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This is a subtle and evocatively written theoretical and clinical discussion of the meaning of powerful negative countertransferential responses that are especially difficult for the analyst to acknowledge and bear. They appear in the work with certain types of patients, in which feelings of visceral hatred, and what the writer describes as a ‘regressive defusing of [the analyst's] ethical functioning’, have to be vigorously grappled with in order that any useful understanding of the patient's psychopathology be achieved. The analyst becomes increasingly aware of perverse impulses towards the patient, where sadomasochistic identificatory exchanges are sought by the patient in order to fend off unconscious fantasies of pre-oedipal emasculation (versus Oedipal castration) in respect of a longed for homosexual union with the father/analyst. The author presents a composite (male) patient and recounts a fictitious but pivotal session, itself a composite of many analytic situations which the author has experienced, a device employed both for reasons of confidentiality as well as because Martin-Vallas has accumulated a number of experiences of working with patients with a similar personality profile and evoking a similar quality in the transference/countertransference relationship. The session is pivotal in the sense that it is the harbinger of a period of analytic work that is more authentic and in which the patient is more engaged than he had been capable of previously. Significantly, it follows on from the experiences of the analyst of the depths of his negativity, when intuitively there might have been an expectation of a lack of future capacity to go on working in the analytic relationship.
It is the mark of the breadth and depth of a practitioner's analytic attitude to have imaginative access to a huge range of pathological, as well as non-pathological, internal possibilities, in the form of thoughts, affects, somatic responses and impulses to act. These may find thei