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The Masochistic Therapist

Nancy McWilliams admits in her book Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process that she can sometimes be a masochist with a depressive personality, which can gear itself up towards rescuing her clients from themselves.

In her section “Therapeutic Implications of the Diagnosis of Obsessive or Compulsive Personality,” she says “… by accepting compulsively self-harming people into analytic treatment unconditionally, the therapist may unwittingly contribute to their fantasies that therapy will operate magically, without their having at some point to exert self-control …”

This is known universally in Therapy World as “rescue fantasies.” Sometimes there is a repeat pattern of trauma in therapy where the obsessive, compulsive self-harming client with abandonment issues regresses and imploringly begs the therapist for extracurricular activities, and the therapist panics and enables the client to regress further by trying to pull them out of their regression with a magical cure, trying to rescue the client by crawling into their fantasies and merging with them. This can cause the client to withdraw and disintegrate or verbally attack the therapist in a sadistic manner due to feelings of overwhelming engulfment. This is where the cure can be worse than the disease. 

Therapists who encourage merging fantasies, like parents who indulge their spoiled children are not doing their clients any favours. These well-meaning, highly sensitive and intelligent healers were sometimes the Atlas child in their family of origin. In a lot of cases, they were the oldest, who was expected to help bring up younger siblings and whom the family relied and sometimes depended upon.

But the more the therapist, and parent, gives the more the client wants and expects and throws a tantrum when the therapist does finally set some well-needed boundaries. Enabling bad behaviour is not therapeutic.

For clients, it’s the mastery-control, repetition-compulsion drive that Freud espouses, but what is it for therapists who cannot set good boundaries when the client is clearly regressed and out of control?

Are they caught between a rock and a hard place?

The Masochistic Therapist

Sonia Neale

Sonia Neale was recently awarded the Inaugural Barbara Hocking SANE Australia Fellowship to study and research Borderline Personality Disorder overseas in the USA, Canada, UK and Ireland. Her previous Psych Central blog was called Therapy Unplugged. She is the author of two books, The Bad Mother’s Revenge and Death by Teenager, both published by ABC Books/Harper Collins. She lives in Western Australia, is married with three adult children, has studied psychoanalytic psychotherapy, has a Certificate IV in Mental Health and is studying for a Psychology/Counselling degree. She currently works as a peer support worker in the mental health field. Please email her on davson at

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APA Reference
Neale, S. (2010). The Masochistic Therapist. Psych Central. Retrieved on March 30, 2020, from


Last updated: 31 Mar 2010
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