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.