A long-term case study with sadistically-tinged countertransference elements


This case report sketches the psychoanalytically-informed supportive psychotherapeutic treatment of a single man through his life challenges over a twenty-year period. The decades-long challenges arise from obsessive compulsive disorder, pathologic self-effacement with insatiable and unusual erotic components, and severe visual impairment leading to blindness. Sadistically-tinged impulses arising in the countertransference are described.

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  1. Camus, A. (1942). The myth of Sisyphus and other essays. (J. O’Brien, Trans.). New York: Random House.

  2. Horney, K. (1950). Neurosis and human growth. New York: W.W. Norton.

    Google Scholar 

  3. Ingram, D. H. (2001). The Hofgeismar lectures: A contemporary overview of Horneyan psychoanalysis. American Journal of Psychoanalysis, 61, 113–141.

    Article  PubMed  Google Scholar 

  4. Ingram, D. H. (2011). When long-term therapy is not long enough. Journal of the American Academy of Psychoanalysis, 39, 181–188.

    Article  Google Scholar 

  5. Ivimey, M. (1946). Basic anxiety. American Journal of Psychoanalysis, 6, 3–11.

    Article  PubMed  Google Scholar 

  6. Kelman, H. (1949). Medical problems in psychoanalysis: II. The psychoanalyst’s viewpoint. American Journal of Psychoanalysis, 9, 56–66.

    Article  Google Scholar 

  7. Phillips, J. (2008). Book Review. Good goodbyes: Knowing how to end in psychotherapy and psychoanalysis. By Jack Novick and Kerry Kelly Novick. Journal of the American Psychoanalytic Association, 56, 330–336.

    Article  Google Scholar 

Download references

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Correspondence to Douglas H. Ingram.

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Douglas H. Ingram, M.D. is Faculty, Supervising and Training Analyst at the American Institute for Psychoanalysis; Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College.

Address Correspondence to: Douglas H. Ingram, M.D. 4 East 89th Street, #1C, New York, NY 10128, USA. Email: DHIngramMD@aol.com.

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Ingram, D.H. A long-term case study with sadistically-tinged countertransference elements. Am J Psychoanal 79, 94–102 (2019). https://doi.org/10.1057/s11231-019-09175-5

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  • countertransference
  • long-term treatment
  • blindness
  • obsessive compulsive disorder