The conceptualisation and treatment of moral masochism in substance abuse sufferers : the lens of psychodynamic therapists

Abstract

The current study aimed at investigating the manner in which psychodynamic therapists conceptualise and treat moral masochism in patients suffering from substance abuse. Therapists’ perceptions of the possible role moral masochism plays in the cause and perpetuation of substance abuse and its implications for treatment was explored. Psychodynamic therapists’ diverse ways of conceptualising moral masochism were compared and contrasted and the manner in which they deal with the particular transferential challenges faced when treating such clients was investigated. A qualitative methodology was adopted, in which five in-depth, semi-structured interviews with psychodynamic psychotherapists, who are familiar with or have some experience working with substance abuse, were conducted. Data was analysed by means of Reflexive Thematic Analysis (RTA), in accordance with the guidelines provided by Braun and Clarke (2006, 2016, 2021). The study yielded several key findings, including the existence of common factors linking moral masochism and substance abuse related behaviours. Possible motives underlying the behaviours of these clients were also elicited as themes from the data. Issues of transference and counter-transference were also highlighted. Implications for treatment of this client group included helping clients to develop ego strength and an internal locus of control; addressing guilt and helping clients relationally reconnect to themselves and others through the encouragement of growth. The importance of reflexive practice in order to help navigate specific issues of transference and countertransference was emphasised.