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The study of a patient's forepleasure behaviour reveals the predominant patterns of pre-genitality and their relation to end-pleasure, genitality and orgasm. Forepleasure may express not only instinctual needs but also defensive manoeuvres which are themselves directed against the instinctual drives. Greenson believes that forepleasure offers one of the richest opportunities for observing the interaction between instinctual drives and defences. After giving an account of what may be considered adequate criteria of normal forepleasure activities, certain typical patterns of forepleasure are described as pathological. First, lingering at forepleasure to the point that orgasm occurs prior to coitus; second, elimination of forepleasure activities; third, rigid and unchanging patterns of forepleasure.
Greenson subdivided his material into (a) aberrations in the relationship between forepleasure and endpleasure. There are patients who demonstrate an overemphasis on forepleasure. They are avoiding some specific anxiety about coitus. There are also patients who avoid forepleasure, for to them it represents pre-genitality or masturbation. (b) Aberrations in regard to the rôle of the sexual partner; there are many persons who use foreplay to obtain reassurance from the sexual partner. There are others who are unable to establish any sympathy with the sexual object. (c) Forepleasure can be a means of enacting unconscious phantasies.