A Sadomasochistic Transference - Beth J. Seelig, MD

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.: