The Sadomasochistic Character and Borderline Personality Organization

Working Through the Underlying Conflicts and Defenses Using Transference-Focused Psychotherapy

Serna-Galindo, Juandiego Emiliano

Department of Psychiatry, The Center for Psychoanalytic Training and Research, Columbia University

Juandiego Emiliano Serna-Galindo is now at Aspen Medical Center, Monterrey, Nuevo León, Mexico.

Data sharing is not applicable to this article as no new data were created or analyzed in this study. The authors have no conflicts of interest to disclose. No funding was received from private or governmental institutions for the development of this article.

In the article, we focus on detailed clinical vignettes from a previously treated case. Consequently, institutional review board approval was not sought for this specific submission, as the work does not constitute research involving new patient data or interventions. The core ethical requirement was obtaining informed consent from the individual whose treatment is described. To ensure privacy and confidentiality, identifiable information such as the client’s name, age, employment, family composition, geographic location, and specifics regarding the husband’s education and employment have been altered. The patient has thoroughly reviewed the article for accuracy and context and has provided written informed consent for the publication of these deidentified vignettes. This approach aligns with ethical guidelines published by the American Psychological Association for the protection of patient confidentiality and the responsible dissemination of clinical findings.

Juandiego Emiliano Serna-Galindo, Lic. Psy, Aspen Medical Center, Corpus Christi 2320, Lomas de San Francisco, 64710 Monterrey, NL, Mexico [email protected]

Psychoanalytic Psychology 41(4):p 153-160, October 2024. | DOI: 10.1037/pap0000518

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. It explores the effectiveness of transference-focused psychotherapy (TFP) in managing sadomasochistic personality, emphasizing the importance of considering the level of personality organization. Using a case example, we illustrate the potential of TFP for symptom amelioration and improvement of interpersonal relationships in individuals with sadomasochistic personalities, as well as addressing emerging resistances in treatment. Furthermore, the article underscores the imperative for further research to understand and address this intricate phenomenon.