What is it about?
This case study follows a seven-year psychoanalytic treatment of "John," a middle-aged man struggling with paedophilic fantasies. For over a decade, John had been creating digital "short films" by manipulating images of women and girls he knew into sexual scenarios - a behavior that both expressed and contained his dangerous impulses without acting them out in reality. The paper traces John's journey from psychological isolation to genuine human connection. Severely traumatized in childhood by an abusive mother and boundary-violating father, John had learned to relate to others only through control and manipulation. His paedophilic fantasies served as a defense against even deeper psychological breakdown. Through intensive psychoanalytic work, John gradually moved from a "one-person psychology" - where others existed only as extensions of himself - to recognizing others as separate human beings. This transformation allowed him to eventually discard his digital films, improve his relationship with his son, and engage more authentically with reality. The treatment demonstrates how even severely disturbed patients can achieve meaningful psychological change through sustained therapeutic work.
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Why is it important?
This work addresses a critical gap in psychoanalytic literature on treating paedophilia, despite recent research showing a 50% increase in online paedophilic material and prevalence rates of 1-5% in the male population. The case provides rare clinical insight into how psychoanalytic treatment can help individuals with paedophilic fantasies develop healthier coping mechanisms without acting on harmful impulses. The study's significance lies in demonstrating that even patients with severe perverse organizations can achieve therapeutic progress through careful attention to boundaries, countertransference, and the gradual development of a genuine therapeutic relationship. It offers hope for a population often considered untreatable while contributing essential clinical knowledge to a field with limited published case material on this challenging presentation.
Perspectives
This case study represents a significant personal and professional journey that challenged many of my assumptions about treatability and therapeutic boundaries. Working with John required me to confront my own countertransference reactions - including fear, vertigo, and periods of feeling overwhelmed - while maintaining the therapeutic frame necessary for meaningful change. The seven-year duration taught me that transformation in cases of severe perverse organization cannot be rushed. My initial approach of allowing unlimited dream material and maintaining traditional analytic neutrality actually enabled John's resistance rather than facilitating growth. Learning to set firmer boundaries - limiting dreams to one per session, becoming more silent when he used talking as resistance - paradoxically created the safety needed for genuine engagement. The technical adjustments, including my decision to carry a personal alarm during sessions, reflect the real-world challenges of working with patients whose internal violence can feel threatening. These practical considerations don't appear in textbooks but are essential for maintaining the analyst's capacity to think and remain present. Perhaps most significantly, this case reinforced my belief that even patients with the most disturbing presentations retain the capacity for meaningful psychological development. John's ability to eventually discard his "short films" and forge a genuine relationship with his son demonstrates that the human capacity for growth can emerge even from the most damaged psychological organizations. This work has deepened my appreciation for the intersubjective nature of psychoanalytic treatment - how both patient and analyst are inevitably changed through sustained engagement with unconscious material. It also highlighted the critical importance of consultation and supervision when working at the edges of our therapeutic competence.
Sheila Levi
Birkbeck University of London
Read the Original
This page is a summary of: Identification with the hated object in a case of pedophilic fantasies., Psychoanalytic Psychology, September 2025, American Psychological Association (APA),
DOI: 10.1037/pap0000561.
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