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작성자  simonshin 작성일  2016.11.07 21:39 조회수 1213 추천 0
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 신현근 박사 강의안 - 피학성 성격 장애   
첨부파일 : f1_20161107213917.pdf
 

과목:  진단과 평가

주제Masochistic (Self-Defeating) Personality Disorders

강사: 신현근 박사

내용: 강의안 피학성 성격 장애

교재: PDM Task Force. (2006). Psychodynamic Diagnostic Manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations

 

Masochistic (Self-Defeating Personality Disorders)

1.      Overview

1.1.   Individuals with a masochistic personality disorder find themselves repetitively suffering.

1.2.   To others, they appear to keep putting themselves in harm’s way.

1.3.   Like “sadism” (named for the Marquis de Sade), the term “masochism” (for Leopold von Sacher-Masoch) originally denoted a sexual psychology in which orgasm is achieved via pain or humiliation.

1.4.   By analogy, the terms became applied to personalities in which some valued experience (e.g., self-esteem, closeness) has become intrinsically associated with necessary suffering.

1.5.   Many prefer the term “self-defeating,” which avoids sexual overtones (people with masochistic personalities are not necessarily masochistic in their sexual behavior) and is less associated with “blaming” the victims of abuse for their mistreatment (Herman, 1992).

 

2.      Masochistic and depression patterns

2.1.   Self-defeating individuals often strike interviewers as simply depressive, but eventually their masochistic patterns become evident.

2.2.   One indication of characterological masochism noted by many clinicians (but not yet researched) is that psychological and pharmaceutical measures that typically relieve depression tend to be ineffective with masochistic patients.

2.3.   Many self-defeating individuals repeatedly complain to practitioners, sometimes with a faint smile, that their latest intervention has failed.

2.4.   Because depressive and masochistic psychologies share several central dynamics (sensitivity to rejection and loss, inferiority feelings, unconscious guilt, inhibition of conscious anger at others), many people may be regarded as encompassing both.

2.5.   Such patients are aptly diagnosed with a depressive-masochistic personality (Kernberg, 1984; Laughlin, 1956; Westen & Shedler, 1999b), a configuration usually found at the neurotic level of severity.

2.5.1.      Kernberg (1988) uses this term for persons with neurotic-level depressive and self-defeating dynamics who use faulty ways of processing grief and sadness, have excessive but disavowed dependency needs, and make unreasonably critical demands on themselves.

 

3.      Moral masochistic

3.1.   The more an apparently depressive patient seems aggrieved rather than sad and self-critical, the more masochistic traits may be assumed to predominate.

3.2.   Self-defeating patients typically enter psychotherapy seeking sympathy for their misfortunes and may seem more invested in demonstrating the magnitude of the injustices they have suffered than in resolving their problems.

3.3.   This attitude characterizes people once labeled “moral masochists” (Freud, 1924; Reik, 1941), whose suffering expresses unconscious guilt and who subtly convey a sense of moral superiority through pain or through seemingly altruistic submission to others.

3.4.   Such individuals are clearly on the introjective pole of Blatt’s continuum (Blatt & Bers, 1993; Blatt, 2004).

3.5.   Some people who act self-destructively on the heels of every success or victory fit in this group.

3.6.   Cooper (1988) has argued that the narcissistic function of characterological masochism is so inseparable from the self-defeating behaviors that identify masochistic personality disorder that the concept of a “narcissistic-masochistic character” is warranted.

 

4.      Relational masochistic

4.1.   Another version of self-defeating personality structure, one more likely to be at a borderline level of personality organization, is a more relational masochistic pattern located closer to the anaclitic pole (Berliner, 1958; Menaker, 1953).

4.2.   The behavior of some individuals suggests an unconscious belief that attachment requires suffering; that is, that others are there for them only if they are not doing well.

4.3.   Patients who self-mutilate, binge on substances, or become sexually involved with strangers whenever the therapist is on vacation exemplify a borderline level of a masochistic way of revenging themselves (not necessarily consciously) on the absent therapist.

 

5.      Treatment

5.1.   Clinicians working with characterologically masochistic patients initially may feel a strong sympathy for them, which sometimes evokes their own masochistic tendencies (e.g., seeing the patient at inconvenient hours, lowering the fee drastically), but they soon find themselves feeling irritated and even sadistic.

5.2.   A therapist’s warm acceptance in response to hearing the patient’s troubles (an attitude that is usually vitally helpful to depressive patients) may, by reinforcing in self-defeating people the conviction that it is their suffering that brings connection, unwittingly invite increasing self-destructiveness rather than growth toward self-care.

5.3.   Hence, masochistic patients must eventually be tactfully confronted about their own contributions to their recurrent difficulties, and clinicians confronting them must be prepared to tolerate their resulting anxiety and anger.

 

6.      Summary

6.1.   Contributing constitutional-maturational patterns: None known

6.2.   • Central tension/ preoccupation: Suffering/ losing relationship or self-esteem

6.3.   • Central affects: Sadness, anger, guilt

6.4.   Characteristic pathogenic belief about self: By manifestly suffering, I can demonstrate my moral superiority and/ or maintain my attachments

6.5.   • Characteristic pathogenic belief about others: People pay attention only when one is in trouble

6.6.   • Central ways of defending: Introjection, introjective identification, turning against the self, moralizing

6.7.   • Subtypes:

6.7.1.      P106.1 Moral Masochistic

6.7.1.1.            Self-esteem depends on suffering; unconscious guilt disallows experiences of satisfaction and success (cf. Reik, 1941).

6.7.2.      P106.2 Relational Masochistic

6.7.2.1.            Relationship is unconsciously believed to be dependent on one’s suffering or victimization.

6.7.2.2.            Existence outside of one’s current relationship, however abusive it may be, may seem unimaginable (cf. Menaker, 1953).

 

 
 
 
 
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