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The author addresses perversion from a broad and integrating perspective of identity which draws on viewpoints about drive and object, sense of self, affective attunement and states of consciousness. As a dehumanizing enactment for aggressive discharge, perversion, in its wider sense, is seen as stemming from arrested development in unattuned, two-person, part-object relationships in a world of unacknowledged and incompletely mourned loss. Love, requiring full separation-individuation, relies on the development of a trust-promoting potential psychic space to facilitate symbolization, mutuality of play, and entry of a third person into the matrix. For Bach, the absence of early affective attunement, of holding, and of parental affirmation of the self, tend to limit the pervert to splits and dissociative states from which enactments emerge. Case vignettes demonstrate the analyst's human task of engaging the patient through attunement, holding, containment and recognition of the self, in a long early phase of treatment to provide the potential space for growth of trust, before words can have affectively laden symbolic meaning in communication.
Each of the book's eight chapters is organized around a different theme related to development and clinical work. The emphasis is on omnipotence and deficits in attunement in narcissistic and dissociative pathologies. By exposition and case example, Bach re-addresses several problems in the development and treatment of perversion according to the themes of each chapter. These problems include effects of splitting and disassociation, absence of parental relatedness, and tolerating the paradoxes of human existence.
In Chapter One, “Sadmomasochistic Object Relations,” Bach looks at the need-gratifying exploitative nature of perversion. Sadomasochistic relationships are viewed as developmentally related to sexual perversions in that they serve as a defense against, and an effort to, repair inadequately mourned, disavowed traumatic loss