What is it about?
Masochism is a complex, dimensional psychological phenomenon. At the severe end of the spectrum, it is better conceptualized as sadomasochism, involving severe self-destructive behaviors driven by hidden pleasure and underlying conflicts, presenting diagnostic and treatment challenges. This article elucidates its clinical manifestations and discusses the implicated conflicts and defenses associated in this type of psychopathology. Using a case example, this article explores the effectiveness of transference-focused psychotherapy (TFP) in managing sadomasochistic personality.
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Why is it important?
Masochism, when it becomes extreme, can deeply affect a person’s life and relationships. While everyone might have some small tendencies toward masochism, in some individuals, it can become a major issue, leading them to seek out painful or harmful situations as a way to find hidden satisfaction derivated from deep psychological conflicts. This behavior is especially damaging in relationships, where it can create cycles of conflict and suffering. The article uses a specific therapy called Transference-Focused Psychotherapy (TFP) to understand and treat these behaviors, particularly when they appear in people with borderline personality traits. It shows how this therapy can help identify and work through the hidden conflicts that lead to these harmful patterns, helping individuals develop healthier relationships and a better sense of well-being.
Perspectives
In my clinical work with patients with severe personality pathology, those with sadomasochistic tendencies often seek out pain, suffering, and control within interpersonal relationships. This is typically manifested through cycles of provocation, a victim-like attitude, followed by self-pity, depression, and a belief that 'this only happens to me.' These dynamics frequently leave both themselves and those around them emotionally bruised. Stemming from deep psychological conflict, these patients vacillate between fear and aggression, seeking safety through control utilizing suffering. Unfortunately, this pattern often perpetuates their fears (e.g., abandonment, rejection, mistreatment, and contempt), becoming a reality. As therapists, our work is to help this population gain more reflective capacity and resolve those inner conflicts that cause them to become their own worst enemies.
J. Emiliano Serna-Galindo
Read the Original
This page is a summary of: The sadomasochistic character and borderline personality organization: Working through the underlying conflicts and defenses using transference-focused psychotherapy., Psychoanalytic Psychology, October 2024, American Psychological Association (APA),
DOI: 10.1037/pap0000518.
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