A Sadomasochistic Transference - Beth J. Seelig, MD

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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? - 971 - 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 - 972 - 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.
Page 1 and 2: 1991). Journal of the American Psyc
Page 3 and 4: y Kernberg, 1984) that had not been
Page 5: herself, she immediately projected
Page 9 and 10: I wanted to die. There was no one t
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Page 13 and 14: to distance her from her siblings a
Page 15 and 16: primitive dyadic maternal-infant is
Page 17 and 18: gratification from their sense of v
Page 19 and 20: incorporates the maternal viewpoint
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A Sadomasochistic Transference - Beth J. Seelig, MD

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