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Record: 1
Title: The Development and Consequences of an Aggressive
Symbiotic Fantasy
Authors: Awad, George, A.
Source: Psychoanalytic Study of the Child, 2000; v. 55, p180, 22p
ISSN: 00797308
Document Type: Article
Language: English
Abstract: Chronic anxiety in a female patient was understood to have
multiple meanings in relating to the mother through the fantasy of
a symbiotic union. The origins of the fantasy are traced to the
patient's poor relationship with a preoccupied and unavailable
mother. The fantasy underwent several transformations under the
influence of subsequent developmental phases and the special
role of aggression in its elaboration. This paper illustrates the
reciprocal interactions between separation-individuation and
psychosexual development and their influence on the
development of the self and gender identity, defenses against
aggression, development of a sadomasochistic style, and
transference-countertransference interactions. The symbiotic
fantasy is seen as carrying the imprints of all developmental
phases and as having multiple functions.
Accession Number: PSC.055.0180A
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The Development and Consequences of an Aggressive Symbiotic Fantasy

George A. Awad, MD, author
Chronic anxiety in a female patient was understood to have multiple meanings in relating to the mother
through the fantasy of a symbiotic union. The origins of the fantasy are traced to the patient's poor
relationship with a preoccupied and unavailable mother. The fantasy underwent several transformations
under the influence of subsequent developmental phases and the special role of aggression in its
elaboration. This paper illustrates the reciprocal interactions between separation-individuation and
psychosexual development and their influence on the development of the self and gender identity,
defenses against aggression, development of a sadomasochistic style, and transference-
countertransference interactions. The symbiotic fantasy is seen as carrying the imprints of all
developmental phases and as having multiple functions.
During the Last Ten Years I have Worked with Three Female Patients in whom a major area of their
psychodynamics was a symbiotic fantasy involving their mothers. I use the term “symbiotic fantasy” to
describe both a consciousfantasy of physical and psychological connections to their mothers and the
unconscious contents uncovered during analysis. Different fantasies resulted in different
psychodynamics and transference manifestations. In this paper, I report only on one patient, whose
fantasy was that she was physically bonded to her mother like a Siamese twin.
The developmental theory of separation-individuation (Mahler, Pine, and Bergman, 1975) is

complementary to the psychosexual development theory. The literature includes contributions about
interactions between the two theories in observed children (Bergman and Fahey, 1994) and in general
(Parens, 1980, 1991). This trend in reporting has continued as separation-individuation theory has
evolved (Lax, Bach, and Burland, 1980, 1986; Akhtar and Parens, 1991). However, clinical contributions
about the relationships between the two lines of development in adult patients have been few.
Furthermore, these two lines cannot be isolated from other lines of development. This paper
reconstructs the development of the symbiotic fantasy as an illustration of the connection between
separation-individuation and psychosexual development, as well as their connection to other
developmental lines. The patient's preoccupation with her mother affected her subsequent development
and transference manifestation. In this paper, I focus on the first three years of continuing analysis but
will mention relevant issues from the subsequent two years.
Definitions
Since the terms “symbiosis,” “symbiotic fantasy,” and “genital anxieties” are used throughout this paper,
I will clarify my understanding of each one.
In the 1960s and 1970s, the Mahlerian concepts of symbiosis and separation-individuation formed a
dominant psychoanalytic idiom, at least in North America (Mahler, Pine, and Bergman, 1975; Mahler
and McDevitt, 1989; McDevitt and Mahler, 1989). However, Shapiro (1993) noted a relative disuse of
this idiom during the 1980s, as the existence of the autistic and symbiotic phases of development
increasingly came under question. The strongest critic of the Mahlerian concepts has been Stern
(1985), but others also have suggested abandoning them (Peterfreund, 1978; Lichtenberg, 1983;
Horner, 1985; Tustin, 1991). This criticism raised the question of whether all Mahlerian concepts were
based on false assumptions. If there are no autistic or symbiotic phases, can there be separation and
individuation?1
My view is that any adjective used to describe any period of life is bound to be inadequate. Specifically, I
do not think the terms autistic and symbiotic describe the essence of the first few months of life. Our
formulations about the early inner life of patients, including the transformation of symbiotic wishes and
gender identity formation, are a mixture of inferences from data and assumptions from clinical work.
Thus, while the infant is a social being from birth and has far more cognitive abilities than previously
thought, these abilities are evident only during one state, that of alert inactivity, which constitutes a small
part of an infant's day (Wolff, 1959). Concomitant with the experiences of alertness and differentiation
are the inferred states of symbiotic moments (Pine, 1990), such as the physically and emotionally
attened feeding or falling asleep in the mother's arms. Even during states of alert inactivity, there are
periods of affective attunement that may be experienced as affective and emotional symbiotic moments.
The mother's responsiveness to the emotional cues of the infant may be experienced by the infant as its
ability to change the mother. This sense may be a precursor of the later elaborated fantasy of coercing
the object. The need for physical and psychological symbiotic moments is not outgrown but is
transformed into the need for adult symbiotic experiences, such as orgasm, physical and emotional
closeness, and religious and artistic experiences. The vicissitudes of the boundaries between self and
object are paradoxical developmental processes toward different moments: differentiation and
separateness, coexisting with moments of closeness and fusion.
Adult symbiotic fantasies are not fixations or regression to earlier phases but rather are constructions
created for adaptive and defensive purposes. These fantasies have precursors in earlier symbiotic
experiences and fantasies. Once formed, fantasies not only influence subsequent developmental tasks
but are themselves influenced and transformed by them. Thus, adult symbiotic fantasies carry the
imprints and alterations of the whole developmental process (Lachman and Beebe, 1989); their
functions go beyond wish fulfillment to include problem solving, reassuring, and defensive and adaptive
functions (Sandler and Nagera, 1963; Brenner, 1982; Sandler and Sandler, 1987; Hayman, 1989).
The earliest mental constructions of a female infant are representations of her body, including her
genitals. Constructions at that age are influenced by perceptions and sensations from her body: what
she can see, touch, manipulate, mouth, taste, smell, and hear. Undobtedly there is an early phase of
primaryfemininity (Stoller, 1968, 1976) as well as genital sensations during infancy (Kleeman, 1975).
There are some structures she can touch and perhaps occasionally smell, parts she can see, and a hole
leading to a potential space (Mayer, 1985). In addition to whatever sensations a female infant
experiences, the mental representations of her genitalia are influenced by her fantasies and by how her
mother represents female genitals; the mother's representations are influenced by her own unconscious
representations and anxieties. Thus the psychosexual developmental task of infancy is to begin building
gender identity, including mental representations of genitalia. The process is fraught with anxiety and
conflict about the shape and contents of the inner space, access, injury, being closed, and the
diffuseness of sensations. Thus primary genital anxietiesconcern the structures and functions of her
genitals and the possible dangers to them. The signal affect is anxiety; danger is anticipated, and the
compromise formations are intended to prevent it (Mayer, 1995).
However, at about 18 months of age, all children discover anatomical differences (Galenson and
Roiphe, 1976). They react to the discovery with anxiety and with explanations such as castration,
mutilation, hidden penis, and fantasypenis. These are called secondary genital anxieties—that is,
reactions to the discovery of genital differences. They are the female infant's reactions to the genitals
she does not have and fantasizes having lost. The signal affect is depression: the loss has occurred,
and the compromise formations are to deal with it. The resolution of both types of genital anxiety is
influenced by parental views and attitudes toward female sexuality. My use of these terms is similar to
those proposed by Bernstein (1990, 1991) and Lax (1994).
Case Presentation
Andrea was a 25-year-old single white female who was referred to me by a colleague from another city,
where she had been in analysis for six years. Her move was precipitated by the loss of her job there.
She wanted to continue her analysis because she still felt angry and fearful, had low self-esteem, and
was unable to maintain a relationship with a man. She attributed her anger to domination by her mother.
Andrea, the oldest child, had a 23-year-old brother and a 22-year-old sister, both living in the west. She
described herself as having been a good student and a bookworm who did nothing on her own, did not
date much, and felt unattractive. After graduating from college, she worked for a couple of years before
moving here.
Her opening statement in the first analytic session was, “I am scared to death.” She indicated that her
previous analyst was upset by her decision to move and suggested that she could not tolerate being
unemployed or what was happening in her analysis. He initially refused to give her the names of
analysts in our city. At this point she was crying, so I handed her a box of tissues. She said that she had
considered continuing with Dr. X out of a sense of duty toward him and had gone on unemployment
insurance. Then she adde, “You know, he never gave me Kleenex, he said, ‘Bring your own.’” I asked
how she felt about my giving her the Kleenex. She commented on my “generosity” but felt frightened by
it, and added, “To be buried in your generosity. There are two years behind this remark. However, I do
not know what was his and what was mine. I felt that many interpretations were forced on me and I got
to accept them.” Then she looked at the tapestry on the wall next to her and said she wanted to touch it
but was afraid of upsetting me, adding that I had told her to take her shoes off. I said she seemed to
experience me as generous because I gave her the Kleenex and as stern because I told her to take her
shoes off. She answered that she needed to maintain a distance and not feel overwhelmed. She wished
to withdraw into a dungeon and tell me to fuck off, because it was important for her to own what was
hers. Then she expressed disappointment because an unattractive friend of hers was getting married,
while she (Andrea) had had “zero success with men.” Later, she expressed anger at Dr. X for telling her
that she could not make it on her own and that her life would be bleak without analysis. She recalled his
disapproval of her having unprotected sex, telling her that she had no space for a baby. She expressed
the wish to put everything Dr. X told her into a garbage bag and toss it away, because she wanted to be
herself. She ended the session saying, “I do not feel good about myself; I hate my mother.” The issues
raised in the first session turned out to be the central themes of her analysis.
The following pattern soon evolved: Andrea was in a chronic state of anxiety, and our sessions were
filled with material about her mother, whom she described as bitter, angry, and domineering, dissatisfied
with her role as a wife and mother. Andrea felt that her birth was responsible for her mother's fate. Her
reaction to her mother was a mixture of fear, anxiety, anger, and hate. Yet she felt so tied to her that the
slightest shift in her mother's mood devastated Andrea. She was also preoccupied with and hated her
brother for taking mother's attention from her. She made little mention of her father, who was presented
as benign and absent, or her sister, who was remembered fondly.
What struck me was that, other than her ability to free-associate, I could see no evidence of a change
as a result of Andrea's previous analysis. I felt she was testing me to find out how I was going to relate
to her. She compared me with Dr. X, whom she experienced as being like her mother, domineering and
imposing his views on her. The following dialogue illustrates the interchange between us:
Andrea: (describing an incident where an ex-boyfriend ejaculated in her mouth): Why did I not insist on
using a condom in blow jobs? … I feel like caressing your carpet, but it is inappropriate to do it.
Analyst: Why is it inappropriate to caress my carpet?
Andrea: Do not tell me it is massaging your penis. I talk like Dr. X. May be that is the difference between
you and Dr. X. He interprets and you ask questions. I felt overwhelmed by him but not by you. These
were his interpretations and not mine.
About the same time, her fears of being controlled and dominated by me appeared frequently. For
example:
Andrea: I do not trust you at one level.
Analyst: Why is that?
Andrea: I feel that you will take me over. Sex is only part of it. It happened with Alan (an ex-boyfriend).
He took over my life, wanted to buy a TV with me, move in, have me dress in a certain way.
Analyst: Do you worry that I would do the same thing to you?
Andrea: I don't know.
I also realized that interpretations about sexual themes in particular were experienced as being forced
on her and have become ready-made explanations.
Andrea: I have no place for those feelings; I cannot handle them.
Analyst: What are those feelings?
Andrea: Anger and resentment. There is the sexual energy that keeps coming to my mind. I cannot let
go because I will get out of control. Last week I felt I wanted to hang on to something: a penis, and then
I pulled my hair.
Analyst: It seems that issues around penises make you upset.

Andrea: And it is going to be that I wanted my father's penis! … I remember a discussion with Dr. X who
said I may have seen my father naked. I wondered why would I want his penis in my mouth and he said
infants put everything in their mouth.
I also sensed that she had a need to turn every encounter into a battle:
Andrea: I am convinced that something bad is going to happen to me. You cannot take that away from
me. May be I am mad because I feel you want to take it away from me. I know what it is like to be afraid,
have nightmares, be a failure. You cannot convince me otherwise.
Analyst: You feel I have another agenda for you?
Andrea: Yes. Don't worry, be happy.
Analyst: What is your agenda?
Andrea: I don't know what my goal is. If I attributed it to you, then I experience it as something you are
imposing on me. My position is fuck you, I don't want you to define me. If I assume you want what I
want, then I make it your agenda so as to fight you.
These encounters (and many similar ones), as well as her relationship to her mother, alerted me to two
problems. First, Andrea felt dominated and defined by her mother and by her previous analyst; and,
second, she experienced most passionate relationships as sadomasochistic encounters. I felt that
Andrea experienced interpretations of all sorts, particularly sexual transference, as someone else
defining her, and thought she needed a long period of being listened to to help her feel that she was
defining herself. Therefore, I elected to listen and help her talk about herself and others. My verbal
interventions were cautious, tentative speculations about what was going on inside her and between her
and me. On many occasions, I interpreted her attacks on me and her wishes that I would be more
aggressive and more interpretive than inquiring as her desire that I try to define her, just as her mother
did, so that she could defy me. I avoided getting entangled in sadomasochistic encounters by being
patient and not responding to her provocations. This approach I believe avoided the enactment of an
ambivalent maternal transference. However, because of Andrea's preoccupation with her mother, most
of my interpretations centered on that relationship and its influence on Andrea.
About four months into the analysis, a series of sessions clarified her feelings about her gender. She felt
that as a female she was meant to be a doormat and was supposed “to be fucked … to grovel and give
someone a blow job while I am on my knees,” and that she was supposed to suck “dicks” for the rest of
her life. However, she also had retaliatory fantasies, such as dicing a man's penis, putting it in potato
salad, and eating it. She saw the penis as a weapon, a status symbol, and a means of control. The
superiority of the penis was as much a fact as “the sky is blue.” Men are “haves” and she is a “have not,”
congenitally defective and physically handicapped. My penis (i.e., my interpretations) were her crutch; if
she had a penis, she would not need me. She experienced my non-confrontational style as the
equivalent of telling her, “well, Andrea, buckle down and suck my penis.”
She often ended such association with the comment, “I feel sad, I want my mummy to come and make
me feel better.” She agreed with my interpretation that when she felt overwhelmed by unpleasant
feelings, including shame about her genitals and gender, she wished to regress to a period when, she
imagined, she was comforted by her mother; she wished I could comfort her but could not allow me to
do that.
Most sessions continued to be filled with her preoccupation with her mother and her anger at her
brother. She alternated between being angry with her mother and crying for her and wanting her mother
to hold her and make her feel better. About six months into her analysis, Andrea started dating Bill, who
became her long-term boyfriend. Despite having a loving boyfriend and a good job, her anxiety
increased. I suggested that this was due either to fear that her aggression would injure someone she
loved, or fear of retaliation for her oedipal victory. Later, sadomasochistic masturbatory fantasies
emerged, in which she directed a man to tie her to a pole and masturbate and rape her in front of an
audience. I suggested that sadomasochistic modes of relating seemed to be not only her model of
relationships but also her model of sexual intercourse. In addition, I pointed out that even though she
was the victim in these fantasies, she was also in control.
During the second and third years of analysis, Andrea maintained a good relationship with Bill and
continued to progress in her work. In a Friday session about 16 months into her analysis, she reluctantly
talked about enjoying sex and practicing new sexual activities with Bill, but indicated that some practices
were still prohibited. When she hinted about anxieties about her insides, I wondered what her fantasies
were about the insides of her genitals. Andrea answered, “What occurs to me is that my vagina is full of
shit. … If a man knew what was inside me he would not want to have sex with me. May be there is
hydrochloric acid inside me that dissolves their dicks.” She ended the session by saying, “I cannot have
sex on top, I will get killed.”
On the following Monday she started by saying, “I am a miserable lump, leaking misery and shit. I am
leaking piss and shit and vaginal discharge. Maybe they are one and the same for me.” She had
endured a miserable weekend: she had slapped herself hard, called herself “bitch,” wanted to kick
herself, to break her wrist and elbow. Then she wished the same on her mother. She also fantasized
about punching her jaw or putting a gun in her mouth and blowing her head off. She then suddenly
slapped herself hard several times and screamed, “Bitch, bitch, bitch! The fantasies are not supposed to
be sexual!” Later, she added that she had “a really sick fantasy of giving a blow job to a gun barrel. I
hate myself. It is disgusting. It is an explosive issue. If I don't watch out I will get killed. If I have a real
orgasm, I'll blow up and get killed. … Yesterday, I fantasized about hiring a male hooker who slapped
me around and then raped me.” My attempts to interpret these fantasies in the transference—that is, I
could be the wished-for male hooker—produced more anxiety and rage. However, she could accept
non-transference interpretations—injuring the loved and envied one (dissolving his penis) by her rage,
confusion about her genital anatomy, seeing the sexual act as a sadomasochistic encounter of injuring
or being injured and orgasm as explosion of her body.
For the next several months, Andrea had several panic attacks a day that interfered with her work and
kept her awake at night. Even though it was clear that the sexual material was causing severe anxiety, I
recommended a consultation about the use of medication. She was put on 150 milligrams of sertraline
(Zoloft), which controlled her panic attacks.
About 18 months into Andrea's analysis, she and Bill visited her parents. She returned in a mood of
frenzied despair. She felt severe anxiety about changing and was not sure that she could survive the
changes. She was particularly angry with me: “I hate your guts, Mr. nice, compassionate, tolerant
analyst. I would like to kill you. Shove a gun up your ass, then blow you up. Why don't you fight with
me?” I remained calm, replying: “It would be important to understand what made you so anxious and
your wish that I fight with you.” She said she felt bad because she blamed me for abandoning her,
whereas in reality she was the one who went away. Taking her boyfriend with her was a death-defying
announcement: “I am an adult sexual woman with a partner.” This defiance was soon followed by a wish
to be a toddler who would be held in her mother's arms to be comforted and lulled into sleep. Yet on
other occasions she felt overwhelmed by her tie to her mother.
Around this time she explained that she experienced her tie to her mother as being like Siamese twins
connected through the abdomen; she felt that her skin was glued to her mother's at various parts of their
bodies. She experienced separation as an aggressive act, a tearing a part of the skin and muscles: both
persons would be hurt and bleeding, or both could die. Thus she needed to defend against
aggression/separation. She couldn't understand her wish to fight with me: “Despite my anxiety, I am
doing better. You are responsible for this, and you have to be punished for that.”
Conflicts over symbiosis and separation started to fill most of the sessions. She felt the pull and push of
two “black holes.” In the symbiotic black hole, she would be under a protective rock that also
overwhelmed and crushed her. Her anxiety was increased by the realization that the rock was really a
sponge, because her mother was “pathetic.” On the other hand, in the black hole of separation she was
spinning out of control in outer space. Separation would not give her safety: “The world is too small for
my mother and me. I feel I should kill her. … You cannot live next door to Hitler. You have to kill him to
feel safe.” It slowly emerged that Andrea did not experience her mother as helpful to her in working
through major developmental anxieties, particularly those relating to separation and sexuality. However,
Andrea realized that symbiosis was a two-way street and that she continued to resist separation. In
addition, Andrea was bewildered by her wish to destroy what was positive in her life.
Despite her anxiety, Andrea was changing and exploring the meaning of change. She started to dress in
a more feminine, sexual way but then expressed fear about losing control, a fear she attributed to
starting to feel separate from her mother. However, one of the remarkable changes associated with
feeling more separate was a decrease in her bondage and rape fantasies. During intercourse she now
felt connected to her body, not floating outside it. She could now enjoy giving her boyfriend orgasms but
could still not let him give her one. She understood that her inability to experience orgasm was caused
by several fantasies: her mother's disapproval of her sexuality, the penis as a gun, orgasm as an
explosion inside her body. Enjoying an orgasm meant realizing that she had a vagina and not a penis.
At this point, Andrea reconstructed the development of her sadomasochistic style. She felt angry at her
mother, but aggression and the expression of aggression were not tolerated. So she expressed it
passively, by “nibbling” slowly at her mother, becoming relentless in her passive demands until her
mother exploded. Andrea then became anxious and guilty and asked for forgiveness by submitting to
her mother, thus repeating the cycle.
Positive changes continued gradually. Andrea was gaining a sense of herself. She also felt that she
belonged more to the “have” group. She developed the ability to differentiate between physical and
psychological phenomena, particularly orgasm and anxiety. She started to experience herself as more
inner-directed and able to tolerate negative affects, both in herself and directed at her. Furthermore,
Andrea recalled her mother's oft-repeated statement that she should not have had any children, and that
she, i.e. mother, understood why a woman threw her children out the window. I suggested that the
threat of abandonment was a constant theme in Andrea's life. She agreed, indicating that she never
believed that I would be there the next day.
Her father began to fill her psychic space. Andrea was angry with him for being absent while she was
growing up and called him a “vacation father.” She was especially angry with him for not acting as a
buffer between her and her mother. She also called him a “highly functioning limited father” because he
was available on some occasions (for example, he taught her to drive and to do Grade 9 math), but he
continued to disappoint her because of his passivity and unavailability. Yet she realized that he was
close to her sister and wondered whether she had pushed him away by her preoccupation with her
mother.
Andrea differentiated between her psychological and physical connection with her mother. She felt more
separate from her psychologically than physically. She experienced a struggle over the possession and
control of her body: “I feel that my body belongs to my mother or is hostage to my mother. … My body is
the last battleground.” Despite this conflict, she started to develop some sense of possession of her
body: “Before I was only a brain, now I am a body.”
While these changes were occurring, Andrea continued to be aware of her resistance to change. Some
of it was due to fear and anxiety about what would happen if she separated, such as the violent nature
of separation (skin being torn off), loss of control, and the genital anxieties already described. However,
she also realized that her psychic state gave her a sense of power and privilege that she did not want to
give up. Through the symbiosis, she maintained control over her mother. Being a victim gave her
privileges. For example, “I have claim to more attention because I am a victim, damaged.” If she were
not special, then she was “ordinary, one of the crowd, a regular schmuck, an ordinary Joe,
humanosorus.”
Andrea alternated between wishing for a penis and fantasizing that she had one. The latter made her
feel calmer, the former anxious. She often hinted about having a penis. For example, she told me of an
old masturbatory fantasy in which she watched two homosexual men having sex while she imagined
herself to be “the active one, maybe screwing another man with a vagina or having anal sex with him. …
I used to have fantasies about women with penises screwing other women but not a man with a penis
screwing a vagina. I hate vaginas. If I cannot be a male, then I want to be neutered.” She used to argue
with her mother because she (Andrea) insisted on calling herself “a post-adolescent female, and not a
woman.” Although she could imagine being a man, Andrea could settle for being a female or a girl but
not a woman, because a woman cannot have a penis. Subsequently, the wish to turn herself into a
penis became apparent. This material continued to be interpreted as indicating gender-role and identity
problems, wishes for physical closeness with her mother, and fears about losing control over her body.
It also reflected Andrea's fantasies about what passionate sexual relationships between adults were and
her role in them—i.e., primal scene fantasies.
Another object that started to fill her psychic space was me. She indicated that one reason for her
resistance to change was fear of losing me. She talked about her strong desire to pick a fight with me
and her relief/frustration at my refusal to respond. She realized that sadomasochistic encounters were
her models for relationships. Yet for three years she experienced any type of transferenceinterpretation,
sexual or otherwise, as an attempt to make myself more important than I was and to displace her
mother. She found it “preposterous” that I was trying to put myself on the same “playing field” as her
mother. She felt such interpretations had to be destroyed and would not consider the possibility that I
mattered to her.
However, during the third year of analysis and over a period of several months, we were able to analyze
certain aspects of the maternal transference-countertransference configuration. Throughout that period I
remained calm and empathic and did not retaliate. I clarified and interpreted her agony, her anxiety,
and, most important, her fear of my defining her. This approach evoked many responses indicating that
she experienced me as calm and accepting and appreciated my non-retaliation. For example, she felt
that she could “push the buttons” of her previous analyst, repeating her relationship with her mother.
Through interpersonal conflict she was able to avoid the pain of intrapsychic conflict. Since she could
not get me to fight with her or make interpretations reflecting my deeply held convictions, which she
could resist, she had to face her intrapsychic conflicts. This resulted, according to her, in a major
change in attitude. She had fantasized change as acquiring a penis. Now she experienced it as a plant
growing; it needed good soil, good weather, and time. I was providing her with the opportunity to grow.
We also realized that my withdrawal from a domineering maternal role made me a paternal transference
figure. I became a “highly functioning limited analyst”—i.e., her father—someone who could be calm and
supportive but not perform his full analytic job of making certain interpretations. Like father, I was a
witness and not a participant in the epic battle between her and her mother. We both thought that my
accepting the role assigned to me allowed the analysis to proceed. However, a limited analyst can
achieve only a limited analysis. I felt that something was lacking. Although all the fantasies contributing
to her resistance were probably accurate, they lacked immediacy and passion. Only when she could
see that her resistance was directed at me, that she wanted to defeat me, did she achieve more
resolution of the transference and resistance. Furthermore, she experienced my genetic interpretations
as my ability to stand up to her mother, verbalize her mother's pathology, and not be afraid of her
mother as her father was. She felt that the reconstructions helped her see herself in a more benign light
and that I was sympathetic and supportive.
Her new-found ability to move between past and present, outside and the here-and-now, reconstruction
and transference, can be illustrated by the work done on her experiencing herself as greedy and my
having Kleenex in my office. Her tearing-off/separationfantasy meant that she could tear off some of her
mother's skin and muscles if she separated from her. Whatever she had, she had taken from someone.
This made her feel greedy, guilty, and angry so that she could never enjoy anything she got because
she had deprived someone else of it. At first she felt that way about the amount of Kleenex she used.
The availability/non-availability of Kleenex became a symbol of an atmosphere of deprivation and giving.
Its non-availability represented her previous analyst's depriving atmosphere. She responded by tearing
pieces of his paper pillow covers and using it as Kleenex while feeling guilty that she was tearing pieces
from him. Yet her response was also part of her masochistic pattern, because she could have brought
her own Kleenex and avoided the guilt and rage. Kleenex was available in my office, yet she continued
to experience herself as greedy and as tearing it from me. Later, she “joked” about my need to have a
special budget for her Kleenex and promised to give me a huge box as a termination present. Matching
her “joking” attitude and without reflecting, I said that Kleenex was inexpensive and that I had bought a
large amount of it on sale just for her. This spontaneous comment turned out to be one of the best I
made. Subsequently, she indicated that the Kleenex issue reflected an atmosphere of giving on my part,
that giving was not too hard for me, and that there was an adequate amount of Kleenex/giving available.
She no longer felt that she was “stealing” Kleenex or tearing pieces of skin from me.
Andrea's good relationship with Bill is currently six years old, and they recently married. She continues
to do well at work. She is more separate from her mother although there are still episodes of
preoccupation, particularly when she achieves more separation—e.g., her marriage. Yet all is not well
with Andrea. Even though her sexual life is far better than it used to be, she still avoids having orgasms,
which continue to be fraught with anxiety. However, Andrea is clear that for the first time in her life she
has choices: to maintain her sadomasochistic, revengeful style and her symbiosis, rage, low self-
esteem, genital anxieties, and gender confusion or to separate, calm down, forgive, and enjoy her
sexuality, femininity, and adult relationships.
Discussion
The clinical material presented covers a wide range of themes: separation-individuation, psychosexual
development, gender role and identity, sadomasochistic object relationships, aggression, primitive
defenses, and perverse sexual fantasies. How is one to organize this myriad of material? One way is to
use a developmental/genetic approach in which self-object undifferentiation manifesting as symbiotic
fantasies plays a central organizing role.
Symbiotic fantasies have been defined as experiences of a “dual unity with the not clearly demarcated,
bordered-off, and experienced self” (Mahler, Pine, and Bergman, 1975, p. 48Parens, 1991). I also want
to clarify what I mean by the developmental/genetic approach. The narratives we reconstruct during
analysis are not linear or causal but a combination of creation and discovery—i.e., both hermeneutic
and constructivist/empirical (Fajardo, 1993). Our reconstructions are not about how things actually
happened but are about the past as viewed from the present; nonetheless, they are anchored in real
past events and relationships. Furthermore, whether the narratives we reconstruct represent an
historical unfolding of events or retrospective explanations is not vital clinically. What is most important
therapeutically is the psychic reality of patients about their narratives. Yet, in my experience, some
analysands need to establish self-continuity through a sense of the sequential unfolding of time. Andrea
was such a person. Thus, the formation is presented in terms of the usual early and later times, both to
reflect Andrea's sense of time and to organize the material. Finally, the discussion is both theoretical
and clinical in that it is an amalgam of insights gained from the analytic material and theoretical
constructs. However, I claim that this formulation was a joint narrative; neither Andrea nor I thought that
this was my narrative imposed on her.
The reasons for suggesting symbiotic fantasies as the organizing structures were clinical rather than
theoretical. Before I worked with Andrea, I had no more than a passing familiarity with Mahler's work. I
still do not consider myself a Mahlerian, nor do I privilegeseparation-individuation over other themes.
The first phase of Andrea's analysis led me to believe that issues around symbiotic fantasies provided
the most relevant clinical material, for two reasons. First, I realized early on that Andrea had not
benefited much from her previous analysis, which she indicated had centered on sexual themes. She
was parroting sexual interpretations but using them to distance herself from her material. I therefore
kept transference sexual interpretations to the minimum because she used that material to provoke
sadomasochistic struggles with me. Second, I saw that in Andrea's psychic reality only she and her
mother existed; everybody else had to play a secondary role. Thus, most of the work during the first
three years focused on genetic reconstructions of the symbiotic fantasies and psychosexual
development—work that helped Andrea take a more benign view of herself.
However, I think the most important achievement during that period was Andrea's feeling that her needs
were more important than mine; namely, that her need to focus on her relationship with her mother was
more important than my need to be central in her life. The only way to be central was to enact a
maternal transference: to define Andrea through transference interpretations and engage with her in
sadomasochistic interactions. Instead, I provided a containing function through calm acceptance of her
anxieties and provocations. This put me in a paternal transference role. However, I was both her real
father, who was benign and did not attack her, and the hoped-for father, who was not weak and afraid of
mother. My interpretations about her relationship with her mother, with their implications of maternal
pathology, meant that I could stand up to her mother.
I suggest that Andrea's symbiotic fantasies developed to serve adaptive and defensive functions in her
internal and external worlds, particularly the reality of her interpersonal relationships (Weiss, 1993).
These involved an angry, self-absorbed, overwhelmed mother and an absent father. Abandonment
themes were also prominent. Andrea's fantasies may have started as wishes to be held and comforted
by mother and a defense against abandonment. The fantasy of influencing the mother through her
moods may also reflect earlier experiences of states of affective attunement and efficacy. These
dynamics may be similar to those of the “long embrace” fantasy, suggested by Akhtar (1991) as related
to unresolved separation-individuation. Aggression was the response to the frustrations of those wishes
and influenced their development and transformation.
Andrea focused on her brother's birth as a nodal and traumatic event in her development, symbolizing
the totality of her early experiences: her mother-daughter, father-daughter, and mother-son
relationships, as well as her own developing abilities. Andrea's father was not the father of separation
(Abelin, 1971) who helped her to separate from her mother. Her brother's presence made her mother
less available to her. Andrea responded to the trauma and loss with more aggression, directed primarily
at her mother and brother. It was not the healthy aggression that helps in the separation process but
pathological aggression, caused not only by the mother's unavailability but also by her pathology,
particularly her aggression, threats of abandonment, and inability to help Andrea express, modulate,
and resolve her aggression. This overwhelming aggression and primitive defenses against it, which
included projection, denial, manic defense, and omnipotent control, became important features of
Andrea's dynamics.
Aggression colored the elaboration of the symbiotic wishes into fantasies. We know from child-
development studies that only after the age of 18 months could Andrea have the cognitive abilities
(language and symbolization) to develop and elaborate the physical and emotional closeness wishes
into physical and psychological fantasies. Her fantasies were coercive, meant to control the frustrating
and unavailable mother. This is the intrapsychic process that Mahler and McDevitt (1989) described:
“the child attempts to maintain the stability of the object representation by coercion and by repeated
contacts with the mother” (p. 44). There was a reciprocal relationship between aggression and symbiotic
fantasies: aggression helped construct the coercive fantasies, and symbiosis became the vehicle to
express aggression toward the mother; that is, Andrea could upset her mother with her own moods.
Andrea's failure to modulate her aggression strongly affected her psychic organization. One result was
guilt, self-hate, and punishment for the hateful person she felt she was. She showed guilt over several
issues: the aggressive nature of the separation process (tearing off the skin), her greed (whatever she
has, she has taken from somebody else), her wish to destroy her mother if she survived the separation
(her mother as Hitler who has to be killed), and her survivor's guilt over her professional, personal, and
sexual success. In addition, Andrea's bondage fantasies were due partially to her guilt over her
enjoyment of her sexuality. Aggression, guilt, and punishment became the model of her
sadomasochistic relationships.
The impact of the symbiotic fantasies on the discovery of genital differences may have heightened
Andrea's genital anxieties, ushered in a change in mood, and initiated defense reactions. Her brother's
arrival represented a breach of the symbiotic fantasy at several levels. At the preoedipal level, his birth
represented mother's bodily independence—i.e., mother could do something with her body that was
outside Andrea's control. Her brother's existence is a constant reminder of Andrea's failure to maintain
the symbiosis—hence, her continuing hatred and aggression toward him. At the oedipal level, mother's
pregnancy represented her sexual betrayal of Andrea. Mother used, and probably enjoyed, her genitals
in a sexual act with another person, outside Andrea's control. Thus, Andrea's hatred of her mother
reinforced her refusal to identify with her mother's genitals. Her vagina was a “shit-hole,” she was a
“dickless wonder,” and the penis was a source of danger that had to be destroyed lest it destroy her.
However, the fantasy of having a penis and the wish to turn her whole body into a penis reflect her
continuing search for the elusive phallus that could give her a sense of wholeness. This fantasy is
similar to the symbiotic fantasy in that something outside the self that is frustrating and beyond control is
taken in and forced to be part of the (bodily) self. In this struggle was the beginning of both gender
identity and gender-role disturbance. Even in Andrea's sixth year of analysis (a period not covered in
this report), we are not clear whether the wished-for penis is an identification with the phallic mother or
with the father.
The lack of resolution of both the separation-individuation process and psychosexual development will
influence the achievement of a sense of a separate, cohesive self. A sense of separateness and core
gender identity, which cannot develop without an acceptance of genital differences and of one's own
genitals, is essential to that process. Thus, Andrea continued to have a fragile sense of self and gender
identity.
These fantasies evolved and were elaborated by subsequent events and developmental phases. They
had a particular impact on her oedipal and primal-scene fantasies, which represent two sides of the
same coin. The Oedipus complex reflects the child's fantasies about its relationship, particularly sexual,
with one parent and the exclusion of the other from this relationship. Primal-scene fantasies represent
the child's fantasies about passionate sexual relationships between parents and about her role in them.
Andrea proved capable of forming long-term relationships with her boyfriend and with me. However, we
were both accepting of her aggression and tantrums—i.e., were maternal with her. Furthermore, both
relationships are limited. With her boyfriend, the sexuality is restricted. I was allowed to be the wished-
for but restricted maternal and paternal objects but not the object of sexual desires.
I suggest that her current dynamics represent the negative effects of her aggressive symbiotic fantasies
on her disturbed ideas about genital anatomy and her lack of resolution of the oedipal conflicts. In my
opinion, Andrea did not enter the positive Oedipus complex but was fixated on the earliest phases of the
negative oedipal situation. Neither reconstruction nor current material provided evidence that her father
had become her primarylove object. In addition, neither her present boyfriend nor I, in the transference,
are her primary or passionate love objects. In the oedipal triangle, she was and still is preoccupied with
her mother and could not (in her mind) allow her mother a sexual relationship with father. Mother
continues to be Andrea's primarylove object and has not become an object of identification.
Identification with the mother in the early genital phase includes acceptance of anatomical differences
and identification with the mother's body and with female genitals as normal and desired, not as lacking
a penis. However, resolution of the negative oedipal phase includes having father, and subsequently
another male, as the primarylove object and identifying with mother's procreative capacities—i.e., the
wish to have a baby. It is clear from genetic reconstruction, current life, and transference manifestations
that Andrea has not achieved that state.
Andrea's primal-scene fantasies, influenced by the aggressiveness of her symbiotic fantasies and her
genital anxieties, made sexual intercourse a violent, sadomasochistic encounter. (Primal-scene
fantasies are here defined as universal expressions of internalized object relations and their vicissitudes
[Knafe and Feiner 1996]. Specifically, they refer to the child's working model of what sexual and
passionate relations are and the construction of multiple identifications that shift in conjunction with
dynamic changes in the child's perceptions of his or her relationships to parents and self.) The lack of
self-object differentiation and pathological gender identity also affected Andrea's primal-scene fantasies.
In these fantasies, Andrea is observer, participant, and at times both. When she participated, however
bizarre the anatomy and action were, there could never be normal, healthy intercourse of a man with a
penis and a woman with a vagina (mother having intercourse with father) with the child excluded.
Andrea could have a vagina only in her bondage fantasy, when she is ceremonially raped, depicting
intercourse as aggressive and humiliating. This psychic state, I suggest, represents the confluence of
several developmental lines: the impact of the aggressive symbiotic fantasies on psychosexual
development, gender identity, and role and on the creation of a sadomasochistic model of internalized
object relations.
I would like to contrast this formulation with recent thinking about the beginning of the Oedipus complex
and its relationship to primalscene fantasies. Britton (1989) suggests that the Oedipus complex starts
with the child's recognition of the nature of the parental relationship and her fantasies about them. This
puts the start of the complex earlier than it was formerly believed. However, the prior presumptions were
about the positive Oedipus complex, clearly a later developmental phase. I agree with Britton's
suggestion that fantasies about triadic relationships start early, as illustrated by the discovery of
anatomical differences, primal-scene fantasies, and the negative Oedipus complex.
My formulation about symbiotic fantasies refers to the earliest relationship between a female infant and
her mother. Several female analysts have focused on the importance of mutual bodily satisfaction for
the infant's development. These authors imply, as I do, that the absence of mutual bodily satisfaction
and mutual concerns derails development. The infant constructs fantasies of symbiosis (or fusion,
merger, or self-object undifferentiation) to compensate for the lost experiences. For example,
Chasseguet-Smirgel (1989) is clearly talking about a similar phenomenon. Yet she seems to be
discussing a universal symbiotic fantasy of draining the mother's insides and rediscovering a smooth
universe without obstacles or roughness, identified with the mother's insides, to which one can have free
access. Andrea had a different fantasy. I suggest that many people may wish for symbiotic fantasies;
however, their importance in the analysis varies, and their contents, qualities, and dynamics may differ
substantially. This point is further illustrated by Chasseguet-Smirgel's cases about submissive daughters
who wanted to capture love that was slipping away. To survive psychically, they needed to be on their
guard, be as good as gold, and not show fear, anguish, or pain. These patients put themselves in
danger with men because they denied the bad character of the object, idealizing the object instead. This
situation contrasts with that of Andrea: her submission to mother was one episode in a long
sadomasochistic cycle, and since she could see the badness of the object, she never put herself in
danger. In fact, she chose a passive, loving, and faithful man and maintained a long-term relationship
with him. Furthermore, more difficulties seem to be associated with symbiotic fantasies like those of
Andrea's than with others. Two patients described by Balint (1973), for example, were preoccupied with
satisfying their mothers but also able to enjoy and value their vaginas, although not their femininity. I
believe that Andrea was more primitive because she could not accept her vagina as a source of
pleasure for her or her husband.
My formulations about symbiotic fantasies are probably closest to those of Lester (1985, 1990, 1993).
She states that the wish-fantasy for a union with the mother becomes a powerful motive in the girl's
behavior and that aggressive impulses and destructive fantasies against the frustrating mother form the
basis for strong ambivalence toward her. Lester also speculates about how the analyst's gender
influences the manifestation and working through of these fantasies. She indicates that regressive
maternal transferences are usually not so intense or sustained in the male analyst-female analysand
dyad as in the female analyst-female analysand dyad. She implies that male analysts overfocus on
oedipal issues at the expense of regressive pre-oedipal ones. She also believes that regressive
maternal transferences, sustained over time, are the ground upon which the early infant-mother patterns
of interacting can be identified and analyzed. I believe that there may be differences between analysts
that go beyond gender. For example, Andrea and I remained immersed in the symbiotic fantasies for
three years, and I made little mention of oedipal material. It is true that Andrea's maternal transferences
were fleeting. However, her transference to me as a benign, part-time, but non-abandoning father
formed the basis for working through the symbiotic fantasies by genetic reconstruction. Is working
through by genetic reconstruction inferior to working through in the transference? I don't think so. In fact,
I think that the analytic literature has focused too much on moment-to-moment experiences of
transference/countertransferenceanalysis. Although these moments are extremely valuable and form
the backbone of successful analysis, they are not the only parts of an analysis. There are long periods
of reconstruction of the past, even though whatever is reconstructed is particular to the specific
transference/countertransference at that moment in the analysis.
Finally, I believe that Andrea's bondage and rape fantaises symbolized her disturbed sexuality.
However, the issues of symbiosis dominated the phase of the analysis reported here. Andrea needed a
long period of holding and of an accepting, maternal, and paternal attitude on my part to resolve her
symbiotic fantasies. Her analysis is now able to focus on her restricted sexuality without the
explosiveness and debilitating anxieties that characterized previous attempts to deal with issues.
Footnotes
1
Many followers of Mahler have come to question the existence of the autistic and symbiotic phases. In
fact, Harley and Weil (1979), in their introduction to the selected papers of Margaret Mahler, which was
written during Mahler's lifetime, and one would assume with her approval, renamed the autistic phase
“quasi-autistic.”
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Psychoanalytic Study of the Child, 2000; v.55, p180 (22pp.)
PSC.055.0180A
Record: 2
Title: Brief Communications from the Edge: Psychotherapy with
Challenging Adolescents
Authors: Horne, Ann
Source: Journal of Child Psychotherapy, 2001; v. 27 (1), p3, 16p
ISSN: 0075417X
Language: English
Abstract: Issues of technique in work with adolescents who, if adult, would
attract a forensic label, are discussed with especial focus on
interpretation and countertransference in the light of primitive
anxieties and body-based mechanisms of defence. The therapist
as ‘new object’ and ‘developmental object’ is explored. The case
study of Matthew — a mid-adolescent who has abused a younger
child, is delinquent, seeks violent and dangerous situations and
experiences outbursts of aggression — is used as illustration
throughout.
Accession Number: JCPTX.027.0003A
(Permalink): direct=true&db=pph&AN=JCPTX.027.0003A&site=ehost-
live&scope=site
direct=true&db=pph&AN=JCPTX.027.0003A&site=ehost-
live&scope=site">Brief Communications from the Edge:
Psychotherapy with Challenging Adolescents</A>
Brief Communications from the Edge: Psychotherapy with Challenging

Adolescents
Ann Horne, author, Independent Group psychotherapist, has a lively interest in talking to and learning
from colleagues across traditional theoretical divides. She served a term of office as head of the child
training at the British Association of Psychotherapists, where she trained, and is now involved in
teaching and continuing professional development within the BAP and with colleagues in Prague. She
supervises for both the Anna Freud Centre and the BAP. A former co-editor of the journal, she works at
the Portman Clinic, London.; The Portman Clinic 8 Fitzjohn's Avenue London NW3 5NA
Issues of technique in work with adolescents who, if adult, would attract a forensic label, are discussed
with especial focus on interpretation and countertransference in the light of primitive anxieties and body-
based mechanisms of defence. The therapist as ‘new object’ and ‘developmental object’ is explored.
The case study of Matthew — a mid-adolescent who has abused a younger child, is delinquent, seeks
violent and dangerous situations and experiences outbursts of aggression — is used as illustration
throughout.
Prologue
The Winnicottian child, allowed an experience of ‘good-enough’ in-tune mothering, is in a position to
meet the world with confident curiosity. As a profession with different theoretical emphases in our
trainings, we would hope equally as child psychotherapists to be able to greet each other with a similar
curiosity - grounded in our own experience but engaging with the ‘other’ with interest. In this area of
work - with the adolescent who is on the cusp of a perverse or delinquent solution that may harden into
character disorder - we need to be able to share ideas, think flexibly about what makes sense
theoretically and what works clinically, and find an arena for sharing the burden of managing especially
difficult countertransferences (Winnicott, 1947; Lloyd-Owen, 1997; Wilson, 1999). Parsons and Dermen
(1999), writing about the violent child and adolescent, describe this burden well:
From the therapist's point of view, she has to deal with the impact of the child's very primitive
anxieties which will inevitably trigger her own. In practice, the twin dangers are that she may either
defend against her own anxieties by denying that she is with a patient who could well attack her, or be
so afraid of this possibility that she cannot be receptive to the patient's needs…. The patient will find it
intolerable to be at the receiving end of the very defences he relies upon…. Additionally, the therapist
will have to contend with the arousal of her sadism when attacked. She may respond to this by wishing
to control or get rid of the patient. Since the work proceeds slowly and acting out is inevitable, she will
also have to deal with feeling useless, helpless and guilty. (Parsons and Dermen, 1999: 344) upon….
Additionally, the therapist will have to contend with the arousal of her sadism when attacked. She may
respond to this by wishing to control or get rid of the patient. Since the work proceeds slowly and acting
out is inevitable, she will also have to deal with feeling useless, helpless and guilty. (Parsons and
Dermen, 1999: 344)
We may argue as to whether to interpret anxiety at once or not. When we do not do so, it is for the very
good reason that interpreting such primitive anxiety too early in the analytic process may be counter-
productive and simply strengthen maladaptive and perverse defences - a technical issue often
elaborated by Anna Freud in her writings (A. Freud, 1936: 36-7, 1968: 143). Indeed, in sustaining
traditional and often fundamentalist theoretical positions, rather than engaging with curiosity with each
other, we can attack each other with theoretical and technical difference, not recognizing in our rigidity
and our activity that we actually mirror the defences of the challenging adolescent.
The challenging adolescent, who if an adult would attract a forensic label, has not found a position of
confident curiosity in relation to his world. Where early trauma, overwhelming to the immature ego and
not able to be processed, has been a feature (as it frequently has), the young person has often been left
with early body-centred defences as a way of blocking out the primitive anxieties of annihilation,
abandonment, disintegration, falling endlessly and merging. In the therapy room we encounter in the
patient and ourselves the capacity to act in and out, and experience anxiety about acting-out outside -
when society may well intervene. As Winnicott notes, ‘the analyst must expect to find acting-out in the
transference, and must understand the significance of this acting-out, and be able to give it positive
value’ (Winnicott, 1963a: 210).
In the countertransference we find ourselves in touch with fundamental primitive fears, cruel and
punishing superegos, immature atoll-like egos, and defences designed to deny intimacy, attachment,
affect and pain. We need to cope with not-knowing - often for long spells - and to think both
developmentally and psychoanalytically (Alvarez, 1996; Fonagy and Target, 1996), recognizing when
the opportunity of becoming a ‘new object’ glimmers, yet in touch with the dangers inherent in this for
the patient (Loewald, 1960).
Introducing Matthew
Matthew was 14 years old when he abused the 7-year-old sister of a friend. The court requested,
through the Youth Justice Social Worker, an assessment as to the suitability of psychotherapy for
Matthew in relation to his offence. I saw him three times around his 15th birthday, a colleague meeting
his paternal grandmother and stepmother and then his father and stepmother. Once weekly therapy
began two months later.
Matthew's parents married when his mother was 17 and his father 18, his motherbeing six months
pregnant with Matthew. Matthew's mother had been brought up in an abusive home and was sexually
and physically abused by her stepfather as well as suffering severe emotional neglect. Her mother died
when she was 13. Mr P (Matthew's father) had suffered serious depression from his early teens,
attempting suicide twice and having a spell of adolescent in-patient psychiatric treatment. He had,
according to his own mother, suffered most in the family when his parents separated when he was 4
years old. When Matthew was 3 years old his father's depression worsened and Matthew's mother
ended their relationship. Mr P moved in with his mother, Matthew's grandmother, who came to the clinic.
His wife moved a boyfriend, Sean, into the home with Matthew and her. There were violent episodes
between the parents, occurring over Mr P's requests for access to Matthew, and an injunction was
granted by the court banning Mr P from approaching the home. He spent a few weeks in prison, having
destroyed their kitchen, and did not see his son for over a year.
Sean disliked Matthew. It was only following the referral that Sean's gross physical abuse of Matthew
emerged as the family began to be able to talk of it. Matthew knows that this relationship was abusive
but has blocked out his memory of it. He does, however, recall his parents arguing and fighting.
When Matthew was 5, his mother was killed in a road traffic accident - she was knocked down by a car
on a zebra crossing. Matthew was left in the ‘care’ of his abuser as his mother had stated that this was
her wish in her will. There ensued a long custody battle, Matthew being made a Ward of Court, and at
one point, when he had been sent to stay with his abusive maternal step-grandfather, he was kidnapped
by his father and grandmother, so anxious were they about his care. Matthew's father finally won
custody. When Matthew was 6 1/2, he and his father moved in with Mr P's girlfriend, Sammie, and her
daughter, Emma, who is a year younger than Matthew. They now have a son, Alex, who is eleven years
younger than Matthew.
Matthew's past and present functioning

Mr P and Sammie approached their local Child and Family Consultation Service when Matthew was 7
years old, for help with his aggression, but it was felt that time to adjust to the new family was all that
was needed. By the age of 9, Matthew had been expelled from six schools, sometimes for violence,
sometimes for not being there. He described escaping out of school windows and commented, ‘I
thought that was mad - being expelled for not even being there!’ There was no sense of a
comprehending or a pursuing adult. Finally he ended up in a day school for children with emotional and
behavioural difficulties, a school that creditably managed to hold on to him.
In school he was said to be ‘bright’ - brighter than most of his peers, ‘capable of clear thinking but
stubborn’. He could attack other children with words, and be rude, unpleasant and undermining to
others. This verbal aggression remained worrying to the school and it tipped over into physical fights at
perceived slights.
Peer relations were said by school and family to be poor, although it emerged in therapy that Matthew
belonged to a group of delinquent lads with whom he spent much of his spare time. His descriptions of
their meetings contained much excitement and activity, and were empty of thought or reflection.
Matthew had an ambivalent relationship with his father whom he tried to like but who shouted at him, hit
him and only rarely listened. He could have been allied to his stepmother, Sammie, as both are
intelligent, but he felt excluded by the birth of his half-brother, Alex. His paternal grandmother remained
a ‘good object’ for him.
His offence occurred when he was at a friend's watching England being beaten by Argentina in the
World Cup. This friend often had sexual intercourse with his girlfriend in the presence of a group of
friends, which Matthew found exciting and disturbing. When he went to the toilet, his friend's 7-year-old
little sister pounced on him from her bedroom to play, punching him and jumping on his back, and he
threw her onto her bed. There he began to tickle her and what began as a game moved to his touching
her genitals. When he found that he was trying to remove her pants, he stopped himself, wondered what
he was doing, and went home. The others in the family, however, had a sense of something more
sinister and asked the little girl what had happened later in the evening. Matthew was arrested at 2 a.m.
and taken to the police station. He told me his father followed but, in fact, it was Sammie who came to
see him. Initially insistently denying everything, when faced finally with the video interview with the child
he agreed that her version was right. He received a three-year Supervision Order, with a strong
injunction from the judge that, should he appear in court on any count in future, he would be given a
custodial sentence. When I saw him he was embarrassed to talk of it and ashamed of what he had done
- hopeful signs. Like many violated young people, however, he was furious that the police had kept his
clothes for analysis - as if he were trying to focus on the external to avoid thinking of the body, its
actions and the internal.
Thinking about work with adolescents

The key tasks of adolescence, as we all know, involve separation, individuation and becoming
responsible for the self. In classical theory where psychosexual development is the main thrust, this
means taking ownership of the body and sexuality at a time of great change. Where there has been
early trauma and the immature ego has been overwhelmed, we have to think with care about technique.
Defences are often pre-verbal, pre-representational, centring on the body-self, its traumatization and its
survival. What the young person does with the body, therefore, is significant:
(1) in the offence of sexually abusing others (the victim's report is extremely helpful in letting us know
just what is so intolerable that it has to be decanted outside the self)
(2) in delinquency and putting the body at risk
(3) in violence or aggression where we often encounter either violent provocation, designed to repeat
an earlier experience of being violated, or self-preservative violence in Glasser's (1998) terms, designed
to protect the fragile ego from perceived threat.
(4) in the unconscious use of the body in ensuring one's exploitation. The prime example of this is the
rent boy whose repetition compulsion in relation to his own abuse is masked by a veneer of being in
control of those whom he chooses to think he seduces and who are made to ‘pay’.
Thus issues around the body, bodily conflicts and its use need to be addressed. Yet the adolescent task
is to take over this body at a time when infantile fantasy and curiosity is revived. One solution for the
therapist is to separate mind and body -‘Isn't it interesting what your body gets up to - being chased,
being hit, being where it shouldn't be?’ Addressing the functioning part to explore together the infantile
part can help ‘save face’ and avoid humiliation. Sometimes, though, this is not enough. Edgcumbe
(1988) approached such issues when thinking about the technical problems of interpreting (or not) in the
transference with adolescents, and ‘whether to take up defence, content or affect, and at what depth or
level to deal with content of conflicts’ in the light of ‘the adolescent's heightened fear and shame about
regression’ (Edgcumbe, 1988:1). Following case illustrations, she concludes:
I have stressed the importance of taking up material from the angle of the higher level conflicts which
have engendered regression, rather than the infantile instinctual wishes and modes of relating which are
expressed in the regression…. Shame and anxiety are likely to be best relieved by making sense of the
situation which led to the regression. In this way the analyst can remain aligned with the part of the
patient's self which is striving for growth, without denying the regression.
(Edgcumbe, 1988: 12)
It is just this kind of carefully thought-out, conscious choice of what to take up that often seems to have
been totally misunderstood in the past in disputes between theoretical traditions. It led Winnicott in 1962
to an interim, transitional position that he called ‘working as a psychoanalyst’ when the ‘anti-social
tendency’ (among other clinical issues) was present. Today, one hopes, we are clearer that this
ispsychotherapy and that it is, moreover, a question of conscious, sophisticated analytic choice.
In parallel with issues about the body comes the danger of relationships and especially of intimacy. Of
particular importance in work with young people in search of a perverse solution (a survival technique) is
Glasser's (1979, 1996) concept of the core complex. Here, one sees the search for intimacy as the start
of what becomes a vicious circle. Gaining intimacy, the adolescent is overwhelmed by anxieties of a
primitive nature - anxiety about merging with the object, about suffocation and loss of individuation. This
arouses a violent response - violence in the service of protecting the immature ego - in order to escape
anxiety; and a consequent sense of abandonment (again, a primitive anxiety) ensues with the necessity
once more to pursue intimacy. And ‘la ronde’ continues. Classer finds this to underlie all perverse
psychopathology.
Psychotherapy requires a relationship of considerable intimacy, yet the adolescent process, too, is
contrary to this. Apart from the danger in hoping that this relationship might be different from earlier
ones, the adolescent can experience being understood both as a relief and as an enormous threat,
bringing back just such primitive fears of merging with the object, of not being separate. One has to
pace this experience of being understood and be aware of what is too intimate, and know that the young
person may be driven to disparage it when it is desired, arousing as it does memories of vulnerability.
Even pauses and silence need judgement: silence may become a threatening absence of the object,
especially if this mirrors the young person's early life. At times, one has to be an ‘enlivening object’
(Alvarez, 1992); otherwise one is perceived as abandoning and annihilating. It is ‘either-or’: there is little
middle ground here - indeed, the process of therapy seeks to develop this. The ‘all or nothing’ quality
Winnicott encapsulates in ‘There is not yet a capacity to identify with parent figures without loss of
personal identity’ (Winnicott, 1963b: 244) is exacerbated in the adolescent who has still to achieve a
capacity for symbolization, for whom emotional states are bodily experiences (Parsons and Dermen,
1999: 341). The risk involved in ‘hope’, too, may be one reason why, with adolescents, one often gets
‘brief communications’ followed by escape.
We are all used to adolescents as escapologists. In a sense, this is a healthy adolescent process,
distancing oneself. It contains elements of the toddler who has learned how to make the adults pursue
him - except that with adolescents we are made to feel great uncertainty as to how much we should
pursue. This capacity to put the grown-up into a ‘double bind’ seems to arrive with the hormones at
puberty. Again, this requires delicacy. The conflict belongs in the adolescent, not in the therapist or
network, and should be gently returned there. A very simple example would be the adolescent who
invariably arrives 15 minutes late for his session. One can say how important taking control is, and how
essential; it is a pity, however, that in taking this necessary step he costs himself 15 minutes of his time.
That's an interesting dilemma he has there - and the conflict is quietly returned to its owner but not in the
tone of his own dismissive and shaming superego. The other side of escapology is the defence of
activity - a return to the body-self of toddler years. Activity often occurs as a way of blocking out thought,
which itself involves unbearable recollection and memory. It is, in this context, unfortunate that the UK
Government has instructed the Probation Service in England & Wales to breach offenders (i.e. to bring
them back before the court) if they miss two appointments. One could point to a recourse to action and
an absence of thought in Government for this anti-adolescent decision. Thinking, too, in adolescence is
a further aspect of intimacy -intimacy of mind - and ‘The fear of thinking may derive both from conflicts
over curiosity and from reluctance to let the analyst/mother intrude on painful private matters. Here,
again, transferenceinterpretation may have to be used sparingly, to free the patient's thinking’
(Edgcumbe, 1988: 13).
Creating a space for thought is not easy when the drive is to activity and not thinking. Making space for
curiosity about the self helps, and one can often capture adolescents by picking up the paradoxes in
their lives or offering the unexpected in comment, especially when the unexpected is in contrast to their
dismissive, abandoning or punitive superego:
Matthew described being on the back of a friend's motorbike (legitimately) in the park and the police
cruising past. By their actions, the group made the police pursue them, but eluded them. I said that was
interesting. Matthew had expected something more negative. ‘How?’ I said that he had really made the
police pay attention. Perhaps he had wished people had done so when he was little. Matthew went on to
say how his father often thought he was ‘up to something’ when he was not, then told of his favourite
teacher, a female art teacher, who had taken his side in a dispute that he had actually caused, leading
to another youth being punished. He grinned. I said that perhaps I needed to hear the warning - all is not
necessarily as it seems? He grinned more widely. I said that this was another area for me to be curious
about - he can change reality. something’ when he was not, then told of his favourite teacher, a female
art teacher, who had taken his side in a dispute that he had actually caused, leading to another youth
being punished. He grinned. I said that perhaps I needed to hear the warning - all is not necessarily as it
seems? He grinned more widely. I said that this was another area for me to be curious about - he can
change reality.
It is worth thinking here about the concept of ‘therapist as developmental object’, so well described by
Hurry (1998) and a part of the work of the Hampstead Clinic for many years. The young person engages
with a curious ego and supportive superego in the ‘developmental object therapist’ who deliberately
takes up a position of notbeing used as a projection of the child's cruel, shaming and undermining
superego. When one thinks of early trauma and the ‘breaching of the shame shield’ described by
Campbell (1994) in the young abusers whom he has treated over thirty years, one sees a further reason
for creating possibilities for alternative identifications and routes to a different ego ideal. Wilson, writing
about delinquents, put it rather well:
The key therapeutic task is to resist the young person's implicit invitation to repeat the past…. The …
ability to find ways of responding that are different from what young people expect and which do not
meet the dictates of the transference is essential. Ultimately, it is through the child psychotherapists’
behaviour that they convey their understanding of the meaning of the young person's delinquency and
provide the safety and boundary that the delinquent needs. Such behaviour, sustained by the child
psychotherapists’ own insights, constitutes interpretation and serves as a stimulus and basis for further
verbal forms of communication and understanding.
(Wilson, 1999: 318)
It is also important, with the drive to acting-out in adolescence and the risk of self-harm, that there is a
functioning network that enables the therapy to continue, a subject addressed later.
Issues of sexuality appear throughout the treatment, often beginning in the form of remarkably crude
jokes that show very early childish fantasies of destruction, inadequacy and incorporation in intercourse.
The fantasies of adolescence, after all, overlie for such young people a very often traumatically abusive
childhoodreality. Work in this area tends, I find, to be consolidated nearer the end of treatment although
it appears throughout - it is only after much work that the young person can, with confidence, face
exploring the kind of adult sexual being that they would wish to be, and the fears and fantasies around
that. Issues of a procreative body are acute for abusing and violated boys and girls. The necessary
fusion of aggression, agency and sexuality for adult functioning is terrifying in its potential for destruction
and much work on the positive role of aggression is necessary first.
Young people, defending against the memory of helplessness in the absence of a protective object, find
aggression paradoxically difficult. It emerges in an uncontrollable fashion in their lives, overwhelming
others and themselves. They need practice in appropriately assertive aggression and righteous anger,
and a capacity to recognize and name emotions and affects, in order nor to be swamped by them.
Identifying with the adolescent's victim role can mean the therapist missing aggression: it is important to
have it in mind as a constant undercurrent, and to connote aggression and agency as necessary and,
where it is problematic, to perceive the roots in an early defence against intolerable feelings. ‘Anger
management’ strategies work well where there is a more integrated, functioning ‘self’; where this is not
so, the construction of an emotional vocabulary and ‘anger practice’ - the capacity to recognize agency
and aggression, to note when they are appropriate and to begin to exercise them -are essential.
Attention to such ego developments as affectrecognition and affect tolerance is vital in psychoanalytic
work with young people where the ego is immature and patchwork.
There are implications within all of this for assessment - the information one needs, the environment
necessary for an assessment to be relevant and if therapy is to be considered, and the assessment
encounter itself. These are beyond the remit of this paper but must be flagged up: ‘The essential thing is
I do base my work on diagnosis’, said Winnicott to the British Psychoanalytic Society (Winnicott, 1962:
169).
Thinking about Matthew

Matthew presents as not typical of young abusers but rather demonstrating the mixed symptomatology
of mid-adolescents who arouse concern. Most abusing adolescents appear either to be rather isolated
individuals with one clear known abusive incident or to be multiple abusers with a real polymorphous
feel. Matthew's history shows difficulties in equal peer relations (his mates are all less bright than he is),
longstanding outbursts of aggression and seeking violent situations, delinquency and sexual abusing.
His capacity for putting himself at risk is also becoming clearer.
With Matthew we can see the clear pattern of early violence where there is no protective figure, outlined
in the Great Ormond Street Hospital research on young abusers: the two main factors correlating with
abusing others are:
1) an experience of unpredictable and unprocessable violence and trauma, when the ego is too
immature to make sense of it (Lanyado et al., 1995). Matthew witnessed early marital warfare, was
beaten from the age of 3 and traumatically abandoned to his abuser at age 5.
2) having a mother who has herself been abused and unconsciously projects onto her male child the
expectation that he, too, will abuse.
The memory of such victimization (especially the humiliation and vulnerability) can be dealt with by
developing a fantasy of abusing someone weaker and smaller, becoming powerful in the process and
making someone else into the victim - identification with the aggressor. Part of the treatment thus
involves exploring the patient's own ‘victim’ experience before one can reach the victimizing.
There is also ‘the ambivalence of the object’ - a mother who consciously and deliberately leaves him
with an abuser - and who turns a blind eye to his abuse when she is there. We should not be surprised
that he ‘tricks’ the grown-ups in return and should expect this in the therapy. Thinking inter-
generationally, Matthew's mother was abused and abandoned on her mother's death to her abuser and
the scenario was repeated with Matthew. Matthew's father lost his father at age 4; his mother lost her
natural father at a very young age; Matthew lost his for a considerable spell at age 3. Welldon (1988)
has alerted us to the necessity of thinking across at least three generations where abuse is concerned.
We can also note the use of activity as a defence, beginning with his early escaping from school - but no
one pursues, instead he unconsciously makes the process of his being abandoned happen repeatedly -
and continuing in his delinquency. Indeed, one might find his delinquent activities to be a seduction of
me, as therapist, away from the abusing that formed his offence, as well as a practised way of using
excitement to mask depression. There is also the compulsion to repeat sensations of fear, as we will
see in the clinical material; in some of his delinquent activities, Matthew scares himself. More
profoundly, one might think about identification with the dead mother; it is unusual for a 22-year-old to
have made a will and colleagues have suggested that her accident may have been suicide. Being alert
as to Matthew's unconscious ‘suicidal’ behaviour, therefore, becomes a factor, and the meaning of an
abandoning, not protective, even malevolent maternal object important.
Finally, it is worth commenting on aggression, an issue of long-standing for Matthew, noted first at the
age of 7. This use of self-preservative violence has begun to turn into an enjoyment of others getting
into trouble - the early beginnings of a sadistic quality - and it is essential for his development that work
is done with Matthew on this.
An encounter with Matthew

This session occurred in early December, almost nine months into therapy. Matthew at this point is
living with his grandmother.
Matthew arrived early for his session, wearing a new, padded, warm jacket. (He had come the previous
week in a sweatshirt and with an awful cold.) Although his cold was still bad, he said that he was OK,
that he had taken lots of soup. This comment came with a smile - in our last session he had told me that
his grandmother was very good at making soup. [Paternal grandmother has transference implications.]
He hadn't been allowed to take a day off school, however. I wondered if he could have been able to
bear that - not beingactive and just sitting with his thoughts. He agreed he could not, he would rather be
in school. I reflected on this unusually intimate start and wondered when reaction would set in. [When
Matthew attends, he always takes time to re-discover his object: he seems, indeed, to expect a corrupt
object.]
There was a sustained pause. He looked very sad. I wondered if he were thoughtful now or just fed up?
Fed up. His father had said that the moped was too much for his Christmas present and he probably
wouldn't get it. He expanded on how it would have cost £200. His father was giving his brother Alex a
computer worth £200; Matthew would get a new mobile phone worth £100 and his sister, Emma, a
present worth £75. There was a pause, half sad, half angry. I wondered rather weakly if that seemed
unfair? Yes - Alex gets everything. [Alex, indulged at age 5, contrasts with Matthew, abused and
abandoned.]
After a further pause Matthew wondered if his father would give him the money and he could put it
towards a bike himself. Then he deflated, recalling that his father preferred to pay things up week by
week. I said that it seemed impossible for the adults to get things right for him. We reflected in silence.
‘Do you know a Pa … Po … something like that - it's a bike.’ It emerged as a Piaggio. ‘They're very nice!
I really like them. I was out last night on one!’ I felt anxiety begin to rise and wondered inside about this
need to make the adult anxious, and why. There followed a story of Matthew and five or six friends.
Dave had brought the bike and all had tried it out in the local park. Steve did a ‘wheelie’ and drove into a
tree. Matthew also tried it - ‘It was really good!’ He described sharp turns, sudden acceleration, mud
flying, excitement. As he was in full flow, his mobile phone rang. He looked apologetic, muttered, ‘Sorry’,
said the answering service would pick it up, and could not resist checking the screen. It was Dave
leaving a message: ‘He already phoned twice when I was on the train coming here! It's about meeting
tonight.’ The phone was switched off and put away. He continued with the bike tale - taking it out on the
road out of town, a vivid description of Dave nearly coming off the back of the bike as Matthew
accelerated, ‘It can do 45 miles an hour!’ and finally return to town.
I thought about the sense of life and energy in the midst of this extremely dangerous behaviour. ‘You
know, you really like being “on the edge”, don't you.’ Matthew looked questioning. I said that on the bike
he liked being in control himself (he didn't like being on the back) but it could tip over - Steve had
managed to hit a tree. I suggested he was also ‘on the edge’ with the police, were he found, and with
the court as the judge had told him that his return to court on any count would mean a custodial
sentence. And he had told me before (in an earlier session) that being on a bike could be scary and he
didn't like that. ‘Yes, that's why I won't let Steve drive.’
There was a pause. I interpreted then that it was interesting that this ‘on the edge’ excitement had
actually followed a very painful description of him and Emma feeling ‘on the edge’ in the family. He gave
me a very direct look. I offered that one way he had learned of being in control of these very difficult, sad
feelings was through the excited ‘on the edge’ feelings, but they were risky. I wondered, too, about the
excitement keeping me ‘on the edge’, not sure of his safety, and wondered if he was good at making the
adults and me feel this. He smiled gently.
There was quite a long pause. Matthew launched into a story of his friend, Joseph, a very small 14-year-
old. Joseph's passion was cars - with a particular emphasis on taking and driving them away. I noted to
myself the connection between my interpretation of the pain in the family and his further recourse to
excitement and danger, moving from bikes to cars, but did not interrupt. Matthew gave great detail of
how Joseph would break into the black boxes behind the steering wheel panel, where to locate these in
a Rover Metro, and diverted into a variety of ways to break into a car. Joseph had been doing this since
he was 7 years old. The police knew him well - had been to see him the other day as he is the first port
of call when cars go missing. ‘He has been cautioned and the police know him. Pathetic!’ ‘Pathetic -
who?’ I asked. ‘Joe. He knows they'll come to see him first. When he takes a car he drives with the
headlights on full beam so that he can't be seen himself. He just gets very excited by cars. Once when I
was with him he saw a Jaguar. I said, ‘NO!’ but Joe kept talking about what it would be like to drive it
when we were walking away.’ I wondered if Joe had the same sense of excitement in relation to cars
that Matthew had talked of with bikes. He looked surprised: ‘No, he's pathetic’ I commented that
sometimes things are both pathetic and exciting, reminding him of the 36” television set he said his
father had bought that in one way seemed pathetic to him but in another seemed full of excitement and
potential. This had been in an earlier session. He grinned - ‘That's true!’ I continued, ‘So you know some
things that are both pathetic-daft-dangerous and pathetic-exciting-“on the edge”?’ He nodded
thoughtfully.
The story of Joe continued. He had ‘torched’ a car. This felt suddenly very unsafe, as if the juxtaposition
of ‘pathetic’ and ‘excitement’ had to be avoided. He had tried to break into a car in Tesco's car park (the
known area where local youth find and dump cars and bikes) but couldn't get at the black box. Realizing
that he had left his fingerprints all over the vehicle, he had found a cloth and jerry can of petrol in the
boot and poured it over the front seats, leaving the can in the car before striking a match. He had singed
his hair. ‘He's totally pathetic! He could have burned himself badly. He had the rag from the boot - he
could have wiped off his fingerprints. He ran off and it went “Whump!” exploding. The Fire Brigade was
called. He could have hurt people!’ Matthew sounded very upset. I said gently that I thought he had
witnessed this, been there with Joe. He nodded. I added that it was frightening that the excitement and
‘on the edge’ bits could tip right over into danger and wondered if he scared himself. He nodded, saying,
‘He could have been harmed!’ Yes. After a pause I added that it was interesting that such a memory of
danger had followed my saying to him that he wanted me to feel ‘on the edge’ sometimes - that he was
letting me know how dreadfully dangerous things sometimes felt for him and that it was right that we
were both concerned.
He recalled a teacher at school, in car mechanics class, whom Matthew had asked something that
implied how to hot-wire cars. The teacher had given him the information and not asked why he wanted
to know. I said I thought he was letting me know about two things. First, grown-ups may not be straight
but collude with exciting illegal things, like the teacher giving him the information. [I was thinking of
corrupt objects again.] How, then, could he possibly know to trust me and my concern? Second,
perhaps he was warning me that he could be tricky - tricking the teacher and perhaps other grown-ups,
like me. He gave me a very direct, straight look. [Collusion, of course, is one of the major pressures felt
in the countertransference with psychopathic patients (Symington, 1980).]
There was a further pause. Matthew said, ‘The bike engine's still running.’ The bike, of course, had been
stolen and hot-wired. His friends were ‘second time thieves’, having come across it stolen and
abandoned. They had bypassed the ignition and could not turn off the engine. They would have to cover
the exhaust pipe, cutting off the air supply. (All endings, I thought, are traumatic - even for the bike.)
‘Someone stole it last night.’ I must have looked astonished. ‘Yeah, when we'd gone home Dave had left
it at his back gate and phoned to say it had been taken. We found Steve had taken it and had it at his
place. It would have been pathetic if a nicked bike had been nicked - I mean we couldn't report it to the
police, could we?’ I said that I thought that was really interesting: that, when something has gone wrong
in the past, the grown-ups will simply not take a young person seriously. Perhaps in some ways this was
a little like Matthew - it is impossible for him to hope that the adults will be concerned now for his safety
when they made such a bad job of it in the past. ‘You mean Sean,’ said Matthew, referring to his
mother's abusive boyfriend. ‘Yes, and everything that happened then. Now, as a result of that, you are
making me into another of these grown-ups who hears very dangerous things but can't stop you.
Sometimes it feels better to do that than for you to hope that it might be different.’
The following pause felt more thoughtful. ‘I'll only go tonight if Steve has a crash helmet for me. I know
he's got one. It is scary - but exciting scary.’ [‘Crash helmet’ has become equated with me, interesting
when one thinks about heads and minds.] I added that that was why he insists on driving, being in
control: ‘It's like not taking the risk that the adults won't protect you again, but it's also the same “on the
edge” excitement of waiting for something to happen that was awful and too much for you when you
were little.’ Matthew nodded slowly.
It was almost time to stop. Matthew checked the clock and put on his jacket. He told me that he was
careful as sometimes it could get too scary. Moreover tonight they wouldn't be on the road but in a
farmer's field. I said that he was taking on some of the adult bits about protecting himself but still being
‘on the edge’. He was leaving me with something to worry about - perhaps he needed to do that. He
gave a quiet smile and ‘See you next week!’ I thought it was a promise to stay alive.
A note on networks
There must be a functioning, communicating network that is able to create a safe, holdingstructure if
therapy for the young person who is a risk to himself and/or others is to be considered a treatment of
choice. We all recall Winnicott's exhortation that delinquents need placement, not psychoanalysis, after
he had the clinic basement flooded, his car jump-started and his buttocks bitten - more than once - by
his first child analytic patient (Winnicott, 1956, 1963a). If there is not such a network, the issue is
certainly placement. One could view this as offering practical ‘containers’ until the stage is reached
where words can contain and anxiety be symbolized rather than enacted. This cannot be stressed
enough. Our omnipotence - or pressure from the network - may take us into a therapeutic relationship
that then fails because external containment and understanding are lacking, and we repeat and re-visit
trauma upon a young person who unconsciously seeks it. In Matthew's case the problems of finding a
good residential community did not arise. There was a functioning, thinking network: he was at a good
EBD school, had a three-year Supervision Order from the court, which gave time to work, and had a
good, involved social worker. His family moved a distance away but, with joint planning, Matthew stayed
with his grandmother through the week, sustaining attendance at the same school, and went to his
father at weekends. Issues arose about leaving school: this is often experienced by adolescents as the
school's abandonment of them, although they cannot articulate this, and the temptation is to get oneself
thrown out or to leave it before it leaves you. This Matthew tried - and the network contained. He
completed his exams.
It is also important that the network be experienced as safe and ‘holding’ as, in therapy, the young
person will inevitably get in touch with the early feelings of victimization and humiliation that led to the
offending behaviour. Such a time may present a risk of suicide - as does the later stage when the
adolescent begins to look at what he has done to others and guilt and shame arise - and a good support
structure is essential. Equally, the defences, based on activity, may reassert themselves, as they did
originally, to blot out such pain and the risk of further offending ensues. This has to be understood and
not reacted to in a superego-ish way.
Networks suffer transference and countertransferenceprocesses. All too often, this remains unconscious
and damaging. It is vital, when working with young perpetrators, that a ‘case manager’ be appointed to
work with the network and help the unconscious become conscious. This needs an experienced person.
When warfare breaks out in the network, or communication stops and unilateral decision making
appears, there seem to be three main processes at work (Horne 1999):
(1) individuals in the network identify with and take up the positions of different family members
(Kolvin and Trowell 1996). Such identifications polarize - the young person is viewed either as a poor
traumatized victim or seen as a dangerous perpetrator; the parents are said to be overwhelmed by their
ungrateful evil child or perceived as dreadfully neglectful and abusive. Holding all views together and
recognizing the transference manifestations is vital.
(2) the family system also gets re-enacted in the network - the myths, collusions and strategies for
family homeostasis become replayed by all of us.
(3) the internal world of the offender patient is realized in the network where we repeat the functions
and attitudes of internal objects and ‘willingly’ reinforce unhelpful defences (Davies, 1996), principally
the drive to activity. This compulsion to act, to do something, is commonplace and, as therapists, we will
enrage other services at times by refusing to do this but requesting space to think together. The process
of bypassing thought and reflection, after all, is the delinquent and abusing adolescent's prime defence,
and he unconsciously tries to make it ours.
There is a paradigm from Transactional Analysis that is very helpful when thinking of networks. It
comprises a triangle:
jcptx.027.0003a.fig001.jpg
We move around it, not at will but pushed by others, taking up all positions. It is a salutary blow to one's
omnipotence to be brought in as a ‘rescuer’ but quickly to be defined by the network as an ‘abuser’ (of
the child by keeping him in therapy; of colleagues by not being able to say that he is no longer a risk) -
and one becomes a victim oneself.
Conclusion
Keeping grounded and keeping sane are the two main tasks for the worker with acting-out adolescents.
Regular clinical discussion is essential, both for support and survival but also to ensure that we are not
seeing only one part of the young person or complying with ‘the dictates of the transference’ (Wilson,
1999). A colleague can provide an Oedipal third for reflection, an antidote to primitive pre-Oedipal
defences and anxieties. Pace and intimacy are important technical issues, and the level at which to take
up conflicts (Edgcumbe, 1988) is an important aspect of judging these. The impact of developmental
deficit, body-based defences and pre-verbal trauma should inform our assessment and work, and a
developmental and psychoanalytic framework is essential. Most importantly, ‘thought not action’ is the
key for patient and psychotherapist - creating space for thinking and reflection.
Epilogue
A year on, Matthew's ‘delinquent group’ is now a social group. All are in work and the group now
includes girls - opening up issues of sexuality in therapy. A sense of responsibility is a strong feature of
his functioning. He dared to ask if there might be any flexibility when he is in work - could I still see him
but at a later time? -a big risk, to ask for something, and on my letting him know that this was possible
he promptly missed the next session (a telephone call - ‘I've lost my train fare!’). Intimacy still takes
careful negotiation.
Note and acknowledgement

This paper was presented at the ACP Conference in September 2000. Earlier versions were given at
conferences in Prague, Surrey and London. I am grateful to all these colleagues for helpful feedback
and ideas.
I am especially grateful to two Portman colleagues - Marianne Parsons and Dorothy Lloyd-Owen - and
to Monica Lanyado for their generosity with time, discussion and thought, and to the Portman team who
always respond with creativity to child and adolescent clinical presentations.
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Résumé: L'auteur approfondit certaines questions techniques qui se posent au cours du travail avec
certains adolescents qui, s'ils étaient adultes, se verraient attribuer un diagnostic médico-légal; elle se
focalise en particulier sur l'interprétation et sur le contre-transfert à la lumière d'angoisses archaïques et
de mécanismes de défense à support corporel. Elle explore la notion du thérapeute comme “objet
nouveau” et comme “objet développemental”. Une étude de cas - celui de Matthew, jeune délinquant
qui avait abusé d'un enfant plus jeune, qui recherchait des situations de violence et de danger et qui
pouvait se montrer violemment agressif- sert de fil conducteur et d'illustration clinique.
Mots clefs: Adolescents difficiles et provocateurs; interprétation; approche développementale et

psychanalytique; délinquance; abus sexuel; agressivité.
Riassunto. Vengono qui discussi problemi di tecnica nel lavoro con adoloscenti, che, se fossero degli
adulti, sarebbero classificati come criminali. Speciale attenzione è rivolta all'uso delle interpretazioni e
del controtransfert, quando sono presenti ansie primitive e meccanismi difensivi corporei. Il terapeuta è
esplorato “come oggetto nuovo” e come “oggetto evolutivo”. A scopo illustrativo viene riportato il caso di
Matthew, un adolescente delinquente che aveva abusato una bambina, ricerca situazioni pericolose e
manifesta la propria aggressività in attacchi di violenza.
Parole chiave: Adolescenti che sfidano; interpretazione; approccio psico analitico e evolutivo;
delinquenza; abuso sessuale; aggressione.
Journal of Child Psychotherapy, 2001; v.27 (1), p3 (16pp.)
JCPTX.027.0003A
Record: 3
Title: Conceptualization of Hostile Psychopathy and Sadism: Drive
Theory and Object Relations Perspectives
Authors: Juni, Samuel

Source: International Forum of Psychoanalysis, 2009; v. 18 (1), p11, 12p
ISSN: 0803706X
Language: English
Abstract: A distinct formulation of hostile psychopathy is presented, based
on analytic clinical experience with psychopathic youth and
adults. Two psychodynamic conceptualizations of aggression are
presented — one connoting a basic destructive drive, the other
portraying aggression as a means of ensuring gratification and
countering frustration. Following Meloy's (1988)analysis of
psychopathy as a combination of a deficient object relational
capacity to bond and high levels of instinctual aggression, hostile
psychopathy in general, and sadism specifically, are
conceptualized from these two perspectives. Sadism, which
features re-enacted events of violence, is posited as a distinct
manifestation of hostile psychopathy with ritualized features
attributable to object relations disturbances. Other variants of
hostile psychopathy are analyzed as derivatives of more direct
aggressive instinctual expressions that are not relational in their
intent or function, in which destructiveness is an end in itself.
Hostile psychopathy is presented as entailing elements of an
instinctual propensity toward aggressive discharge. In addition, a
more elaborate motif is posited in which the pain and suffering of
others is the key factor in sadism. In the latter facet, there is an
actual enjoyment of the others' suffering, and unresolved
relationships are re-enacted with a reparative intent. A
psychosexual developmental hypothesis is suggested, in which
drive-based aggressive discharge is linked to the oral sadistic
stage, while sadistic relational dynamics are posited to reflect the
power-control battles of the anal sadistic stage. As a limitation, it
is noted that the sociopolitical aspects of psychopathy are not
addressed in this clinical analysis. Moreover, since the data
presented are oriented toward the intrapsychic (in contrast to
social) aspects of psychopathy, the countertransference aspects
of relationships that psychopaths tend to engender are not
addressed specifically. (Received 2 February 2007; accepted 24
November 2007)
Accession Number: IFP.018.0011A
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Sadism: Drive Theory and Object Relations Perspectives</A>
Conceptualization of Hostile Psychopathy and Sadism: Drive Theory and

Object Relations Perspectives
Samuel Juni, PHD, author, Professor of Applied Psychology at New York University, specializing in
clinical differential diagnostics. His widely published works on personality research, clinical
psychoanalysis, and theoretical conceptualizations of psychopathology bridge drive theory,
psychometrics, and object relations theory.; New York University, Department of Applied Psychology
400 East Building, New York, NY 10003-6674, USA. Tel: +1-212-998-5548. E-mail: sam.juni@nyu.edu
A distinct formulation of hostile psychopathy is presented, based on analytic clinical experience with
psychopathic youth and adults. Two psychodynamic conceptualizations of aggression are presented —
one connoting a basic destructive drive, the other portraying aggression as a means of ensuring
gratification and countering frustration. Following Meloy's (1988)analysis of psychopathy as a
combination of a deficient object relational capacity to bond and high levels of instinctual aggression,
hostile psychopathy in general, and sadism specifically, are conceptualized from these two
perspectives. Sadism, which features re-enacted events of violence, is posited as a distinct
manifestation of hostile psychopathy with ritualized features attributable to object relations disturbances.
Other variants of hostile psychopathy are analyzed as derivatives of more direct aggressive instinctual
expressions that are not relational in their intent or function, in which destructiveness is an end in itself.
Hostile psychopathy is presented as entailing elements of an instinctual propensity toward aggressive
discharge. In addition, a more elaborate motif is posited in which the pain and suffering of others is the
key factor in sadism. In the latter facet, there is an actual enjoyment of the others' suffering, and
unresolved relationships are re-enacted with a reparative intent. A psychosexual developmental
hypothesis is suggested, in which drive-based aggressive discharge is linked to the oral sadistic stage,
while sadistic relational dynamics are posited to reflect the power-control battles of the anal sadistic
stage. As a limitation, it is noted that the sociopolitical aspects of psychopathy are not addressed in this
clinical analysis. Moreover, since the data presented are oriented toward the intrapsychic (in contrast to
social) aspects of psychopathy, the countertransference aspects of relationships that psychopaths tend
to engender are not addressed specifically.
(Received 2 February 2007; accepted 24 November 2007)
Psychopathy is one of the most controversial disorders of psychopathology (Lilienfeld, 1998). In our
clinical work with psychopaths, we have come to recognize that the inconsistencies in clinical
descriptions and prognostics in the field are due in great part to the distinct dynamic and etiological
factors of superego deficit (Hare, 1991), poor impulse control and low frustration tolerance (Cleckley,
1978), and the disposition toward hostility. The latter is usually presented in the literature as a
behavioral style of interpersonal animosity that includes aggression, violence, and hurting others (Meloy,
1988).
Hostile psychopathy entails a commitment to violence that is qualitatively distinct from poor impulse
control. Whereas poor impulse control involves a reaction (however inappropriate) to an affront or
perceived threat, hostile psychopathy entails aggression that is directed indiscriminately, unrelated to
any threat and not necessarily based on any grievous interaction. More important in conceptual terms,
psychopaths with poor superego structures or poor impulse control often show indiscretions in other
domains (such as sexuality or dishonesty), while hostile psychopathy is limited to primarily to
aggression.
Hostile psychopaths apparently require interpersonal aggression as part of their regular emotional
experience. Violence and hostility are standard aspects of daily existence and are not attributable to
happenstancial provocations or frustrations. These individuals will often choose roles or jobs that allow
them to hurt others. Leisure activities inevitably involve victimization, often of strangers. Some maintain
a semblance of adjustment as sub-limators (e.g. prison wardens, counterinsurgency personnel, etc.)
who have a social sanction to “act out.” However, the earlier the developmental insult has occurred in
childhood, the less likely it is that such individuals can adapt into a socially acceptable niche for their
antisocial dynamics.
Negative carechildhood experiences in general, and traumatic early episodes in particular, seem to
enhance the likelihood of the development of psychopathy in adulthood. In our clinical work, we have
found that this predisposition is most salient to the emergence of sadistic psychopathy. Inevitably, a
history emerges featuring horrific tales of protracted victimization or molestation. Often, past trauma are
presented nonchalantly, with the attitude that “it is all water under the bridge.” Just beneath the surface,
however, there are clear indices of rage, guilt, and themes of retribution. Thus, the American Psychiatric
Association's Diagnostic and statistical manual of mental disorders IV requirement of a childhoodhistory
of conduct disorder symptoms (violations of the rights of others and age-appropriate social norms) to
establish an adult diagnosis of antisocial personality disorder is probably best applied here, rather than
a requirement of superego deficit or impulsive disorder. We have found that the predispositional
childhood diagnosis of oppositional defiant personality (American Psychiatric Association, 2000), which
stresses the early pattern of consistent negativity toward authority, is more predictive of the type of
sadism that is anchored in object relational disturbances. Hostile psychopaths seem to have had
childhood antisocial patterns that featured aggressive expressions which were not directed at specific
individual adversaries. Examples include children who would set fires indiscriminately, sabotage a public
service utility (e.g. train tracks, traffic signals), or hurt house pets.
We begin with an overview of aggression as a basic drive, insofar as it informs our clinical
conceptualization of psychopathy. We proceed to elaborate two major modalities of aggression,
conceptually and clinically. Finally, we present a detailed analysis of fixational features of the differential
development of hostile psychopathy and sadism.
Aggression: A basic instinct or a functional/reactive response?

The instinctual impulse is characterized by a basic tendency to lower excitation levels by discharging
tension. Aggression can be conceptualized as a mode that is essentially designed as a subjective

release of tension, akin to libidinal discharges, in which the object of hostility is not central. Alternately,
aggression can be conceptualized as a relational mode, where the perspective of the object is a
necessary ingredient in the very basis of the hostility.
Freud (1905) first conceptualized aggression and sadism as subsidiary to the basic sex drive. As he
continued to develop psychoanalytic theory, he came to view aggression as a reactive response to the
frustration of libidinal drives. A major digression in this conceptualization came with the publication
Beyond the pleasure principle, in which Freud (1920) proposed Thanatos as a self-destructive death
instinct that is not oriented at pleasure, but rather at self destruction. Aggression, he posited, might be
construed as natural inner-directed destructiveness channeled outward as a defensive maneuver.
Essentially, outward aggression was seen as preserving the self from self-destruction. Despite this
digression, Freud's writings hardly featured natural self-destructiveness as an independent drive. Except
for a minority of analytic theorists expounding the postulates of the British school (e.g. Eisler, 1971;
Klein, 1928; Menninger, 1938), few authors in the analytic literature accepted Thanatos as the basis of
interpersonal aggression. In our clinical experience with sadism, it seems that the etiological linkage of
masochism and sadism — if it exists at all — is actually reversed, self-destructiveness deriving from
aggression that is turned inward. As a rule, however, outward aggressiveness was treated as an instinct
of equal stature with the libidinal drive(Fenichel, 1953).
The developmental path of the aggressive drive is a point of contention. Melanie Klein (Klein, 1932;
Klein & Riviere, 1938) presented strong data from the analysis of children that destructiveness is a
natural drive independent of any libidinal linkage. She argued that oral incorporation epitomizes such
destructiveness. Carl Abraham (1924/1927a) was particularly convincing in his developmental linkage of
aggressive sadism, which is heralded by the eruption of the teeth, and its adaptation into aggressive
analsadism as maturation introduces sphincter control into the child's developmental repertoire. Most
analysts, however, adopted Freud's original formulation that aggression develops either in service of the
pleasure principle or as a reaction to libidinal frustration. Fenichel (1945, p. 86) argues:
Small children actually destroy objects … not because they have a positive striving for destruction,
but rather because they do not care at all … their “aggressive” goal is the end of uncomfortable
situations … The goal of positive destruction originates later, probably first as a means to enforce other
goals (as a quality with which a goal is pursued in the case of difficulties or frustrations) and then,
subsequently, as a goal in itself.
In fact, this reflects Melanie Klein's differentiation between characteristic aspects of the oral position —
greed and envy. Greed is seen as a basic libidinal urge that impels the infant to acquire whatever
possible. In envy, the infant wants all the contents of the good breast and also attempts to destroy the
breast. While greed may also result in the breast's destruction, Klein does not imbue greed without
motive.
While not challenging the analytic data of Abraham and Klein, Fenichel champions the prevalent
analytic opinion that although these cases may indeed entail physiologically based or pathological
manifestations of aggression, they are decidedly atypical and do not represent normal developmental
adaptation.
Despite an active debate over whether the typical developmental emergence of aggression is due to a
direct independent instinctual motif or is a reaction to libidinal frustration, there seems to be general
agreement that each of these loci can be found in some individuals. We assert that the aggressive
mode, especially when it is maladapted into char-acterological hostility, forms the bases of two distinct
forms of psychopathy. One is sadism, as it is expressed in re-enacted victimization, which features a
relational mode toward the victim; the other is hostile psychopathy, where aggression is an end in itself,
with (happenstancial, rather than intrinsic) relational components.
Based on our clinical experience, the hostile aspects of psychopathy are best conceptualized within the
rubric of an aggressive instinct that seeks expression. Elements of self-loathing that inevitably follow the
violent re-enactments of sadistic episodes provide support for the analytic hypothesis that outward
aggression may have some roots in instinctual self-destructive tendencies (which are projected outward
to preserve ego integrity). On the psycho-dynamic level, however, the notion that interpersonal
aggression derives exclusively from a basic self-destructive wish — with the corollary that all aggression
represents a re-direction of self-destructiveness toward external objects (Freud, 1920) — is not
consistent with analytic protocols of basic psychopathy.
Sadism as a mode of object relations

Sadism is a particularly severe form of hostile psychopathy. It does not typify an individual's regular day-
to-day behaviors. Rather, it entails an intermittent pattern, often dissociated from normal life routines, in
which the individual gets involved in highly structured rituals of re-enactment relating to past traumatic
events. These re-enactments are inevitably violent and gruesome. Psychiatrically, there is a distinct
borderline quality to the active sadistic mode, as person perception and orientation often become
temporarily distorted during the re-enactments. An enigma in sadistic psychopathy is that the crimes are
unpredictable, since the perpetrators apparently choose victims randomly. It is argued that this
randomness is deceptive; in fact, the victim chosen often is reminiscent of key players in the
primarytrauma. As such, it can be understood as a special case of transference.
The concept of transference has its historical roots in the psychoanalytic psychotherapy literature,
where patients are described as often replaying old agendas in response to current challenges. Outside
of the therapy context, we find spouses who are chosen because they offer the unconscious aim of
replaying unresolved conflicts with primarycare-givers. Specifically, children who were abused have a
tendency to marry abusive spouses as adults (Griffing et al., 2005). Moreover, even after such
marriages are dissolved, the next spouse chosen has the abusive potential as well. Similarly, children of
alcoholics who repeatedly marry alcoholics (Olmsted, Crowell, & Waters, 2003) are living out the same
transference principle. Other scenarios we encounter with patients are those of individuals who keep
getting jobs with domineering bosses for whom it is impossible to work, or those who keep forming
friendships with people who take advantage of them.
The transference phenomenon is more insidious and threatening in borderline patients, where reality-
testing is strained. In sadism, transference that triggers the repetition compulsion often usurps reality-
testing for the duration of the re-enactment. These psychopaths actually disengage from reality
parameters when they relive their troubled past.
The general maxim stating that psychopathy (as an axis II disorder) does not involve a violation of
reality-testing (Samenow, 2004) may be said to be valid in all of the various types of psychopathy
except for the re-enactment facet of sadism. When in the clutches of a sadistic episode, the perpetrator
is in fact dynamically detached from reality and psychically living in a past horror scene.
Far from the individuals' crime being motiveless, object relations theory conceptualizes psychopathic
offenses as repetitive “replays” of an irresolvable trauma, where the victims are functionally players who
have been designated to “stand in” for key figures in the past, in a drama intended to repair severe
attachment and interpersonal damage. We refer to this mode as re-enactment.
Re-enactment — in which old relationships and aggressive interactions are recreated in the here-and-
now — is dynamically a defensive or ameliorative maneuver. Cognitively, it imbues current reality with
historical artifacts. Clinically, it eventually comes to entail individually designed scenarios, with
occasional distortions or misinterpretations, which stretch reality-testing. If constant, it might be
described as delusional. In effect, it confuses representation with substitution. The characteristics of
classical repetition compulsion are evident in the reiterative form of the symptoms. Patients have
described themselves as finding themselves “addicted to the same event over and over again.”
It is not surprising that aggression is sometimes triggered by the offender's “perception of certain
characteristics of his victims that are of symbolic significance to him” (Douglas, Ressler, Burgess, and
Hartman, 1986, p. 403). We may find that these perpetrators call victims by another's name as they re-
enact scenarios in which the victims are accused of crimes perpetrated (whether real or imagined) upon
the sadist by figures of the past. Victims are then tortured until they “confess” prior to retribution.
Inevitably, the sadist leaves the re-enactment with only a momentary sense of relief, before he or she is
trapped again in an unconscious script demanding yet another re-enactment. This results in a
continuous replay of unresolved events, where the patients are doomed to relive old problems
indefinitely. Although the repetition compulsion is intended to ameliorate, it is never effective because
“the past is gone” and cannot be undone (Mann, 1994).
In his popular presentation of the forensic case of Dennis Rader, a prominent serial killer, Alexander
(2005, p. 167) quotes a co-worker's description of this gruesome sadistic psychopath:
One time he had just taken his kids on a vacation and seemed to be thrilled about it. I could tell he
really cared about his family.
This rather mundane description of a father and family person is not evidence of the gullibility of the lay
person colleague of the killer. Indeed, it is certain that sadistic psychopaths do experience responsibility
and show guilt and superego indices in specific family relations. Instead, the sadistic activities are
mentally dissociated from the remainder of the perpetrator's appropriate (and even conscientious)
interpersonal experiences.
Projecting aggression onto others is the primary mode of object relations in sadistic psychopathy. It is
hypothesized that an early attachment to an abusive caregiver has resulted in a perverse linkage
between abuse and feelings of closeness. Furthermore, the early abuse engendered guilt (since the
child presumes that the abuse was well deserved), prompting self-loathing, which is then projected onto
others. The thrill at the humiliation of others is a function of this linkage that becomes satisfying when
the role of abused is converted to that of the abuser, allowing the psychopath to relive his troubling
history in a satisfying manner.
Some theorists argue that it is the emotional absence of the parent, rather than actual abuse, which
forms the foundation of future psychopathy (Bach, 1994). Early maternal deprivation results in sadism
and self-loathing that is projected outward. As a result of this deprivation, the criminal unconsciously
projects his sense of deserving punishment by punishing others, as a means of negating his own
punishment (Glover, 1960; McDougall, 1972).
Kernberg (1992) argues that the absence of non-exploitive object relations in psychopathy yields an
inability to empathize coupled with a devaluation of others as a defense against envy; as a result,
psychopaths view good objects as weak and morality as weakness in others. It is stressed that a more
damaging facet of sadism, in particular, is the lack of object relational capacity other than as a re-
enactment instrument of earlier unresolved cathexes.
Much of the literature about criminality focuses on the psychopath who commits his crimes as a
personal re-enactment of a disturbing trauma. The dynamics that drive this mode of psychopathy are
clearly sadistic in their execution. Freud (1916) suggested that the criminal's environment is internalized
into a harsh superego, creating an oppressive feeling of guilt due to unconscious unresolved conflict in
sexual development (the Oedipal wish). As Freud sees it (1916, p. 332), the criminal is:
suffering from an oppressive feeling of guilt, of which he did not know the origin, and after he had
committed a misdeed this oppression was mitigated. His sense of guilt was at least attached to
something.
Similar to Bach's theory of distraction from the original source of pain, Freud views the misdeeds as
more tolerable than the feelings associated with the original critical or emotionally detached caregiver.
There is a marked phenomenological similarity between the re-enactment of trauma in psychopathy and
the (more passive) reaction to trauma manifest in post-traumatic stress disorder (PTSD; American
Psychiatric Association, 2000). Patients with PTSD experience their past trauma unwittingly and
passively. Their subjective experience is that they are confronted with situations which evoke
unresolved disturbing past events. Never do they actively evoke or recreate these events. Moreover,
there is no ameliorative motive or intent in the experience of the trauma. Essentially, patients with PTSD
see themselves as victims of “mind games” that their (unconscious) mind plays on them. The condition
is certainly ego-dystonic. PTSD patients, in fact, usually present for treatment wishing they could rid
themselves of the disorder. The psychopath takes this phenomenon a step further, as he or she
contrives his or her current reality to re-enact past troubling events.
The sadistic psychopath who re-enacts previous trauma, by contrast, does not usually present for
treatment. He or she is not bothered by the sadism, because the behavior is intentional. Although
doomed to fail as amelioration, it is designed to correct past pain and to relieve built up tension and
anxiety. Both the re-enacting sadist and the PTSD patient, however, relive their past traumas when they
are in the grip of the symptomatology.
Repeat offenders express their object relations inadequacies within the dynamic rubric of sadistic
psychopathy. The psychodynamic literature attributes this phenomenon to the mechanism of
reenactment. This offense does not solve or minimize the impact of the original stressors (e.g. self-
loathing, guilt, anxiety, etc.). For this reason, it is not a lasting solution, and the anxiety is only briefly
placated. Particularly in sexual perversions, the compulsive need to enact the fantasy works in tandem
with the ability to see the victim as nonhu-man, thus allowing the victim to represent a part of himself
(Bach, 1994). This process is facilitated by victim anonymity.
Yochelson and Samenow (1976) see manifestations of this guilt, which they hypothesize to stem from
shame around the Oedipal wish, in the foolish risks, self-neglect, and self-defeating behavior in
confinement that they have observed in criminals. We argue that acting out may be dynamically
intended not only to produce guilt as punishment by the sadistic superego (masochism), but also to
utilize such guilt to forestall the instinctual reactions to the original cathected object. These dreaded
instinctual impulses may entail extreme hostility toward the parent, or they may entail Oedipal wishes.
Elaborating the object relations perspective, Bach (1994) describes such aggression as necessary for
offenders who must see the object of their offense as a nonperson. This is termed part-object relations
because the offender does not see the object as a whole person. The victim is dehumanized so that he
or she becomes unworthy of compassion. Anonymity of the victim enables the offender to act out his
fantasies without being distracted by reality. It is not surprising that studies of serial murderers show
them to be isolated and to lack meaningful enduring relationships (Ressler, Burgess, and Douglas,
1998). Implicit in this approach is that the superego is not only present (albeit in a contorted manner),
but is crucial in driving the very dynamics of sadistic psychopathy.
From a deterministic perspective, aggression as a primary mode of object relations results from early
emotional neglect, causing the person to resort to sadism or aggression “in an effort to deny the loss
and to buttress a failing sense of self” (Bach, 1994, p. 5). The developmental link between poor
attachment styles and criminality (Allen, Hauser, and Borman-Spurrell, 1996; Stoller, 1987) is thus not
surprising.
A pathognomic aspect of sadism that distinguishes it from the more general form of hostile psychopathy
is that the manifest drive is not merely oriented at tension release via aggression. Rather, it is more
important to the psychopath that the victim experience pain and discomfort than it is important for the
perpetrator to release his aggressive feelings. In that sense, there is a palpable transaction here of
object relations quality. The ultimate intent in hurting another person — even in the extreme case of
murder — is not the result, per se, of the victim being disabled or dead, but the particular pleasure
experienced by the perpetrator as a direct function of the victim's experience of discomfort or pain. Were
there to be only the option of killing others, for example, where the death is sudden and does not involve
suffering on the part of the victim, it would satisfy the general drives of the hostile psychopath, but it
would not satisfy the object relational needs of the sadist to engage in a tormentor-tormented interaction
with the victim. In a more basic differential formulation, hostile psychopathy entails the tendency to hurt
others because it releases aggression, while sadism involves pleasure in inflicting pain, because the
victim's suffering (in as much as it is absolutely linked to his or her “relationship” with perpetrator) is the
desired end.
Often, there is a distinct aspect of sadism that is not object relational in nature, but rather a function of a
harshly punitive superego. The general understanding among experts of serial perpetrators (e.g. Fox &
Levin, 2005) is that these psychopaths may show adequate interpersonal engagement and values
toward family and friends, whereas “strangers mean nothing to them” (Alexander, 2005, p. 170). We
argue that the aggression against the strangers is actually motivated — not because “they mean nothing
to them” but because of the rigid superego that characterizes the dynamics of the perpetrator. The
atrocities that are committed engender the same powerful guilt that they would engender in other people
— in fact, the guilt is even more severe. Dynamically, it is actually a sadistic superego which is triggered
so that the powerful guilt is experienced in a masochistic way. A key result is that the perpetrator
wallows in guilt and self-degradation. The resulting humiliation and self-recrimination (or self-
degradation) is an important ingredient of the punishment administered by the harsh superego. A cycle
becomes fixed in which the repetition of criminal aggression is designed to engender a steady and
consistent reaffirmation of poor self-worth. Any attempts to extricate himself from vice of the sadistic
superego trigger an almost involuntary compulsive repetition of a horrific sadistic act that stifles any
exoneration and affirms the hopeless mire of eternal damnation as a subhuman entity.
It should be stressed, however, that the experience of guilt in psychopathy exists exclusively in a mode
that is dissociated from consciousness. As such, the psychopath never experiences the constructive
effects of a functioning superego mediated through the conscious manifestations of guilt. Instead, a
profound degree of guilt rages in the unconscious, achieving expression in violent behaviors that remain
unelaborated emotionally and cognitively.
Drive theory perspective

Other than the particular dynamic of sadism, hostile psychopathy is, as a rule, not restorative in intent.
Dynamically, it entails the direct expression of id-derived aggression. Behaviorally, it is perceived by
analysts as representing aggression for its own sake. Hostility seems to be an end, rather than a means
to resolve a problem or to effect change. Although it features aggression toward others, aggressive
psychopathy has its dynamic roots in instinctual impulse expression, and is best conceptualized within
the context of drive theory:
The aim of an instinct is its satisfaction or, more precisely, the very specific dischargeaction which
dispels the physical condition of excitement and thus brings about satisfaction (Fenichel, 1945, p. 55).
In this perspective, drives originate from energy that pushes for release. This formulation is monolithic
regardless of the “type” of drive that is being considered. Moreover, different types of drive do not differ
dynamically. Whether we focus on a sexual instinct, a need for food, anal stimulation, or aggression, the
one underlying dynamic is that they all entail a state of tension, whose release “feels good.” Indeed, the
drive “types” actually constitute a single id tendency. Of particular relevance to our understanding of
sadism, those called aggressive drives are structurally indistinct from any otherdrive. Their classification
as hostile is merely deduced from their results.
Some of the early retrospective histories of hostile psychopaths feature a variety of antisocial activities.
They may also include acting-out behaviors such as brutalizing younger peers, terrorizing feeble adults,
tormenting animals, or destructiveness of property and the environment. Analyses of the dynamics of
those activities show that there is usually no fixed relational component in the aggression directed
toward others. Instead, the key dynamic involves drivedischarge (where violence becomes part and
parcel of their personalities), with the choice of objects (whether animate or not) being rather
unelaborated.
Aggression is a built-in human tendency, whose function is self-protective. To keep hostility within
normative bounds, society has established socialization algorithms, beginning in childhood, to curb
aggressive tendencies, curtailing their expression to socially sanctioned venues. The latter process is
eventually internalized into a superegostructure that combines with individual life experiences into a
highly personalized sense of conscience. The aggression that cannot be expressed directly is
expressed indirectly in socially sanctioned sublimations. Healthy functioning is very much dependent on
the sublimation of aggression (i.e. redirection of aggression to a constructive outlet such as sports).
Psychopaths often seem to have a specific sublimation deficit. This may result in a serious threat toward
ego disintegration. Hartmann, Kris, and Lowenstein (1964) describe sadism as an adaptation of
personality that serves the purpose of self-preservation. Ego strength and a positive perspective on the
self require the neutralization of aggression to avoid internalizing it into self-loathing. Aggression that is
not discharged may be internalized by being attached to the superego (the source of family and societal
morals and rules) and transformed into guilt, and result in a self-destructive wish. By externalizing the
aggression as sadism, internalization is avoided, but permanent positive relationships with others are
imperiled.
Impulses seek expression. Unexpressed impulses cause inner tension. People with healthy egos can
tolerate moderate levels of inner tension that are caused by impulses whose expression are not
adaptive. Those with weak egos risk the chance that containing such harmful impulses may result in
their internalization and yield ego disintegration. Internalized aggressive impulses, in particular, become
unconscious self-destructive wishes. Indeed, studies demonstrate a relationship between violence and
suicidality in the criminal population, indicating that those who aggress are at greater risk of suicide
attempts (Hillbrand, 1995; Van Praag, Plutchik, and Apter, 1990). One option in such cases is to
externalize such wishes and to project them onto others in the form of aggression.
For the offender whose ego is too weak to contain violent impulses, aggression erupts as a way of
avoiding ego disintegration(Hartmann et al., 1964). A study by Gough and Bradley (1992) found there
was a significant empirical relationship between low ego integration (an inability to balance impulses
and consequences) and violent criminal behavior. Smith (1922, p. 110) explains the ego role in
discharging violent impulses thus: “The impulse is, at first, resisted, the resistance gives rise to mental
pain, the resistance is usually ineffective, the performance of the act is followed by a sense of relief.”
Aggressive tendencies do not become subject to consistent control in all individuals. In distinction to the
psychopathic condition of poor impulse control, where reactions to frustration leads to aggressive
behavior, hostile psychopaths seek out violence toward others. This occurs even in situations where
there is no underlying motif of self-protection and when it is not a reaction to a perceived threat. Indeed,
violence is exhibited even when it results in self-endangerment. Expression of aggression is intrinsically
pleasurable to these psychopaths.
A stark description of hostile psychopathy (New York Times, 2003) illustrates the visceral excitement
received from raw aggression:
Jurors in Virginia heard an audio-taped confession in which Lee Malvo described the sniper shootings
that left 10 people dead in the Washington last fall with tittering, chuckling and giggling … Malvo
revealed a chilling sense of humor, letting go with yips and giggles and prodigious belly laughs as he
described the attacks … He whistled “Joy to the World.” At one point, it sounded as if he literally slapped
his knee … The juxtaposition between tone and substance was chilling.
It is stressed that we are not dealing here with low frustration tolerance. Indeed, negativity becomes an
end in itself. Moreover, it often seems that even when there is no reality-based context for conflict, a
situation will be contrived to provoke and instigate others, so that defiance can be expressed.
Dynamically, it can be said that the sadist “lives for” such negative and aggressive encounters, and that
oppo-sitionalism is the only mode of engagement he or she has mastered.
The clinical flavor of the adult expression of hostile psychopathy suggests that the disturbance is more
basic, and that it is rooted primarily in pathological drive expression. One need only read a description of
Lee Malvo's court appearance, or observe these individuals get a thrill from running small animals down
as they drive on the road, to appreciate the pronounced damage that has been visited on these
individuals' id structure.
Although analysts are emphatic that severe deprivation and attachment histories are necessary
prerequisites for the development of psychopathy in an individual, such predispositions are not
consistent in producing this personality. It is not clear what early constitutional factors enable one
person to tolerate early noxious experiences when others cannot (Stoller, 1987). It has been suggested
that the individual who acts out on impulses has an impoverished fantasy life and an incapacity to
neutralize aggression though consciousfantasy(McDougall, 1972). While acting-out is temporarily
restorative to the ego by relieving some anxiety, the lack of awareness of the unconsciouslink to the
trauma keeps the person in a desymbolized state and engenders a compulsive aggressive pattern in the
personalitystructure.
Hostile psychopathy falls short of sadism according to the classical de Sade (1966/1996) prototype. The
person is devoted to discharge of aggressive impulses. The impulses are termed aggressive because of
their functional design. They are intended to insure survival by hurting or destroying others.
Phenomenologically, however, what is experienced by an aggression-driven individual involves only his
or her own subjective need to release these impulses outward. Although these do cause hardship and
suffering, that is not the intent of the release, as such. While it can be argued that even when
aggression is directed against animals, there is intent to evince actual feelings of suffering in those
animals (in addition to the discharge of the aggressive drive), how do we construe the aggression of
such individuals against nature and inanimate objects? Clearly, the subjective suffering of the victim is
not an intrinsic part of the psychopathy. It might be argued that the aggression-driven psychopath who is
intent on killing a person or a group of individuals is intent on destroying his victims and neutralizing
them, but has no particular pleasure from making them suffer or feel pain. How victims perceive him or
her, or the resulting power constellation between perpetrator and victim — is far from the perpetrator's
mind (and unconscious) when aggression is expressed.
In contrast, the re-enactment sadist does not vent his fury on inanimate objects or even at animals. It is
the suffering of the victim that is the main intent. The simple defeat of the victim would not serve the
purposes of the pathology. Indeed, the ultimate demise of the victim is merely part and parcel of the
“package” designed to evoke subjective feelings of pain and suffering in the victim, toward the end of a
re-evoked hostile relationship that has soured in the perpetrator's past. How victims perceive him or her,
or the resulting power constellation between perpetrator and victim, is indeed the main dynamic in the
re-enacted aggression. A quick death — where the victim does not cringe and (symbolically) regret
(alleged) past inequities — would not be functional. Subjective suffering of the victim is the key goal
here.
Psychosexual components of sadism

A comparative analysis of the development of the sadistic drive in early childhood elucidates its
characteristics and its partial overlap with object relations. Psychosexual development postulates that as
the body progresses through a series of physical sensitivities and physical modes, there is a parallel
development of psychological or interpersonal modes that are assimilated. Although commonly
formulated as a unitary concept, there is a distinction in the dynamics of sadism as they manifest in
successive developmental stages.
The prelatency stages are most relevant here. Anchored in personality connotations of adulthood, the
chain is represented by the following sequence: oral dependence, oral sadism, anal expulsiveness, anal
retentiveness, and finally the phallic stage. The division of development into phases is merely practical,
since “all phases gradually pass into one another and overlap” (Fenichel, 1945, p. 62). Developmentally,
sadism bridges the two stages of orality and anality. Although sadism is measured psychometrically in
the projective research literature by summing all aggression regardless of its psychosexual components
(Juni, 1993), the loci of these two foci have significant differential implications in the etiology of
psychopathic sadism.
The relational modes that typify these stages are distinct. In the oral stage, physical pleasure is driven
by the need to ingest food as sustenance. The oral stage begins with an instinctual need for oral
stimulation, which initially manifests as a consistent drive to suck. This progresses into a uniform mode
of seeking sustenance. The psychological mode assimilated is that of dependency, with the motif of
harvesting needs from a world. Object relations here are primarily passive (as active facets appear
gradually), with the orientation of “getting” as the major focus (Juni, 1984). In the analstage, physical
control of the sphincters translates into a psychological sense of self-government and directed actions.
Object relations foci develop in the areas of self-control versus being controlled (Juni, 1992). Even as
the concept of the object (the potential provider) begins to emerge, the importance of the object is not
intrinsic. Indeed, the other is important only insofar as he or she is the source of sustenance (or, more
basically, instinctual stimulation/gratification).
There is a developmental continuum in the evolution of sadism as the child matures from early infancy.
As the oral dependent phase yields to the oral sadistic phase, frustrations often pit the child against the
potential provider. Aggression (biting) can now evolve from its archaic incorporative mode, which is
designed to ensure closeness (Fenichel, 1945), into an aggressive adversarial tool facilitating
sustenance. As oral sadism progresses toward analsadism, the oppositional mode begins to
characterize more and more of the interaction. Yet, the aim of the child is to get sustenance
(drivesatisfaction) despite the impediments of the (sometimes) frustrating object. It is only as anality
evolves from expul-siveness toward retentiveness that there is a shift from the stance of getting
satisfaction in spite of opposition, to the point at which “spite” actually becomes the central aim.
Dynamically, the tenor of this continuum entails a role progression of the object from first being a source
of drivesatisfaction, then a likely impediment to satisfaction, and finally a relational adversary. At the
final stage, the child's perspective is not only to win the battle in order to gaindrivesatisfaction; he or she
now has the additional caveat that the defeat of the frustrator is now an aim in itself.
Oral sadism is merely a discharge of energy that is functionally, although not intentionally, aggressive.
At this stage of primarynarcissism preceding the concept of object representation(Freud, 1914), there is
little knowledge yet of other entities as being independent of the self. As such, we take exception to
Klein's (1932) and Rickman's (1936)object relations conceptualization that biting the breast during
feeding is predicated on the infant's mental splitting of the breast into good and bad components,
coupled with directed aggression solely toward the frustrating breast. In fact, the biting response
predates any relational motif and simply entails a discharge of energy. The feelings and experiences of
the “other” are not part of the infant's world view, and certainly do not figure in his intent or “decision” to
bite.
As a working clinical postulate, we tend to confirm Fenichel's (1945) formulation that the oral mode of
taking in can become sadistic/incorporative when significant frustration occurs, engendering hostility
toward the frustrating provider. It is noteworthy that, the developmental progress wherein the infant
comes to realize the concept of an external object enables the response of incorporative sadism, and
this coincides with the development of teeth. This is adopted as an icon of oral sadism (Abraham,
1924/1927a), supported by early analytic evidence that sadists are actually fixated in the latter phase of
oral development(Van Ophuijsen, 1929).
The dynamics during the analstage are qualitatively distinct from those of orality. Whether in the
expulsive or the retentive mode, there is a palpable relational flavor to the analcharacter expressions.
The concept of the significant other as an interested, intrusive, and dominant protagonist is the defining
attribute of this stage, Whether the infant chooses to withhold or expel in the physical mode, or to defy
or comply in the psychological, the relational aspects of this decision are definitive and crucial.
In the oral sadistic (sub)stage, the biting mode entails aggression toward the source of sustenance —
literally, the breast, and figuratively, the caretaker. This is a straightforward expression of instinctual
aggression. As this unadulterated drive is later modified by emerging superego components and
socialization vectors, biting becomes an icon that represents aggression which is linked first to a
response to frustration (i.e. retaliation; e.g. biting the breast because the supply is not “good enough”),
and later to a defensive mode against threat (e.g. using biting as a mode of attack, with the aim of
minimizing threats from others). The original form of the biting mode — rooted in direct aggression that
is not motivated by any ends or a result of any negative input from the environment — typically recedes
to the unconscious and remains repressed, only to appear much later in sublimated prosocial
expressions that bear tell-tale signs of Thanatos.
Biting by the infant is sparked by an instinctual (noncognitive) physical urge to close the teeth forcefully.
When the concept of “other” (as distinct from the self) is assimilated, the sensation is enhanced by the
infant's realization that an object is being bitten. Gradually, there is a sense that the other person
(object) is being hurt or incapacitated, perhaps in retaliation for not providing enough nurture. Klein
(1930) goes as far as viewing oral sadism as a desire to totally destroy the mother at this point. That
coincides with the instinctive intent of the release of energy as a means of destroying predators or
competition.
In the evolutionary sense, this drive is object-cathected by design. Although this unconscious motif can
become incorporated into the biting mode, the reactions and feelings of the object are not part of its
dynamics. In essence, then, all we have here is a drive-release mode, and not a relational one. Oral
sadism in its true form — the pleasure derived from causing “pain” to others (Abraham, 1924/1927a,
1924/1927b) — has not yet been achieved, because the intent is either the release of energy or the
destruction or incapacitation of the object, while the actual sensations or cognitions of the other are
irrelevant. When hostility first becomes a viable response in oral phase, its manifestation entails a mode
of rejection (spitting out), not one of destruction of an object. At some point, the discomfort of the object
does become a partial purpose, particularly when the purpose of the aggression is not so much to
destroy the threatening object (which may not always be feasible or a prudent use of limited aggressive
resources), but to inculcate enough discomfort and pain in the object to dissuade further threats.
Eventually, the aggression of the oral stage acquires an orientation in which the intent is to cause pain
and suffering to the object as an end in itself. Klein invokes the motif of oral incorporative destruction
here, in addition to the hostile biting response. This is where the label of sadism accurately depicts the
alleged intent of the aggressive phenomenon.
We posit that biting, as the prototype of oral sadism, is not relational in its etiology from the infant's
perspective. Rather, it merely represents a discharge of drive, most likely one of generalized unbridled
aggression. Certainly, the discharge is not functional, and there is no particular object relational goal
inherent in the aggression. The infant does not bite the breast because of frustration or anger. Certainly,
biting is not directed at the mother as a person. Rather, it is a primitive libidinal expression of an inborn
aggressive behavior that is not intrinsically object-directed (Juni, 1992). The breast is merely the most
likely (and probably the only) available object to express this aggression. Even in the classic
interpretation of oral sadism by Klein, the construct of splitting the good breast and the bad breast
should not be construed as implying that the perception of a “bad breast” is the cause of biting. Rather,
it entails a post hoc attempt by the infant to reconcile apparently antithetical drives —incorporative and
hostile — directed at the same object. Splitting is a method of deluding oneself that the two drives are
actually directed at two different part-objects, reducing dissonance-based anxiety.
From a pragmatic clinical perspective, one could argue that the Kleinean approach is more relevant to
the developmental etiology of aggression than to the actual understanding of its dynamics in adult
functioning. Granted that sadism may well originate from greed that is aimed at incorporating the other
to insure possession of the “good” as a means of securing gratification, there is no doubt that
aggression then becomes a tool of attacking agents who are identified with painful stimuli. In its final
manifestation, it is argued, aggression becomes an instinctual aim in itself.
Abraham (1924/1927a, 1924/1927c) sees the primaryinstinctual drive in the anal defecating function as
destructiveness (of the feces). Abraham conceptualizes the development of anality as beginning with a
sadistic (sub)phase, in which pleasure in defecation entails the “pinching off” of feces, followed by a
retentive (sub)phase that is not sadistic in its orientation. Whereas the sadistic phase of anality has no
elements of regard for the object, the retentive dynamic was originally construed by Abraham as being
aimed to conserve the loved object (represented by feces). Developmentally, it is noteworthy that the
anal sadistic phase immediately follows the oral sadistic phase, so that the two can be bridged
conceptually within a larger rubric of sadism regardless of somatosexual components.
Gradually, the dynamics of the anal sadistic (sub)stage become independent of the somatosexual locus
and grow to entail the interpersonal caveat of vying for control with the socializing agents. (In the
psychoanalytic literature, this is reflected by the entire analstagebeing identified as “analsadism,”
regardless of whether expulsive or retentive dynamics were at play.) This elicits another mode of
aggressive expression. In the battles over toileting and parallel issues of behavioral control, defying
authority and using the emerging capacity for self-directed behavior to hurt and frustrate others derive,
as in oral sadism, directly from the aggressive instinct. Here, too, the oppositionalism and anger
expressed by the toddler are not motivated by ends, nor do they stem from of any negative input from
the environment. As this unadulterated drive is later modified by emerging superego components and
socialization vectors, oppositionalism and control-related aggression are transformed first into a
response to frustration (e.g. a reaction to feeling inappropriately dominated or “pushed around” by
others), and later to a defensive mode against threat (e.g. using oppositional aggression and hostility as
a mode of attack, with the aim of minimizing threats from others).
Analsadism — whether expulsive or retentive — is most evident developmentally as a relational style.

The interactional concomitants of the analstage rooted in toilet training and disciplinary efforts by adult
caretakers, juxtaposed with the emerging needs of autonomy and efforts at self-control by the child,
serve as the cornerstones of conflict in the analstage. Aggression, which gradually coalesces into
analsadism, builds on this antithetical conflict situation. As such, it is engendered reactively in response
to frustration. Rather than a direct expression of underlying hostility that is bereft of context, it represents
a functional response that is intrinsically object-oriented against the agents which impose external
limitation and interfere with autonomy. Moreover, the goal of this aggression is tangible —the cessation
of frustration.
The analphase brings with it sadistic components in its very psychosexual design. Essentially, demands
by the caregivers are such that they engender power-lessness and impotence. The ego is forced to
renounce autonomy in favor of compliance with the powerful other. Analsadism, when it erupts,
emerges as a combative aggressive dynamic designed to fight this oppression. For once, the child is
presented with perceived power, entailed in his or her decision whether to relinquish the feces, which
carries connotations ranging from control to defilement and disruption. The aggression associated with
this stance is certainly not a manifestation of the physical release of energy. Rather, it is intrinsically
object-related, and, moreover, it is created as a reaction to the infringement on the ego's autonomy by
that object.
Furthermore, it should be noted that the nature of the aggression in analsadism differs qualitatively from
the aggression in oral sadism. Biting is painful and can pose a veritable threat to objects (especially
living organisms). Anal contrariness and oppositionalism is a threat primarily on the interpersonal level.
The initial anal response to toilet training and other forms of control at this psychosexual stage is
oppositional, rooted in the toddler's attempt to maintain autonomy and freedom of action (Fischer & Juni,
1981, 1982). When a straightforward position is realized to be untenable based on the balance of
power, sadism comes in as a tool. At this point, causing discomfort and pain becomes an interim goal in
the power-competition goal. Although this involves a relational battle, the feelings engendered by the
object as a result of aggression are not ends, but rather means to the end of dissuading the caretaker
from threatening and oppressing the developing ego of the toddler. What is crucial at this stage is that in
no way is the analsadism oriented at, nor does withholding or expelling feces ever have the potential for,
actually hurting the perceived aggressor or oppressor in the physical sense. The discomfort engendered
by the anal sadistic response is essentially interpersonal and object relational variety. Caretakers feel
discomfort by the anal sadistic response of the toddler because they feel frustrated, defeated,
embarrassed, and exasperated. It can thus been understood why analsadism is rooted in the domain of
object relations.
As conceptualized in drive theory, the basic elements of sadism originate from the need to express
aggression as a drive-reduction mechanism. In the oral sadistic biting mode, the feelings that ensue on
the part of the object of the aggression are not central to this process. As development proceeds,
however, object relational concomitants are inevitable. Particularly in the anal (sadistic) stages, the
dynamics become intrinsically interpersonal in their motivation (i.e. battling for control and power), and
are direct repercussions from the process in terms of attachment styles and interpersonal relationships.
It is hypothesized that the continuum of hostile psychopathy — ranging from an extreme aggressive
disposition to a sadistic mode whose aim is the infliction of suffering — derives from these two stage-
related components of psychosexual sadism. Specifically, aggression driven sadism is seen as
dynamically most consistent with oral sadistic components, where the intent of the aggression is
drivedischarge. No ameliorative or reparational efforts are involved here. Re-enactment sadism, by
contrast, is proposed to derive primarily from the later aspects of analsadism, whose dynamics are
object relational. The force behind the aggression derives from the frustrated interactions with significant
others that damaged the ego severely. The intent of the expressed aggression is reparative, mediated
by the repetition compulsion. Despite its futility, sadistic behavior is nonetheless directed at an object
relations goal of maintaining contact with an alienated loved one, although guilt and masochism distort
this effort into a gruesome caricature that dooms its mission.
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The Development and Consequences of an Aggressive Symbiotic Fantasy

The developmental theory of separation-individuation (Mahler, Pine, and Bergman, 1975) is

compromise formations are intended to prevent it (Mayer, 1995).

Analyst: Why is it inappropriate to caress my carpet?

Andrea: I do not trust you at one level.

Analyst: Why is that?

Analyst: Do you worry that I would do the same thing to you?

Andrea: I don't know.

Andrea: I have no place for those feelings; I cannot handle them.

Analyst: What are those feelings?

Analyst: It seems that issues around penises make you upset.

Analyst: You feel I have another agenda for you?

Andrea: Yes. Don't worry, be happy.

Analyst: What is your agenda?

anatomical differences, primal-scene fantasies, and the negative Oedipus complex.

transference/countertransference at that moment in the analysis.

Brief Communications from the Edge: Psychotherapy with Challenging

Matthew's past and present functioning

Thinking about work with adolescents

(2) in delinquency and putting the body at risk

(Edgcumbe, 1988: 12)

(Edgcumbe, 1988: 13).

(Wilson, 1999: 318)

Thinking about Matthew

expectation that he, too, will abuse.

An encounter with Matthew

Note and acknowledgement

and Abused Children. London and New York: Tavistock/Routledge . (PPTX.005.0177A)

5 Edgcumbe , R. (1988) ‘Formulation of interpretations in clinical work with adolescents', unpublished

6 Fonagy , P. and Target , M. (1996) ‘A contemporary psychoanalytical perspective: psycho-dynamic

London: Hogarth Press , 1975 .

Mots clefs: Adolescents difficiles et provocateurs; interprétation; approche développementale et

Authors: Juni, Samuel

Conceptualization of Hostile Psychopathy and Sadism: Drive Theory and

(Received 2 February 2007; accepted 24 November 2007)

Aggression: A basic instinct or a functional/reactive response?

tension. Aggression can be conceptualized as a mode that is essentially designed as a subjective

Sadism as a mode of object relations

Drive theory perspective

received from raw aggression:

Psychosexual components of sadism

Analsadism — whether expulsive or retentive — is most evident developmentally as a relational style.

Abraham. London: Hogarth Press . (Original work published 1924 )

8 Cleckley , H. (1978). The mask of sanity, 5th ed. St Louis: Mosby .

10 Douglas , J. E. , Ressler , R. K. , Burgess , A. W. , & Hartman , C. R. (1986). Criminal profiling from

36 Lilienfeld , S. O. (1998). Methodological advances and developments in the assessment of

41 New York Times (2003, November 22). pp. A2-A10.

44 Rickman , J. (1936). On the bringing up of children. London: Kegan Paul .

46 Smith , M. (1922). The psychology of the criminal. London: Methuen .

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