No pain, no gain

Masochism as a response to early trauma and implications

for therapy

Bea Gavin*

Student Counselling Service, National University of Ireland, Galway, National

University of Ireland, Galway University Road, Galway, Ireland

(Received June 2009; final version received 17 February 2010)

This paper explores the relevance of the concept of moral masochism as
a response to early trauma and the implications of this for
psychotherapy.

Consideration is given to early conceptualisations of moral

masochism within the psychoanalytic literature, in particular, the
move from drive theory to object relations. More recent developments
in relation to trauma and defences, such as disassociation, are explored.
It is suggested that a more complex and fuller understanding requires
thinking about the subtle and shifting interaction of both these levels.
This allows the possibility of building a more nuanced understanding
which can look at both behaviour, as described in the trauma literature,
and meaning which is the core of a more classical psychoanalytic
approach.

Case histories are used to illustrate the linkages between moral

masochism and trauma and the transference and countertransference
dynamics and challenges involved. Progress varied in these cases, with
both positive and negative outcomes. This theoretical background is
used to suggest why this may be so.

Keywords: moral masochism; trauma; defences; transference; counter-
transference

This paper aims to explore the implications for psychotherapy of masochism
as a response to early trauma. When I first began to consider masochism as a
clinically relevant topic, I did not link it with trauma specifically. I was
perplexed by the experience of working with a range of clients where there
appeared to be early indications of positive progress, yet this did not
materialise. I began to recognise that my initial response to some of these
clients changed to frustration and on occasion a sense of helplessness dread
as their session times approached.

*Email: [e-mail]

Psychodynamic Practice
Vol. 16, No. 2, May 2010, 183–200

ISSN 1475-3634 print/ISSN 1475-3626 online
Ó 2010 Taylor & Francis
DOI: 10.1080/14753631003688134
http://www.informaworld.com

Pain and distress are frequently experienced during the course of therapy

and can be a part of the process of achieving significant gains. The difference
with this client group was that pain and distress were expressed, but did not
lead to progress. Maintaining, retaining and elaborating painful experiences
and expressing grievances became the focus of the work.

This led me to consider that there must be some motive behind this

apparent wish to hold on to painful experience. I also became aware that,
though I might feel despondent and lacking in hope, this did not lead to
clients choosing to leave. In other cases there appeared to be progress,
followed by a negative reaction to the therapy and even by abrupt
terminations of treatment.

This apparent wish to hold on to painful experience is described in

popular culture; descriptions such as ‘doormat’, ‘making the worst of
things’, ‘victims’, ‘saints’, ‘martyrs’ and ‘people pleasers’ are used. Such
people may exhibit a fear of success – ‘Wrecked by Success’ to use Schafer’s
(1988) description.

Moral masochism

Freud used the term ‘moral masochism’ in his 1924 paper ‘The Economic
Problem of Masochism’ (Freud, 1924/1995). His description of moral
masochism is very relevant. He differentiated it from sado-masochism,
which is a set of sexual practices where various scenarios can be played out.
There are standard roles such as master and slave. The sadist inflicts pain on
the masochist, but the nature and degree of this is controlled by the
masochist. The motive in seeking pain is conscious sexual gratification.

‘Moral masochism’ refers not to sexual behaviour but to a personality

trait, which when severe can become a character disorder. The moral
masochist would present as a perplexed victim rather than a masochist,
passive and compliant, exhibiting constant disappointments and unaware of
their repetitive activity in maintaining their victimised role (Freud, 1924/
1995). There is little overt hostility and often an explicit fear of
confrontation of any kind.

Masochism and trauma

I became aware of many clients where there was a history of trauma, and
masochistic phenomena were apparent. The challenge was to see how these
aspects might be linked. I began by looking at conceptualisations of moral
masochism in the psychoanalytic literature and tried to relate these to more
recent developments in the trauma literature, which seem to focus more on
behaviour and biological explanations. The psychoanalytic literature
emphasises the role of mental conflict and the unconscious meanings of
behaviour.

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Although there appears to be a significant link between trauma

experiences and masochism, this is not always the case. Those who have
experienced trauma react in a variety of ways, ranging from positive
resilience and determination to overcome earlier difficulties, to aggression
and a wish to harm. Equally, some people can present with masochistic
responses, without an obvious history of trauma.

A cautionary note

Kernberg (1988, quoted by Meyer & Lewin, 1990) reminds us that not all
self destructive behaviours are masochistic – the underlying anxieties,
defences and motives must be considered. Seelig and Rosof (2001) discuss
altruism and point out that altruism and masochism often co-exist. They use
the term ‘Pseudo-altruism’ to describe behaviour which serves as a defensive
cloak for underlying sado-masochism.

Kernberg stressed the universality of masochistic behaviour and the

unclear boundaries between such behaviours and psychopathology. Such
‘normal’ masochism is not to be confused with the sublimation necessary to
achieve any kind of goal where the gratification or reward is deferred, as in
work or sport, for example. It also depends upon the cultural context and
expectations. Many cultures have initiation and religious rituals which
involve pain and suffering (Rancour Lafferriere, 2003).

It is very important to distinguish masochistic personality traits from the

behaviour of abuse victims, where there is a realistic fear that seeking
external help will lead to greater violence or physical harm. This is a
complex area, extremely difficult to disentangle. There is an exceedingly fine
line between exploring the interaction between unconscious aggression and
sado-masochistic dynamics and appearing to blame the victim. Despite
potential contentiousness, a sensitive and careful elucidation of the
dynamics involved in, for example, domestic violence can empower
the abused party to make positive changes, such as not remaining in the
situation where the abuse is occurring.

History of the concept of moral masochism – drive theory to object relations

Thinking about masochism has been influenced by shifts in psychoanalytic
thinking. Early conceptualisations developed in the context of drive theory.
The unconscious guilt so frequently associated with masochism suggested a
link with the development of the superego.

Grunberger (1995) suggested that a need for punishment has at its base

an unresolved Oedipus complex. He pointed to a fantasised wish to castrate
the father (a critical point in the vicissitudes of normal aggression and
narcissism) which, when not integrated, becomes the basis for the formation
of the masochistic character. This can then be transformed into the fantasy

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of being castrated by the father (so that the fantasy is turned against the
self). Other superego derivatives might be the fear of failing to live up to the
ego ideal and consequent guilt.

The debate about masochism in the 1950s centred around the relative

roles of libido and aggression, the child’s vulnerability to excitations and
addictive attachments to sadistic objects. Humans can experience any
intense stimulation as sexually exciting, which adds to the complexity of the
whole area.

Berliner (1995) emphasised that moral masochism is essentially an object

relation. This marks a shift in psychoanalytical theory from an exclusive
focus on drives and instinctual gratification as the basis of human
motivation, to seeing subjects as fundamentally object seeking. Masochism
is seen less as a drive and more as a defensive adaption to a less than
favourable situation. Repression of hostility and the acceptance of suffering
becomes a means of avoiding the loss of the love object. The masochist
inflicts himself upon his love object with possessiveness and reproachfulness.
He collects grievances and retains causes for resentment.

The work of Fairbairn on the retention of the bad internal object quoted

by Lebe (1997) adds another strand. In response to inadequate parenting the
child comes to feel that his love is bad, relationships with others are
dangerous, and the internalised sadistic maternal object even though
punishing or rejecting is retained as safer than the alternative which is
abandonment. The loss of the punishing inner mother can be experienced as
a loss of the self, so that if the patient rids himself of the attachment to this
inner mother he fears that he is killing himself.

Dorpat (1989) places the major emphasis in the aetiology of masochism

at the pre-oedipal level. The apparent passivity of many masochistic clients
lies in the dilemma of whether the patient has the right to become more
autonomous. The core issue is not being able to separate. He feels that his
achievements belong to another. He feels guilty about telling the therapist
about a growing capacity to regulate the self. He feels that the therapist
would feel hurt or abandoned by any independent activity on his part, that
he had broken the implicit rules of the pathological symbiotic caretaking
relation to his mother. He concludes that the central complex is the
introjection of parental sadism, not the patient’s owns sadism turned against
the self which would be a superego derivative.

A critical developmental challenge is posed by separation and

individuation. Separation inevitably involves pain. This is damaging to
the infant’s sense of magical omnipotent control. The terror of losing the
object and fears of abandonment feature strongly in masochism. This
throws light on one of the puzzling features of masochistic personality
traits, the apparent inability to separate from relationships which appear
to result only in pain and suffering. This was the central issue in the case
of Elizabeth.

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Elizabeth
Elizabeth was a woman in her thirties who had two very young children. The main
focus over the first year of therapy was her unsuccessful efforts to separate from
her partner

.

Her parents separated and her father died when she was young. She gradually
recognised various difficult dynamics within her family. Her mother was quite
hysterical, manic and masochistic. Her older brother was indulged. Her sister
confronted her mother while she herself was very compliant. She felt that she was
treated as second best, that she was invisible

.

She felt that she had become the repository of her mother’s complaints and
anxieties, which made her feel constantly guilty. These dynamics were reflected in
her relationship with her partner

.

She came to therapy initially because of the deep unhappiness she experienced
as a consequence of her partner’s emotionally and verbally abusive and
exploitative attitude. He was an alcoholic and gambler. She had allowed him
to successfully convince her that she was responsible for his problems. He was
the attacking and dominant sadist, while she took a masochistic position.
Living with her partner’s resentment and blame had made it difficult for her to
use the therapy to claim the space for herself. It took some considerable time
before it was possible to move from thinking about her partner to looking at
her own experience

.

This did eventually change. She began to experience some compassion

for herself. She recognised that maintaining her grievances against her
partner only served to trap her in an impossible situation. She was
eventually able to leave that relationship and become more assertive and
challenge family members

The role of trauma and abuse

The growing literature about trauma brings in a complementary but
different perspective on understanding masochistic behaviour. The focus is
clearly on describing behaviour and seeking biological explanations for
reactions to trauma.

Howell (1996) says that masochism is post traumatic, and that the

victim does not seek suffering but is subject to it, precisely because so
much of the memory and experience connected with the trauma is
unassimilable or disassociated. It is therefore more liable to be repeated
rather than remembered and worked through. The masochist’s often
described lack of will or agency and sense of helplessness also describe
traumatic victimisation. Poor reality testing brought about by the damage
caused by rigidified disassociation contributes to further victimisation. In
disassociation there can be a frequency of hypnotic-like states, feelings of
being both helpless and blameworthy, and an inability to read danger
signals which contributes to the dangers of revictimisation. Trauma
can shatter the structure of the self and the organisation of attachments.

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Pre-existing soothing introjects can be disconnected by trauma and the
disassociative response to it.

Van Der Kolk (2007) proposed diagnostic criteria which include

problems with affect regulation, self destructive behaviours, addictions
and somatisation among others. In an earlier paper (Van der Kolk, 1989), he
provided a biological and behavioural basis to explain why traumatised
people expose themselves in a seemingly compulsive way to situations
reminiscent of the original trauma. Freud described this as repetition
compulsion.

Van der Kolk (2007) describes the effects of chronic hyperarousal, in

which victims react to current stimuli and trigger events as if the trauma had
returned (the return of the repressed). It becomes impossible to distinguish
between past events and current realities. In later work, he emphasises the
use of disassociation, a view shared by Schore (2007), who says that
attachment trauma triggers not a fight/flight response but the psychobio-
logical survival response of pathological disassociation. In behavioural
terms, he links this to increased attachment behaviours such as clinging on
in face of danger.

In the ever expanding field of neuroscience, increasing attention has

been paid to the impact of attachment on brain development and the
ability to regulate affect. In The Brain that Changes Itself Norman Doidge
(2008) describes the move away from the older idea of localisation of
functions within the brain to an understanding of the brain as an evolving
and flexible structure made up of a vast range of complex neural
pathways which are capable of change. He calls this mechanism
neuroplasticity. When we learn something new, neurons wire and fire
together. An electro chemical process occurs which strengthens these
connections. Equally, when the brain unlearns associations and dis-
connects neurons, a different chemical process occurs. If we only
strengthened connections our neural networks would get saturated. This
underlines the importance of mourning and letting go in order to allow
new development and change.

This would suggest a neurobiological and functionally adaptive

explanation for the repetition compulsion of which psychoanalysts have
long been aware, but would have discussed in intrapsychic terms alone. He
also points out that people under great physical stress release endorphins,
opium-like analgesics, which cause the body to dull pain and generate
euphoria. For example, the sense of relief which patients often describe after
self-harm such as cutting may have a physical as well as a psychological
basis.

Herman (1992) argues very forcibly that the misapplication of the

concept of masochistic personality disorder may be one of the most
stigmatising diagnostic mistakes. She says that survivors of prolonged
abuse develop characteristic personality changes including deformation of

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relatedness and identity. They are vulnerable to repeated harm both self-
inflicted and at the hands of others. She suggested the use of the term
complex post traumatic stress disorder to take account of the experience of
those who have been exposed to prolonged repeated abuse.

Defences against trauma

Considerable attention has been focused on defences used against trauma,
such as disassociation. Howell (1996) takes as her premise that masochism
and psychopathic sadism are differing post traumatic adaptations which rely
upon defensive disassociation. The masochist has disassociated rage and
aggression, while the sadist has disassociated vulnerability, attachment and
dependency. She points to the apparent paradox that the masochist
perceives himself as a criminal, while the sadist feels himself to be the victim.

Disassociation is described in Diagnostic and Statistical Manual of

Mental Disorders (DSM-IV) as a disruption to the usually integrated
functions of consciousness, memory, identity and perception of the
environment. Following Davies and Frawley (1994), Howell makes a
distinction between repression and dissociation, arguing that the former
usually has as its unconscious motivation an attempt at active mastery of the
trauma, while the latter does not.

The following two brief case histories illustrate experiences of early

trauma, followed by a pattern of destructive relationships and addiction, yet
there are clear differences between the defences used. In John’s case, hyper-
arousal was more evident. In Ruth’s case, dissociative phenomena were
more immediately obvious. It is important to note that clients can and do
frequently oscillate between both states.

John

John was a young man in his mid twenties whose father was an alcoholic,
frequently violent to his mother and other siblings. His mother died after a
prolonged illness when he was a young teenager. He described his mother as
‘saintly’, and therefore dared not criticise her judgement or even consider why she
had not left his father. He feared that if he criticised her he would be abandoned
by her. He said that being ill treated made him feel closer to his mother, that he
shared her pain. He worried that if he let her down he would be punished. He
continued to try to help his father, despite his father’s violence towards him, as his
mother had done

.

John sought help to address his drug and alcohol abuse. Over time, he was able to
reduce his reliance on these substances. He then became aware that he was
experiencing episodes of panic, anxiety and depression. He was in a relationship
with a dominant and verbally abusive partner. He felt that he was not good
enough to have a relationship with someone from a ‘normal’ background.
Whenever he tried to leave the relationship his partner would spread negative and
critical rumours about him. He felt humiliated and shamed by this, and would
immediately return to the relationship

.

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When he was finally able to end his relationship he found it difficult to
acknowledge the relief he felt. He became increasingly aware that his deep
seated sense of guilt made him very easy to manipulate. His deep identification
with his long suffering mother contributed to the masochistic traits in his
personality

.

Despite his early history, the masochistic aspects of his personality did

prove amenable to change, which suggested that they were not so deeply
rooted as his history might imply. His presentation was more linked to
chronic hyper-arousal which he tried to overcome by the use of alcohol and
other drugs. This seems very different from clients where disassociation is
the most prominent defence.

Masochistic dynamics frequently feature in many therapeutic encoun-

ters, but their extent and significance vary enormously. Fitzpatrick Hanly
(1995) describes the possible transition from moral masochism to the
development of a masochistic character. This involves the intensification of
masochistic trends into organised and fixed sets of attitudes to the self and
others, usually involving a relationship which allows for a permanent sense
of injustice.

The case of Ruth illustrates an experience of trauma where disassocia-

tion coupled with a persistent sense of injustice is more prevalent. It
was much harder to access her emotions. Passivity and helplessness,
coupled with a repetition of traumatising experiences were present. The
quality of the transference and countertransference dynamics was very
different from those with John, and perhaps contributed to the less hopeful
outcome.

Ruth
Ruth was in her early thirties and had just moved to a new city to undertake a
course of study. Ruth’s sessions were full of complaint. She felt neglected and
hard done by. She generated a slow and heavy atmosphere. People were too
demanding. Her employer and academic supervisor treated her badly and
preferred others to her. She had a boyfriend who she described as passive and
unmotivated. She said that she often stuck at things that she did not want to do
and made herself feel worse. In desperation she had moved to another city, but
then realised that this had made no difference. She spoke about various health
issues, but laughed as she did so. She said that this was the only way that people
took any notice of her. I found myself dreading her sessions and experiencing
great tiredness which would dissipate as soon as the session ended

.

She had been adopted and had recently made contact with her biological mother,
who met her several times but refused to acknowledge her. She denied that she
felt anger about this

.

After several months she acknowledged that she drank heavily at times, but
justified it as a legitimate response to her loneliness. She said that she felt very
self destructive and had an urge to cut herself

.

She complained about her adopted family and said that other siblings were
preferred over her

.

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B. Gavin

Her adoptive mother suggested that she thought Ruth was angry with her. Ruth
confronted her and forced her mother to deny this – a negative victory!

She eventually said that she did not want to be negative but couldn’t help it. Being
negative meant that she did not have to change, or to confront those with whom
she was angry. She described how others became frustrated with her. They
suggested actions which she could take, which confirmed for her that they did not
understand her, otherwise they would never have been so insensitive as to suggest
them

.

This was re-enacted in therapy. In the countertransference I oscillated between
helplessness and frustration. Ruth acknowledged that she felt under pressure from
me, but said it was the only environment in which she could really say how she
felt

.

Ruth’s masochism was a response to very early damage, but it had

influenced her whole personality.

This was reflected in her tendency to somatise, to use substances to self

medicate and in her self destructive urges. Her anger was split off and
projected. Her deep seated sense of grievance kept her tied to her damaging
objects.

Her plan as she ended, was to move to another country, maybe to seek in

a symbolic sense that care and nurture she had been so deprived of. While
her intention was to escape her problems, the likely outcome was rather
that she would hold on to them, which is what had happened in previous
moves.

Narcissistic masochistic character

Pre-oedipal dynamics help us to understand what Cooper (1988) calls the
narcissistic masochistic character. When early narcissistic humiliation is
excessive, being disappointed or refused becomes the preferred mode of
narcissistic assertion. These distortions came to dominate the character. If
one can secretly enjoy disappointment then it is no longer possible to be
disappointed. This can be accompanied by a sense of grandiosity and self
pitying deprivation. The narcissistic gratification (‘I never yield’) and
the masochistic gratification (‘I enjoy suffering at the hands of a master’)
co-exist.

Some of these dynamics are illustrated by the case of Mary, a student in

her late twenties.

Mary
Mary presented in a state of great distress and said that she had not slept for
days. She was a student and having great difficulty balancing employment and
academic work. She feared a negative reaction from her tutor

.

On closer exploration the reason was that she felt her academic competence and
standards were higher than those of her tutor. One of her difficulties with study
was her perfectionism, and stubborn refusal to study at the standard expected in a

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primary degree. Instead she said she could not work within the time constraints,
because her work would be too superficial. If her work was praised she felt
punished by a store of onerous expectations that others would then have. She said
dismissively that when she did do badly, it was in subjects that she did not care
about anyway

.

She elicited great concern from those around. She has a long history of physical
illness, especially stomach problems. She smiled as she told me the doctors were
worried that she was losing weight. I reacted with a sense of surprise and
wondered (to myself!) why I had not been concerned. I wondered if I had been
negligent

.

Mary cried frequently. I felt that I was the abuser, a feeling she shared! Once she
told me, ‘You did not make me cry today’. She said that she only cried in
counselling. I felt completely over a barrel. I was either to join the ranks of cruel
mothers, represented by her actual mother, her employer, her lecturers etc., or to
become passive, listen to her grievances and thereby become part of the inferior
establishment which did not appreciate her

.

When she finished her therapy she said that she had recognised that there

had been many improvements and good aspects to her life. She did say that
she now needed to concentrate on her exams. I had the lingering sense that
she considered this to be far more worthwhile than the work we had done
together!

I was left with the sense that I had disappointed her in some non-specific

way, that I had not really understood her suffering. It was clear that she
experienced a kind of secret triumph as described by Cooper in his
discussion of the narcisstic masochistic character.

Functions of masochism

Meyers (1988) reminds us that seeking pain must serve some unconscious
function and provide some need satisfaction. The therapeutic challenge is to
discover which needs! She describes four different paradigms which help to
illuminate and differentiate these dynamics.

(1) Masochism and guilt. Guilt results from forbidden oedipal

desires and aggression. To avoid the danger of retaliation the
aggression is split off. The masochist provokes and invites hurt and
guilt from others and uses this pain to play on their guilt. Such
patients refuse to accept anything good. This view reflects classical
drive theory.

(2) Maintenance of object relations. Here the masochism takes the form

of pre-oedipal aggression against the mother in the face of infantile
helplessness. Frustration is turned against the self. The aim is to
gratify the aggression yet avoid the retaliation. This masochist will
try to appease the aggressive mother by buying her love with
suffering. Loewenstein (1995) calls this the ‘seduction of the

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aggressor’. Pain and discomfort became associated with love. The
masochist loses if he stops suffering.

(3) Masochism and self esteem. This form of masochism is linked to the

separation and individuation process. The child attempts to repair
narcissistic injury to self esteem by asserting control as if he can
achieve mastery through suffering. Novick and Novick (1995)
elaborate the role of early omnipotence in the development of
narcissistic masochistic personality.

(4) Stolorow (1975) suggested that early trauma leads to a primary

anxiety which is the threat of dissolution. He sees masochistic actions
as a defence against this early anxiety. The search for painful
experiences can be a means of maintaining a feeling of being alive;
merging with a powerful even though punishing other is a way of
assigning self-cohesion

These four paradigms while conceptually helpful, should not distract

us from the recognition that reality is infinitely complex. Patients can
move between these different anxieties or alternatively their difficulties
may be primarily in one or the other of these areas. In the case material
previously described, guilt, the fear of separation and of omnipotence
were all present but varied in intensity during the course of the
therapeutic work.

Transference and countertransference challenges

Following Freud, Brenner (1995) emphasised the unfavourable prognostic
significance of a strong unconscious need for punishment which usually
features in masochistic presentations. He described a negative transference
reaction where the patient gets worse or fails to improve.

Through the ever evolving transference and countertransference

dynamics various complementary roles are played by the therapist and
patient. Racker (1989) made the very helpful distinction between concordant
and complementary identifications. Concordant identifications are those
which belong to the patient’s internal objects and with which the analyst
identifies. Complementary identifications are those which correspond to the
impulses, anxieties and defences of the patient’s internal objects.

A number of complementary roles can be played by the patient and the

analyst. Before considering the patient’s contribution, it is important to
remember what may be contributed by the therapist.

It is often stated, almost as a truism, that those involved in caring roles

may have a greater than usual tendency towards masochism. This may
contribute to their unconscious choice of a ‘caring’ professional role. Racker
even says that masochism is a universal tendency which exists in all analysts.
The issue is to what degree.

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The analyst’s masochism can lead to a number of therapeutic blocks. He

may put his own sadistic internal objects into his patients. He may feel the
need to suffer or feel persecuted by his patient’s negative transference and
aggression, while overlooking the positive transference. He may be inclined
to submit to his patients, allowing himself to become passive and detached.
He may allow the patient to be in charge, even allowing himself to be used,
so as not to frustrate the patient.

With reference to the principle of complementarity, Baudry (1989)

describes how sadistic behaviour may stimulate counter aggression or
compliance. Procrastination or stubbornness leads to nagging. Whining
or helplessness may stimulate either aggression or caring. The challenge
to the therapist is to try not to react automatically, not to make
assumptions about what behaviours may mean, but to question and
explore. This was a very pertinent issue for me in my reaction to Patricia’s
tears.

Patricia
Patricia spent much of her sessions in tears. I began to realise that I felt
strangely unmoved. When I explored with her what these tears were really
saying, she said that her tears often represented her sense of helpless fury and
impotent rage. She said that she feels pushed around and exploited by others.
She felt particularly bitter towards her sister who bullied and humiliated her.
She said she felt very exposed and shamed by this. She had many health
difficulties, and had undergone major gastric surgery. Her stomach acid had
destroyed her stomach valve

.

She described an incident where her employer refused to give her time off for a
social function. Her colleagues interceded on her behalf. Her employer relented
and then she felt trapped because she realised that she did not actually want to
attend the function!

It became clear that she had little sense of her own desire and frequently
misperceived what actually happened in her relationships. For example, she
blamed herself for difficulties with her boyfriend, she minimised and only
gradually recognised the extent of his abuse towards her. He was dismissive, and
prioritised his involvement with his drug taking friends. He was verbally abusive.
She frequently loaned him money and allowed herself to be mistreated in various
ways. She was furious with the behaviour of her sister who she said dominated her
completely, but only much later recognised the severity of her sister’s mental
health problems and their impact on the whole family

.

She said that in her family she behaved very submissively, as if by her compliance
this would differentiate her from her sister. This resulted in a gradual limiting of
her personality, which she tailored to fit in with others. She desired to be the
favoured child, which in turn stimulated rivalry in her sister

.

She began to realise that her mother’s response to the expression of rivalrous
feelings within the family was to respond with passivity and helplessness. This
intensified the rivalry. With her increased ability to recognise her own
contribution to these situations, she progressively felt less helpless, and began
to react more assertively

.

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She started to think more proactively about the future and began what appeared
to be a more supportive, positive relationship

.

In Patricia’s case more improvements proved possible than I would have

anticipated at the outset. Progress occurred when I stopped making
assumption of sadness and helplessness when she cried. I began to enquire
more carefully as to the possible emotions expressed by her tears.
Eventually, she was able to move from passivity to activity and to mobilise
her aggression in a constructive way, which led to changes in her
relationships with significant figures in her life.

Davies and Frawley (1994) described four pairs of transference and

countertransference positions, which although located specifically in the
context of childhood sexual abuse, have a broader applicability where sado-
masochistic dynamics are involved.

(1) Unfeeling, uninvolved parent and unseeing neglected child. In this

constellation, the therapist becomes the uninvolved parent and the
patient becomes the neglected unseen child. The therapist can feel
irrelevant and unwanted. He may feel bored, sleepy and unin-
volved. Another possibility is the patient focuses on caring for the
therapist as she once cared for her parent. Her rage is split off, and
she may involve herself in self destructive behaviour, such as
cutting or self abuse. Lebe (1997) describes the self destructive use
of drugs and alcohol as forms of attachment to a rejecting inner
mother.

(2) Sadistic abuser and the helpless impotently enraged victim. This

paradigm tends to be split off from conscious awareness. It is
particularly upsetting in that both patient and therapist see
themselves as both victim and abuser. The therapist may experience
the patient as intrusive, with her entitled demands for attention,
extra sessions, phone contact etc.

(3) Idealised omnipotent rescuer and entitled child. This dynamic

becomes particularly powerful when the patient begins to mourn
her childhood. The patient needs to experience her grief. The danger
is that the therapist can present herself as the rescuer, which then
truncates the patient’s working through. The patient becomes the
wounded child who needs to be compensated.

(4) Seducer and the seduced. Transference and countertransference

dynamics are erotically tinged. The therapist needs to convey that
sexual feelings and seductiveness are acceptable aspects of human
experience while maintaining the integrity of the therapeutic
boundary. It is this combination of acceptance, availability and
boundaries that allows the patient to differentiate between benign
and malignant seductions.

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195

The unfolding of these enactments is the means by which the patient

creates an inner scene which is apt to serve as a mirror for the experience of
psychic pain and to represent preverbal childhood trauma in a symbolic
way.

Rohde-Dachser (1999) reminds us that what has traditionally been seen

as a masochistic fantasy may also be seen as the ego’s reactive attempt to
compensate for psychic deficiency, defined in terms of the incapacity to
establish an empathic inner object as a psychical structure. Rohde-Dachser
goes on to explore the difference between the therapist’s counter-
transference response and the patient’s expected response. For example,
the analyst’s silence may be seen as an expression of disapproval and
hostility. The premature interpretation of aggressive sadistic aspects of the
sadomasochistic scenario are likely to be experienced as an attack, which
may come from the therapist’s fear of being pushed into a masochistic
role.

On the other hand, too passive a stance may lead the patient to

experience the therapist as a sadistic voyeur, who is secretly thriving on his
dependence and suffering. The analyst needs to adopt a non intrusive
empathic attitude, the unobtrusive witness of mental pain.

This is of course very difficult. One clue as to why is described in Coen’s

1988 paper, Sadomasochist Excitement: Character Disorder and Perversion
(Coen, 1988) in which he explores the complex interrelationship of
masochistic character disorder and masochist sexual excitement. He follows
Freud in suggesting that sadism and masochism are both erotic expressions
of aggression. They are ways of loving and hating others and oneself. They
are concerned with intense ways of engaging which may also mitigate the
dangers of separateness, loss and loneliness.

In this formulation, Coen is bringing together both oedipal and pre-

oedipal developmental derivatives. He says it is exciting to feel able to
induce intense affective responses to another person. The masochist is
willing to surrender to the hostile parental view in order to feel the illusion
of magical protection, caring and specialness under the domination of
the powerful destructive parent. Surrender protects them from the dangers
of both hatred and destructiveness. It is seductive indeed to offer the
other the grandiose prospect of doing whatever he wants. The child
extracts care from the parent, protects the parent from his guilt at hating
or neglecting the child and enhances his own worthiness through his
suffering. The masochist seeks mastery, control and associated narcissistic
enhancement through the provocation and exaggeration of suffering.

Asch (1988) draws attention to the sense of glee some masochistic

patients express when they feel they are defeating the therapist, that there is
a hint of smug condescension. He describes a fantasy in which the primary
object, the pre-oedipal mother, is watching and approving of the defeat of
the analyst. The negative therapeutic reaction is intended to defeat the

196

B. Gavin

analyst’s aim of disengaging the masochist from the death embrace of the
internalised pre-oedipal engulfing mother.

The following description of the case of Peter contains many of these

aspects, countertransference difficulties, the withdrawal of sexuality as a
form of revenge, the fear of separation, the wish to defeat the therapist and
the terror of autonomous functioning.

His passivity stimulated considerable frustration on my part and his

attempts to control the sessions contributed to my sense of helplessness and
impotence.

Peter
Peter was a successful man in his forties. He sought therapy because he said that
his wife was disappointed in him. Their sex life had ceased. His wife had had an
affair two years previously. His father was an alcoholic. He described his mother
as a combination of masochism and aggression. She made it clear that her
children owed everything to her and that she expected to be repaid. He described
her as arbitrary and unpredictable

.

He seemed to be surrounded in his work and personal life with powerful and
controlling females, to whom he responded with extreme passivity. He was
terrified of conflict, avoided intimacy and had distant relationships with family
members. In any position of conflict he immediately identified with the position of
the other, and was unable to think about his own experiences

.

He came to sessions with material prepared, to avoid the possibility of being
criticised. His mother had described him as lazy. He said that his problem was
that he couldn’t communicate and ‘demanded’ that I provide a ‘how to’ guide to
rectify this. By this means I felt that I was being positioned as yet another
castrating female, and was being set up to be responsible for his behaviour and to
be the target of his hatred

.

He described unwillingly going to a social function and then leaving without
telling his wife. He said that she felt suspicious of him, and accused him of being
evasive and untrustworthy. When he spoke about himself, he described himself
through the eyes of others. He said his mother did everything for him, which he
complied with, but she still criticised him. He felt that his wife was superior to
him, and felt that whenever he initiated a social relationship, she moved in and
took over, at which point he became suspicious of her

.

In my countertransference, I began to feel suspicious and began to think that he
might make an arbitrary decision to leave therapy. I began to sense that the
aggression which he had built up in relation to his wife was now being projected
on to me, so that I would be responsible for his decision to leave. I also felt he saw
me as the one with the answers which I was withholding from him. Alongside this
he feared that if he thought for himself he would be abandoned

.

For example he travelled quite a long distance to my office, yet he frequently felt
that I had somehow imposed this on him. He could not experience himself as
having made a choice to seek therapy. Indeed his original motivation in coming
was to appease his wife

.

He did decide to leave. He said he wanted to see if he could make changes on his
own. He said that he didn’t see the relevance of going into his background and
history any more. He retreated into narcissistic omnipotence and I felt that I was

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197

the failure who he then abandoned. The failure I experienced was a re-enactment
of the sense of failure he had experienced with his mother

.

Little progress was made in this case and that of Ruth. The similarity is

that in both cases there was a predominance of passive dissociative features
which seemed to indicate a worse prognosis.

Conclusions

The cases have a striking number of similar features, albeit in different
combinations and each with different significance. They had all experienced
some level of early loss, and deficits in early nurture. All the fathers had
either died when the client was young, or were rather passive. In one case the
father was functionally absent due to alcoholism. These absent fathers
tended to be idealised and viewed as an escape from the difficulties with
mother.

In some of the cases there was a sibling with serious mental health

issues which had a powerful effect on family dynamics. Substance abuse
featured strongly either in themselves or their partners. Physical illness was
another significant feature, either of themselves or of a parent.

Such histories are very familiar in clients seeking therapy. The in-

triguing issue is how these difficulties came to be expressed through
masochistic phenomena. In all cases the clients described themselves as
‘the good one’, who sought parental approval by compliance. There was
an identification with the masochistic mother and a reactive inhibition of their
own personalities. Passive aggressive tendencies were very apparent. In most
cases, these early relationships were reflected and mirrored in the relationship
they had with partners and other people in their lives.

In seeking to understand these presentations, valuable insights came

from considering both psychoanalytical theory and the literature of
psychobiological responses to trauma. The trauma literature tends to focus
more on behaviour, whereas the psychoanalytical literature is concerned
with meaning. A more complex and fuller understanding requires thinking
about the subtle and shifting interaction of both these levels, and the impact
of these on the relationship between client and therapist.

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