A research illustration from the single case archive: thematic analysis of transference patterns in perverse patients using Lacan's L-schema

The Single Case Archive is especially helpful for comparing and synthesizing multiple case studies, as it permits selection of relatively homogeneous sets of cases. We will present methodological considerations and results from a meta-synthesis of case studies on the psychoanalytic treatment of perversion. Transference in perversion, we found, is characterized by specific problems such as a defiant and polemical attitude, erotic transference, projections, and aggression. It has been noted that this transference poses particular problems in psychoanalytic treatment and engenders the risk of countertransference acting out. We propose that Lacan’s L-schema can contribute to this discussion as it distinguishes between an Imaginary and a Symbolic dimension in transference. Eleven case studies on sexual perversion were selected from two databases (www.singlecasearchive.com and Web of Science) and thematically analyzed using the L-schema. The results indicate that identification, fusion, and rivalry in transference are situated on the Imaginary axis. These aspects are related to repetition and resistance, and focusing on them is counterproductive. Rather, the analyst should focus on the Symbolic axis, by paying attention to the content of the transference and by stimulating the patient to put his emotions and phantasies into words. Examples will be provided. The thematic analysis reveals the importance of the position of the analyst in this work, which is described within the L-schema as being the representative of the otherness in the Other. We conclude that conditions for change can be established by occupying this position, rather than through insight and transference focused interpretation