. could be described as a Zetzel type II or III. Easser and Lesser (1965)
called such patients "hysteroid," indicating that their problems were preoedipal.
There is a growing body of work relevant to the kinds of early experiences
that promote distortions in object relations and in self-concept like those Miss T.
presents. Kohut (1971), in his well-known work on narcissism, stresses the
importance of early empathic "mirroring" in the development of a normal self. He
states that narcissistic pathology results from the mother's use of the child as a

self-object. The particular vulnerability of narcissistic characters to failures of
empathy on the part of the analyst is one of his concerns. Stern's (1985) work
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on the function of attunement between infants and mothers highlights the critical
importance of the very early mother-child experience in validating the child's
budding sense of agency, and the negative consequences when the sense of agency
is thwarted. Consistent misreading of the child's cues by the mother is one source
of serious pathology in the child, which is clearly manifested in the rapprochement
phase, as described by Mahler et al. (1975), and which often takes the form of
sadomasochistic character pathology. Although Stern and Mahler have remarkably
different concepts of the origins of the infant's earliest sense of self, parts of their
theories overlap, though with different emphases. Both accounts are useful to our
understanding of the genesis of sadomasochistic pathology in this patient and
other similar patients.
During the rapprochement phase of development, according to Mahler, the
child's euphoric sense of itself (the so-called love affair with the world) succumbs
to the necessity of reconciling its expansiveness with the realization of limits.
Cooper (1988) argues that the narcissistic injuries from this period of life
inevitably invoke reparative masochistic mechanisms to restore self-esteem. The
child does this, according to Cooper, by declaring its suffering ego-syntonic—
willed by itself. Thus he sees at least some minimal masochistic characteristics as
universal, part of normal development. He goes on to argue that if narcissistic
humiliation is excessive, then the child is rendered incapable of authentic selfassertion;
accordingly, the goal becomes "not a fantasied reunion with the loving
and caring mother" but rather "a fantasied control of a cruel and damaging mother"
(p. 128). He correctly concludes that the goal of sadomasochistic defenses is not
sexual pleasure, but the stabilization of the self-concept and self-esteem, thereby
shifting our understanding of masochism from an exclusive focus on the superego
(punishment to preserve pleasure) to narcissistic defenses to preserve self-esteem.
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In a paper on masochism, Kernberg (1988a) contrasts the depressivemasochistic
patient's extreme vulnerability to disappointment with that of the
narcissistic personality "who is over-dependent on external admiration without
responding internally with love and gratitude, [while] the depressive-masochistic
personality typically is able to respond deeply with love and to be grateful" (p.
108). He agrees with Cooper that masochistic patients obtain narcissistic

gratification from their sense of victimization, though he points out that many
neurotic character formations serve such narcissistic functions.
While Cooper emphasizes the narcissistic repair of masochistic pathology, he
stops short of elucidating another important function—the preservation, albeit in
distorted fashion, of connectedness and mutuality. It is here that Stern's concepts
on the developmental process become important, focusing as they do not only on
the child's need for increasing individuation, but also on its ongoing need for
attunement, intersubjective communication, and mutual recognition with the
mother. In her work on masochism, Benjamin (1989) points out that such an
emphasis on mutuality "reintroduces the idea of pleasure, pleasure in being with
the other, which had gotten lost in the transition from drive theory to ego
psychology—but redefines it as pleasure in being with the other" (p. 31).
In the course of development, then, the child seeks not only autonomy (as
emphasized by Mahler), but also relatedness, mutuality, and mutual recognition (as
emphasized by Stern). The achievement of authentic mutuality depends not only
on recognition of the self (by the other), but also on the child's recognition of the
other as separate. Benjamin (1989) presents an eloquent discourse on how the
normal evolution of mutuality may sometimes be subverted by distortions in the
mother-child dyad. For example, the mother may be unduly sensitive to a baby's
unresponsiveness: "The mother who giggles, jokes, looms and shouts 'Look at me!'
to her unresponsive baby creates a negative cycle of recognition out of her own
despair… Here
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in the earliest social interaction we see how the search for recognition can become
a power struggle: how assertion becomes aggression… The child loses the
opportunity for feeling united and attuned, as well as the opportunity for
appreciating (knowing) his mother. He is never able to fully engage in or fully
disengage himself from this kind of sticky, frustrating interaction… Even as he is
retreating he has to carefully monitor his mother's actions to get away from them:
even withdrawal is not simple." Benjamin concludes: "In a negative cycle of
recognition, a person feels that aloneness is only possible by obliterating the
intrusive other, that attunement is only possible by surrendering to the Other" (p.
28). Put another way, autonomy only seems possible through domination of the
other, while mutuality only seems possible through submission. Depending on the
specific pathological interaction, one may see masochistic or sadistic distortions as
an adaptative maneuver aimed at preserving autonomy or mutuality or, as in the
case of Miss T., both (Person, 1988); (Benjamin, 1989).
Our formulation is consonant with Cooper's, but we suggest that
sadomasochistic defenses are mobilized to preserve mutuality (however distorted)

in addition to their role in narcissistic regulation, erotization of suffering,
stabilization of self-esteem. Surrender and masochism, domination and sadism,
then, are "perverse" characterological adaptations that preserve some remnant of
mutuality. (We use the term "perverse" here as analogous to the perverse sexual
solution in which sexual pleasure is preserved, though at a high cost.)
Sadomasochistic pathology allows the individual to maintain intimate though
distorted human contact.
Failure of Triangulation
Distortions in the rapprochement subphase often have negative implications
for the future development of triangulation. As is stressed by Atkins (1982) and by
Galenson and Roiphe (1976), the mother can either facilitate or impede the
establishment of
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the early triangular configuration. Galenson and Roiphe (1976) have observed that
if a little girl's rapprochement subphase has been particularly difficult, she will
form only a shadowy oedipal romance with father, one that lacks the usual verve.
For these girls, the highly ambivalent maternal bond appears to preclude the
normal early turn to the father or any third person.
In his articles on preoedipal triangulation, Abelin (1971), (1975) elaborates
the important role of the father in the separation-individuation process and
describes the individuating child as seeing itself in a "dual mirror" of father and
mother. Mahler and Gosliner (1955) have described the father's role in the
separation-individuation process as intervening between mother and child to aid in
the child's differentiation from the symbiotic mother. Father provides a safe object
for the individuating child, a refuge when the "mother of separation," imbued with
the child's projected aggression, is too threatening. Herzog (1982) describes
difficulties in modulation of aggression in children who have been deprived of
their fathers by divorce. The special role that the father can serve in enhancing the
daughter's self-esteem is described by Ross (1988), and his role in either fostering
or inhibiting her later creativity has been reported by Tessman (1989,
unpublished).
How does the individuating child learn to "see" itself in the "dual mirrors"
described by Abelin? How does the child integrate its reflection in the maternal
and paternal mirrors, and what happens if one mirroring parent is missed and or
distorts? Worse yet, what if one parent is virtually missing and the other
consistently misreads the child's cues and provides a distorted reflection, as was
the case in Miss T.'s childhood?
In early childhood, the mother helps mold the infant's perceptions of self and
other. One could say, she presents the child with her "point of view." The child

incorporates the maternal viewpoint along with the maternal object, but as
differentiation takes place between self and object, the child must also separate its
point of reference from mother's. Father, by representing a different view of the
mother, the child, and other
- 987 -
people, customarily provides an alternative point of reference for the individuating
toddler.
Normal development can nonetheless take place in single-parent families
(regardless of the sex of the parent), with alternate modes of promoting
intrapsychic triangulation. The mother herself (or father) can validate the child's
own perceptions and point of view while presenting another, separate parental
perspective. This requires that the parent be able to "mirror" the child without
overidentification or projection, a task that is frequently impossible for someone
with significant problems of his or her own stemming from the rapprochement
subphase. Or, some other important person may serve the function of providing
another viewpoint.
The child incorporates the father's (or other's) viewpoint with the object, and
is then faced with the task of integrating the different ways of seeing the world of
objects and of self. If these are too disparate, the task may be impossible, and the
child then learns to suppress one of the incompatible images. In the case of Miss
T., failure to move from the dyadic to the triadic with relative comfort appeared to
be the result of three intertwined mechanisms: she was enmeshed in a
sadomasochistic dyad with her mother; her mother actively interfered with her turn
toward the father; the father did not make himself available for triangulation.
Miss T.'s basic sense of herself was that of a "bad girl" who raged against her
mother. Miss T. could not move fully into a positive relationship as a refuge from
the hostile relationship with mother, as this had always led to worse trouble and
the fear of complete deprivation. Her longing for a father surrogate to rescue her
was repudiated out of an unconscious and conscious (painful) conviction that she
could never be happy in any intimate relationship, and moreover would risk the
wrath of the maternal figure, her only safety in a dangerous world. The
sadomasochistic bond with mother and later with the analyst, however painful,
offered Miss T. a sense of connectedness,
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although it had to preclude other involvements. Moreover, if she moved away
from mother, the secret narcissistic pleasures of the roles of victim and phobic
partner would have to be given up. The only choice, other than the formation of

pseudo-relationships, was to persevere in the painful pleasures of the dyad. The
good little girl who did well in school and had lots of friends was felt to be
"phony," while the "bad" self that related to mother felt genuine (Winnicott,
1960). Because superego pathology is inevitable in such patients, superego
conflicts invariably reinforced her sadomasochistic pathology.
It seems very likely that had Miss T.'s analyst been male, she might well have
developed an erotized initial transference as a defense against the underlying
hostile-dependent maternal transference. This is a not uncommon (though not
inevitable) development in the analysis of the "not-so-good" hysteric by a male
analyst. An erotized transference may be mobilized to cloak oral aggression and
sadomasochistic pathology with a pseudosexual defense (Person, 1988). That
Miss T. was referred to a woman made it less likely that an erotized transference
would be used as an initial defense, and facilitated the early emergence of the
rageful sadomasochistic maternal transference. The preoedipal material had to be
worked through prior to the analysis of oedipal material. In fact, after the stormy
initial phase of the analysis, the material became far more typically oedipal. The
remainder of the analysis of Miss T. is beyond the scope of this paper; however, it
was striking that rapid analytic progress occurred after the early transference
regression had been largely worked through.
Sadomasochistic pathology serves many complex needs, and the importance
of one or the other such need may be weighted differently in different patients.
Likewise, sadomasochistic pathology can be understood within several theoretical
perspectives. The analysis of Miss T. led us to focus on the varieties of pleasure
experienced in sadomasochistic interactions. While this case conforms to
descriptions of some of Cooper's patients, we were struck by the pleasure (and
safety)
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of the connectedness Miss T. was able to derive within the purview of distorted
relationships. For some patients, such relationships appear preferable to the only
imaginable alternatives: extreme schizoid or paranoid adaptations. Miss T.'s
analysis helped clarify the way difficulties occurring (or experienced) around
rapprochement issues and preoedipal triangulation may be decisive in locking an
individual into participation in a repetitive series of sadomasochistic interactions.
REFERENCES
ABELIN, E. 1971 The role of the father in the separation-individuation process In
Separation-Individuation: Essays in Honor of Margaret S. Mahler ed. J. B.
McDevitt & C. F. Settlage. New York: int. Univ. Press, pp. 229-252
ABELIN, E. 1975 Some further observations and comments on the earliest role of
the father Int. J. Psychoanal. 56:293-302 [→]

ATKINS, R. N. 1982 Discovering daddy: the mother's role In Father and Child,
Developmental and Clinical Perspectives ed. S. Cath, A. Gurwill & J. M.
Ross. Boston: Little, Brown, pp. 139-149
BENJAMIN, J. 1989 The Bonds of Love New York: Pantheon.
COEN, S. J. 1988 Superego aspects of entitlement (in rigid characters) J. Am.
Psychoanal. Assoc. 36:409-427 [→]
COOPER, A. M. 1985 The unusually painful analysis: a group of narcissisticmasochistic
characters In Psychoanalysis: The Vital Issues Vol. 2 ed. J. E.
Gedo & G. H. Pollock. New York: Int Univ. Press, pp. 45-67
COOPER, A. M. 1988 The narcissistic-masochistic character In Masochism.
Current Psychanalytic Perspectives ed. R. A. Glick & D. I. Meyers. Hillside,
N.J.: Analytic Press, pp. 45-67
EASSER, B. & LESSER, S. 1965 Hysterical personality: a reevaluation
Psychoanal. Q. 34:390-405 [→]
FAIRBAIRN, W. R. D. 1952 Psychoanalytic Studies of the Personality London:
Tavistock. [→]
GALENSON, E. & ROIPHE, M. 1976 Some suggested revisions concerning early
female development J. Am. Psychoanal. Assoc. 24 (Suppl.) 24-58 [→]
HERZOG, J. M. 1982 On father hunger: the father's role in the modulation of
aggressive drive and fantasy In Father and Child, Developmental and Clinical
Perspectives ed. S. Cath, A. Gurwitt & J. M. Ross. Boston: Little Brown, pp.
163-174
KERNBERG, O. F. 1984 Severe Personality Disorders: Psychotherapeutic
Strategies New Haven, Conn.: Yale Univ. Press.
KERNBERG, O. F. 1988a Clinical dimensions of masochism J. Am. Psychoanal.
Assoc. 36:1005-1029 [→]
KERNBERG, O. F. 1988b Object relation in clinical practice Psychoanal. Q.
57:481-504 [→]
KOHUT, H. 1971 The Analysis of the Self New York: Int. Univ. Press. [→]
- 990 -
MAHLER, M. S. & GOSLINER, B. J. 1955 On symbiotic child psychosis:
genetic, dynamic and restitutive aspects Psychoanal. Study Child 10:195-212
[→]
MAHLER, M. S., PINE, F. & BERGMAN, A. 1975 The Psychological Birth of
the Human Infant New York: Basic Books.
PERSON, E. S. 1988 Dreams of Love and Fateful Encounters: The Power of
Romantic Passion New York: Norton.
RACKER, H. 1957 The meaning and uses of countertransference Psychoanal. Q.
26:303-357 [→]
ROSS, J. M. 1988 The eye of the beholder In Frontiers of Adult Development ed.
C. Colarusso & R. Nemiroff. San Diego, Calif.: Univ. San Diego Press.

STERN, D. N. 1985 The Interpersonal World of the Infant New York: Basic
Books. [→]
STOLOROW, R. D. 1975 The narcissistic function of masochism and sadism Int.
J. Psychoanal. 56:441-448 [→]
WINNICOTT, D. W. 1960 Ego distortion in terms of true and false self In The
Maturational Processes and the Facilitating Environment New York: Int. Univ.
Press, 1976 pp. 140-152 [→]
ZETZEL, E. 1968 The so-called good hysteric In The Capacity for Emotional
Growth New York: Int. Univ. Press, 1970 pp. 220-254
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