This paper explores the relation of the delusion of omnipotence to masochism and suggests that this fantasy constitutes a major component of the resistance so prominent in work with masochistic patients. The connections among masochism, omnipotence, negative therapeutic reaction, and clinging to pain are discussed. The classical view has been that the failure of infantile omnipotence forces the child to turn to reality. Our experience with masochistic patients suggests that it is the real failure to achieve competent interactions with others that forces the child to turn to omnipotent solutions. The distinction is made between fantasies that enhance the real capacities of the self and those aimed at denying and transforming the pain and inadequacy of the mother-child relationship. The epigenetic transformations of omnipotent fantasies through all levels of development are described. The patient's need to protect the omnipotent fantasy is discussed in relation to resistance at each phase of analysis.

No abstract

Although the authors do discuss sadomasochism (its development, diagnosis, and treatment), it is only one of many subjects addressed. This is a wideranging book that covers many issues. For example, it stresses the importance of understanding personality and pathology from a developmental point of view, an area that was dear to Anna Freud. In fact, the book is very much influenced by her thinking and it is also dedicated to her memory.The authors take up the concept of externalization in considerable depth. This is an area largely neglected by "adult" psychoanalysis. However, it has a profound impact on a child's psychological development. Externalization is an important mechanism used by parents in unloading their own pathology onto their children.In addition to these central topics, the authors provide readers with a "how-to" element in the book in that there is much supervision, of a good kind, in discussing how to treat sadomasochistic disorders, how to treat interminable cases, how to talk to toddlers, and how to terminate a case. Furthermore, it is also a case book, loaded with many illuminating case histories. A number of the chapters had previously been presented at meetings and have subsequently been revised for this book. In order to try to make the book cohesive, the authors have sometimes stretched their ideas to try to encompass the concept of sadomasochism as central to all the chapters.The authors found that beating wishes and beating games are universal, but that beating fantasies are not. Like Freud, they found that beating fantasies Correspondence concerning this review should be addressed to Samuel Weiss,

This paper traces the history of the therapeutic alliance concept, examining how it has been used and misused, at times elevated to a central position and at others rejected altogether. The loss of this concept created a vacuum in classical psychoanalysis that has been filled by rival theories. The continuing usefulness of looking at the treatment process through the lens of the therapeutic alliance, particularly in relation to the manifold difficulties of working with sadomasochistic pathology, is suggested. To this end, revisions of the theory of the therapeutic alliance are suggested to address some of the difficulties that have arisen in conceptualizing this aspect of the therapeutic relationship, and to provide an integrated dynamic model for working with patients at each phase of treatment. This revised model acknowledges the complexity of the domain and encompasses the multiple tasks, functions, partners, and treatment phases involved. The utility of the revised theory is illustrated in application to understanding the sadomasochistic, omnipotent resistances of a female patient through the phases of her analysis.

Volumes have been written about the patient's love for the therapist, but there has been relatively little discussion of the therapist's love for the patient. In an attempt to create a theoretical and technical space for discussing the appropriateness and role of love in the therapeutic relationship, a revised concept of the therapeutic alliance is applied to provide technical guidelines and understanding of two kinds of love between patient and therapist, corresponding to two systems of self-esteem regulation: an open, reality-oriented system and a closed, sadomasochistic system organized according to omnipotent beliefs. Examples of the role of love through the phases of treatment illustrate the interrelationship of love and the accomplishment of therapeutic alliance tasks.