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The opening paper was “Treatment of the Masochistic Attachment” by Dory-ann Lebe. She reviewed Freud's explanation of masochism: the masochist's oedipal resolution results in a harsh or punitive superego that is the precursor of self-inflicted suffering, indirect sexual satisfaction, and an unconscious sense of guilt. What Freud called “feminine masochism” is the male's wish to be in a passive or homosexual relationship to the father.
Lebe reported that her work with such patients began by following this approach but, although improvement occurred, the central masochistic patterns were not resolved. She concluded that the core of the masochism lay in the relationship with the mother. These patients had experienced a severely rejecting or punishing mother or mother-figure in their very early years, leading to an introject of the rejecting-punishing mother, which carries on what had earlier transpired between mother and child. This attachment occurs early in the patient's life, and its loss is accompanied by the most intense anxiety; to be without the mother is experienced as nothingness or nonbeing.
Because the anxiety these patients feel is so powerful, treatment must proceed slowly and carefully. The analyst must be attuned to the shame and humiliation associated with the patient's longing for attachment, and the fear that the analyst may misuse the attachment. New relationships and inner structures must be in place before this attachment can be relinquished. An analyst who is over eager or unaware of the patient's anxiety may precipitate an abrupt termination.
An extended evaluation, with the understanding that analysis may or may not