by Martha Stark, MD / Faculty, Harvard Medical School




Masochism statements highlight the underlying masochistic dynamic, namely, that the patient’s relentless hope has arisen in the context of the patient’s need to protect herself from the pain of her disappointment – pain that is simply too much to be tolerated.


In other words, the patient defends herself against the pain of her grief by becoming relentlessly hopeful in an effort to deny the reality of what, on some level, she really does know to be the truth.


First the therapist speaks to the reality of the disillusionment (“you know the truth…”), then the therapist addresses the reason for the defensive illusion (“but it hurts too much to sit with the pain of it…”), and finally the therapist resonates empathically with the fact of the defensive illusion (“and so you keep hoping…”).


“Even though you know that eventually you will need to make your peace with just how disappointed and angry you are with your mother, in the moment, the thought of that seems too overwhelming.  And so a part of you keeps hoping that maybe someday things will simply get better without your having to do anything.”

“Although you know that you pay a high price for asking that your husband change and that you are setting yourself up to be ever hurt and disappointed, you tell yourself that it doesn’t seem that unreasonable to be expecting your husband simply to ask you about how your day went when he comes home from work at night.”


“In those moments when you’re forced to recognize that your wife is much more caught up in the things that matter to her than in the things that matter to you, it hurts you to your core – and it makes you wonder how you can go on living.  You had so wanted her to be “the one,” and it is very frightening to think that she might not be.  So it’s easier to imagine that somehow, maybe, you’ll be able to get her to change, than to confront the reality that this may be, fundamentally, who she is.”




Sadism statements highlight the underlying sadistic dynamic, namely, that the patient’s relentless outrage and desire for revenge have arisen in the context of the patient’s experience of having been so unforgivably devastated by the object of her desire that either she has no choice but to lash back or she is entitled to lash back – all this despite the fact that the patient really does know, at least on some level, that she might well later pay a price.


First the therapist speaks to the reality of the potential price paid for the patient’s vindictive lashing back (“you know that you might later regret it…”), then the therapist addresses the reason for the defensive vindictiveness (“but it hurts too much when someone has hurt you like this…”), and finally the therapist resonates empathically with the reality of the defensive vindictiveness (“and so you feel you have no choice but to lash back…” <which speaks to the patient as a powerless victim> or “and so you feel entitled to lash back…” <which speaks to the patient as a powerful victimizer>.


“When you think about how unavailable Selena is, it is overwhelming and it makes you terribly upset.  But then when you begin to feel that she is taking you for granted and not appreciating all the sacrifices that you’ve made for her, you find yourself becoming enraged and thinking about ways to get back to her – so that she can know what it feels like to be so mistreated.”


“I would bet that when you’re feeling you’ve been wronged, you can get pretty ugly if you have to!”


“When your mother is doing her ‘usual,’ it just hurts so much that you think about what you could do to hurt her back.  She should have to take some of her own medicine.”


“When your brother lets you down as he has just done, it makes you feel so awful that you hardly know what to do with your frustration and your outrage.  You know that you might well later regret it; but, in the moment, all you can think about is how you can get back at him.”




If the patient is ever to relinquish her compulsive re-enactments, her relentless pursuits, her infantile need to possess and control, and her self-indulgent / self-destructive behaviors, the reality of the object as separate from the self and as having its own center of initiative must ultimately be confronted and grieved.


But if the patient is unable to make her peace with the reality that her objects are separate and therefore immutable, then she will be consigning herself to a lifetime of chronic frustration, unrelenting heartbreak, impotent rage, profound despair, and tormenting feelings of helplessness and powerlessness every time she is confronted with the inescapable reality that her objects cannot be possessed, controlled, or made over into who she would have wanted them to be.