The Mutative Impact of a Transference Interpretation with a Masochistic Male Patient Exhibiting Sexual Sadism: A Case Study

In this paper I describe a clinical case in which work around a transference interpretation, with a preoedipal focus, proved to have a powerful impact on the course of treatment. The patient is a thirty-five year old male with a compliant, masochistic character disorder who engaged in sadistic sexual behavior. The patient's pathology was most pronounced in the area of intimate relationships with women. In the following paper I confine myself to this aspect of his life. Splitting women into good and bad, the madonna1 whore dichotomy, that Freud originally described in 1912, this patient had internalized a highly repressed and split off image of an unfulfilled relationship with a distant and emotionally absent mother. With a controlling and domineering father, the patient was unable to integrate love and hate. He involved himself in a series of relationships in which he either felt intellectually and emotionally close to a woman or sexually excited by a woman, but never both at the same time. Unable to integrate love and sex, he was continually frustrated, unfulfilled, and in search of an ideal mate.