How do Sadomasochistic Dynamics of Transference and Countertransference Unfold in Nonpsychoanalytic Psychotherapy?

To illuminate transference and countertransference dynamics in sadomasochism, this study explored the intricate relational patterns that emerge in the psychotherapy process of individuals with sadistic, masochistic, and sadomasochistic personality characteristics. This study used a qualitative research design because the main purpose was to discover the relational patterns co-constructed by clients and psychotherapists in the interpersonal reality of their psychotherapy processes. The interactional patterns of four female client–therapist dyads—recruited via convenience sampling—were analyzed using conversation analysis. Psychodynamic diagnostic prototypes were used to assess clients' personality structures. Twenty-four sessions were analyzed; the therapies followed cognitive–behavioral, schema, and eclectic orientations. The analysis yielded three interaction patterns. Some conversational strategies clients employed served to build and maintain collaboration. The other major interactional pattern included a break in collaboration, during which dyads had conflicting conversational goals and expressed negative feelings. In the last pattern, the ambiguity of collaboration, the interaction was characterized by the co-occurrence of collaboration and the break in collaboration in the same sequences. Transference and countertransference dynamics related to sadomasochistic characteristics are interpreted to be reflected in a complex interplay of therapeutically relevant issues, ranging from the capacity to develop a reciprocal relationship and the potential for change to submission, problems with ego boundaries, disavowal of destructiveness, need for control, and dominance. It was concluded that the co-constructed nature of these specific transference and countertransference dynamics deserves further attention from practitioners and researchers regarding the psychotherapy process.