ABSTRACT
Working with highly perverse patients without corrupting the therapy is a frequent challenge for psychotherapists. This chapter describes work with a patient who had developed highly perverse internal structures and mechanisms as a way of surviving physical and sexual abuse, and discusses the ensuing developments and challenges in the transference relationship. It explores the initial use of the therapist as a good object who could bear to hear the horrors which had been survived, and examines the ways in which the perversity became more overt within the consulting room. The chapter explains the existence of a “pseudo-victim” false self that was central in the maintenance of the internal perverse structures. As the therapy progressed in the second year, it became increasingly possible to identify and articulate Jane’s active participation in these perverse happenings. She managed to leave her boyfriend whom she had frequently described as a monster.
