ABSTRACT
This chapter explains the clinical problems that are regarded as perversions are a diverse group of problems. Working at the Portman Clinic with people who present with compulsive sexual behaviours, it is striking how commonly patients are preoccupied with the dangers posed by the therapist. In this context, working in the transference is a necessity if there is to be any chance of patients being held and contained. Freud applied the term 'polymorphously perverse' to the child's early normal sexual development rather than to a specific group of patients. Sexualisation may serve as a manic defence against depressive anxieties to do with guilt, ambivalence or imperfection. It may serve as a narcissistic defence, when the underlying anxieties are of inadequacy, of being pathetic or contemptible. The patient's superego is initially evident as a projection onto the therapist: either the therapist is experienced as disapproving and punitive; or as potentially collusive and indulgent.
