A Sadomasochistic Transference - Beth J. Seelig, MD

(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.