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Incest in the Family:
A Case of Mother-Son Incest: Its Consequences for Development and Treatment
By Dr. Donald Mars

Abstract:
There has been an increase in the number of officially reported cases of incest along with an increase in the number of incest related publications. Yet there is little documentation of mother-son incest, and the psychoanalytic literature on this subject remains equally sparse. By contrast, a popular myth persists that mother-son, or older woman-boy relationships can be beneficial. This paper is the first of several that will attempt both to fill the gap in the literature, and to refute the popular mythology, by focusing on one male patient and the developmental consequences of his incestuous relationship with his mother. Also discussed is the impact of the incest on his later treatment, which was characterized by unusually intense resistances and transference counter-transference reactions



Article:
There has recently been a surge of popular and clinical interest in the sexual abuse of children by parents and other relatives, resulting in a large increase in the number of publications and documented cases. Yet, in spite of this, there are very few cases of mother-son incest reported. Krug, surveying the field in 1989, noted that "the literature documenting sexual abuse of male children by mothers is virtually nonexistent" (p. 111). The psychoanalytic literature remains equally vacant, with the notable exceptions of Shengold (1980) and M. Margolis (1977, 1984).

In contrast to the sparseness of the clinical literature on oedipal mother-son consummations, the related older-woman oedipal fantasy flourishes widely in all the popular media. The romantic belief lingers that boys cannot be seriously damaged by sexual contact with an older adult woman or that mothers cannot sexually exploit and damage their sons. A romantic fantasy exists that stipulates adolescents or preadolescent males can gain sexual experience and knowledge from a sexually experienced female adult. These sexual experiences are presumed to foster the development of a more satisfying and sensitive male lover and are presumed to strengthen masculinity. The older adult woman in essence becomes a mentor, bringing the young male into his manhood.

The motion picture industry has released several major films that portray this romanticized belief. Films such as The Last Picture Show, The First Time, The Chapman Report, Private Lessons, Weird Science, The Tin Man and The Summer of '42 all feature the sexual involvement of adolescent or preadolescent boys with adult women. Other films depict incest between adolescent or preadolescent boys and mothers, stepmothers and grandmothers. These films include Murmur of the Heart, Midnight Cowboy, Mishima: A Life in Four Chapters, and The Little Big Man. It is important to note that not one of these films relates the subsequent adult dysfunction of these sexually abused males as having any relationship to their sexual and/or incestuous childhood.

This paper is the first in a series of studies that will provide evidence that in the real world, mother-son incestuous relationships can have serious consequences. I will focus first on the developmental consequences of a case of mother-son incest and will also discuss the effects of the incest on the patient's treatment, which was characterized by intense resistances and transference counter-transference reactions. Future papers will discuss other effects of the incest, including the patient's ambivalent homosexuality, his pathological grandiosity, the involvement of Christianity in the unconscious incestuous triad, splitting, and the other multiple vicissitudes of his anger.

To what extent do our views still reflect McCarthy's (1986) explanation of the sparsity of adult females found in child sexual abuse cases, "women being viewed as sexually harmless to children. What harm can be done without a penis?" (p. 447).

Banning wrote (1989), "Mothers are perceived as nurturing and asexual to their children. There is widespread societal belief that women cannot be sexually abusive to their children and at worst their behavior is labeled as seductive and not harmful" (p. 567). In the same article, Banning also noted: "Until very recently mother-son incest was considered to be virtually nonexistent" (p. 564).

Margolis reviewed the cases of published mother-son incest and found a total of sixteen published cases. After a detailed review of all sixteen cases Margolis (1986) concludes "With regard to the variability of responses to incest, it appears that having sex with one's mother does not trigger some kind of automatic process of regression or decomposition" (p. 112). Shengold (1980) reported on a case of mother-son incest and among his conclusions wrote, "The incest at puberty seems to have helped him (the patient) reverse a psychic position of subjection to the preoedipal mother, to have modified his rage and reinforced his masculinity" (p. 475). Other studies by Yorukoglu and Kemph (1966) and Barry and Johnson (1958) had previously minimized the impact of mother-son incest.

These conclusions run counter to what we would expect. Parsons (1954) followed by Schwartzman (1974) and Frances and Frances (1976) all concluded that mother-son incest was extremely damaging to the child. In 1989 Shengold coined the phrase Soul Murder, and used that phrase as the name of his book. Shengold (1989) defined soul murder as "the deliberate attempt to eradicate or compromise the separate identity of another person" (p. 2). Shengold proposed that this condition is often the result of incest.

Nonpsychoanalytic writers also recognized the destructive effects of incest. Masters and Johnson (1976) wrote, "A mother destroys her son socially when she brings him to her bed, for inevitably she is overprotective and overdemanding. While isolating him as much as possible from peer group influences, she renders him insecure and extremely self conscious; usually he, becomes a loner. The harder he tries to withdraw from her influences the tighter she holds the reins" (p. 58).

Blair and Rita Justice (1979) wrote "Mother-son incest is less common, and it is fortunate that such is the case for the consequences to the participants may be devastating" (p. 193). These authors state that in their survey of 112 families, only two cases of mother-son incest were found. However, the Justices' (1979) report that "mothers engage more frequently in sexual activity that does not get reported; fondling, sleeping with a son, caressing in a sexual way, exposing her body to him and keeping him tied to her emotionally with implied promises of sexual payoff " (p. 61).

Davis and Frawley (1994) note that there are two lines of thought that currently predominate the theoretical formulations and treatment for incest survivors. These authors describe the struggle as, "One line argues that it is the reality of the traumatic event, accompanied by the actual overwhelming of ego functions and symbolic capacities, that is ultimately more disruptive to adaptive functioning. . ." (p. 2). Davis and Frawley's (1994) second formulation states that "it is more important to understand the way in which traumatic events become incorporated within unconscious fantasy", particularly sadomasochistic fantasy" (p. 2). These authors believe both positions are essential and need to be integrated.

Kramer (1985) offered the broad definition of incest as "deliberate and repetitive overstimulation ... of genitals, anus, or breast ... or as mutual sex play which the mother instigates" (p. 328).

Early in my career an unmarried Jewish male, age 24 or 25, was referred to me for treatment. This patient had been involved in an incestuous relationship with his mother throughout his developing years, beginning as far back as he could remember and ending at the age of 22. This analysand was seen three times per week sitting up for more than seven years. Subsequently, after an interval of approximately 3 years, he returned at age 34 or 35 for additional treatment. He was then seen once per week sitting up for almost four years in psychoanalytic psychotherapy. This included a brief period of 4 months when he was seen twice a week sitting up.

The patient was initially referred to me for treatment after his second psychiatric hospitalization. At that point he lived alone in a furnished room on disability benefits. He was Jewish, single, short and chubby, and had the appearance of a much younger man. He looked unkempt and disheveled and his clothes appeared much too small for his body. He was in fact dressed in clothing purchased for him by his mother years before when he was younger and still living at home. He was an only child. In contrast to his appearance S spoke eloquently, with confidence, and possessed considerable charisma. S was a professional musician who had graduated from a prominent music conservatory. He had a reputation for enormous talent.

S had been hospitalized twice prior to his beginning analysis. The first hospitalization occurred shortly after S returned home after graduating college. The precipitating experience was S's first attempt at a homosexual encounter with an adult. He was hospitalized for six weeks. The medical staff attempted to stabilize S with a range of psychotropic medication. He was also involved in a day program and some group activity.

His second hospitalization occurred a few months prior to our first meeting and was precipitated when he attempted to work in the musical field that would give him and his mother the most satisfaction. This stay in the same hospital was considerably shorter, only lasting a brief time, perhaps a week. Again the hospital focused considerable attention on stabilizing him and symptom reduction utilizing medication and structured group activities.

S presented himself at both hospitalizations in a similar manner. His agitated and manic presentation was complemented with his feeling disorganized, unable to sleep, an inability to concentrate, and a sense of being out of control.

The actual incest with my patient consisted of the caressing of S's genitals, manual masturbation, and some limited fellatio, initiated and performed by his mother. In addition, mother would insist on lying down and cuddling with him at (his) bedtime, wiping and cleaning his anus after he would defecate, and waking him in the morning with body massages.

When S began treatment both of his parents were alive. His father was a watch repairer who worked regularly and was the primary economic provider for the family. Father was an Austrian Jew who joined the resistance during the Second World War. While he was engaged in battle, his family of origin was taken into custody, transported to a concentration camp, and exterminated. He was wounded in combat but managed to escape to England where he recuperated. While in England father met his future wife, my patient's mother. This is the first and sole marriage. Father would not discuss his prewar life or any of his war experiences with his son. Father views his son as a "little boy," and a competitor for his wife's attention. Father rationalizes his son's relationship with his wife, by explaining that S, "Does not understand a mother's love for her son." He was unavailable to S for phallic identification. Father relates to the maternal grandparents as if he were their youngest child.

Mother is a German born Jewish woman whose parents foresaw the outbreak of the war and managed to smuggle her to England just in time. Mother spent the war years with strangers, without any contact or knowledge about her parents until after the war when they were reunited. The trauma of the war and the separation from her family during the war years, I believe, exacerbated a preexisting condition. Mother was primarily a homemaker, although she did work intermittently as a part time bookkeeper while S was growing up.

Mother viewed S as a part of herself. S was that part of her that would make her life worthwhile and give her a sense of pride, glory, and power. S was literally a narcissistic extension of his mother.

The maternal grandparents lived in the same neighborhood as S. Grandfather was the only male figure who was available and able to relate to his grandson as a male. S had memories of them talking about sports, girls, and watching baseball games together. Unfortunately grandfather died in S's early teens. The maternal grandmother always stood up for S against his mother. Grandmother was seen as fostering separation by always telling her daughter "to get off S's back." She defended S and was supportive of him having his own life.

In the initial consultation with me, S stated that while he liked his current therapist, he was intent on finding a new one. He explained that the therapist would tell him that he (the therapist) was available and could be reached anytime. While appreciative of the offer, S explained that he had not asked and this unsolicited offer made S feel helpless, the way he felt at home with his mother. His associations to the helpless feelings he experienced while at home brought us directly to the maternal incest. The incest was fully conscious. The incestuous activity was not repressed, nor was there any dissociation.

S did not like the helpless feeling that he felt undermined him. When he was away at college, for example, he felt different in that he felt more accomplished. He had always been involved in counseling, and the college counselors helped him enormously. With their help he felt accomplished and graduated with honors. When he went home for holidays and vacations, the maternal incest would resume and he would regress. He found that he could not sustain his level of independent functioning and/or activities when he was at home. He did not like the helpless way he felt. The therapist's "offer" undermined his fragile autonomy. He experienced the old helpless feelings again. He knew this was not healthy for him. His wanting a new therapist was a statement about his seeking a new and different kind of mother.

Since I knew the therapist to whom he was referring, I suspected the therapist was involved in some powerful counter-transference reaction. I knew this was not his (the therapist's) usual style of work. I subsequently learned and experienced the patient's extraordinary ability to get special treatment and to manipulate people into infantilizing him.

I was encouraged by the consultation. S was uncomfortable with the infantilization, although it was not as ego dystonic as it appeared. He sought to be separate, to be a man, and to have his own life. In addition, S's ego could clearly shift from the experience to a more observant position and then join with me to examine a part of himself. These were necessary and essential conditions in my acceptance of him for treatment.

As previously noted, the sexual relationship between mother and son was fully conscious. It was not repressed, split off, or dissociated. In fact it was an association to the helplessness, which he experienced when his previous therapist would infantilize him, that led us directly to the maternal incest and to S's baths.

Bathing for S had multiple purposes. It was often used as a reward. Mother might want to reward S for something he did for her or she might use the bath to encourage him to do something that would please her. All other activities would cease. S would go into his room and prepare for a bath. Father would leave the house and visit the maternal grandparents, returning home later.

When the bath was ready, S would get into the tub while mother sat outside the tub. Mother would then wash him, and when she reached his genitals, she would begin to stroke his penis. As she continued to masturbate him, she would verbalize a fantasy that she would call an escapade. She named S's penis Harold and her husband's penis Bert. She would create a fantasy about Harold and Bert going "out on the town." Both Harold and Bert would be dressed in formal wear, a tuxedo or tails, and would be dining in one of the city's finest restaurants. They would be going to the opera, etc. Harold, my patient's penis, was always the preferred one; more successful, more powerful, and grander than her husband's penis, Bert. Just before ejaculation, S would lose his erection and would say he felt as if his penis became disconnected from him. S would depersonalize. S would describe himself as if he were looking down at himself from the bathroom ceiling. The disconnection from his penis represented a break or rupture in his body ego, a literal sacrifice of his penis to his mother. Mother had created a "living" part object under her control.

When he came out of the bath, she would dry him. Sometimes when she reached his penis, she would initiate some sex play. Sometimes she would bend down and kiss his genitals. This could lead to fellatio that would end quickly. S would always lose his erection.

Mother would not tolerate independent thinking or actions. S recalled that his mother became hysterical the only time their views were divergent. He recalls her running through their apartment and out into the hallway of the apartment building screaming, "Help, help my son is killing me!" S believed that mother could not survive without him. If S did not comply with her wishes, mother would die; without her, his own survival felt impossible.

Mother would also not tolerate his cleaning himself after he defecated. Mother inspected S's underwear, claiming she found "brown spots" when he cleaned himself. Mother would insist on entering the bathroom and wiping and cleaning his anus, whenever they were together and S defecated.

At bedtime, mother would lie down with him in his bed until he fell asleep. S reported they would lie in his bed like "spoons" until he fell asleep. He often found it difficult to fall asleep because he was so sexually aroused. In the morning she would wake him by massaging his body. S recalled waking in the morning with an erection and with his mother's hands caressing his body.

S could not date the onset of any of the incestuous or intrusive maternal behavior. Mother's sexualization of his bath, her insistence on inspecting his dirty laundry and then wiping his anus after defecation, cuddling him at bedtime and entering his room to wake him with body massages simply went back as far as lie could remember. They were a normal part of everyday life while living at home. These activities were temporarily suspended when S lived outside his parent's home while he was attending college. However, whenever S returned home, for any occasion and for any period of time, they resumed. After S graduated from college and returned home everything restarted as usual. Termination occurred when S moved out of their apartment and into his own. S was approximately 22 years old at the time.

S's first dream in treatment clearly expressed his unconscious struggle to gain his masculinity, restore his body to a whole, and become a separate individual. S reported the following: "I was lying down in a pasture, looking up at the sky. There were some large puffy clouds floating by. Suddenly, there was a parting of the clouds and behind the clouds there was a gigantic phallus in the sky."

S said that the giant phallus in the sky was God's phallus. God, for S, needed to be a man. S wanted to connect with God's phallus, to be one with it, and in so doing he would never have that disconnected penisless feeling or that helpless feeling again. S continued and said that if he was baptized then he would have an unkosher penis that his mother would not touch.

The first dream dramatically expresses S's struggle to gain his masculinity. There is no doubt he wishes to be both whole and a man. He seeks and hungers for a God-like masculine power with whom he can identify. S feels an omnipotent male power is necessary to break the incestuous maternal hold, and help him become a man. Yet, as I will discuss, he is unable to identify with his wished for powerful male.

In the beginning phase of treatment S would arrive early for his session and would find the consultation room door closed. He reported that he would pace the waiting room frantically. He was keenly aware of the closed consultation room door and he felt we were apart, separated, and this made him feel very anxious. S reported walking to the bathroom and looking at the bathtub and saying to himself, "No, Donald would not do that to me."

This is S's wish and defense. S is barely able to maintain himself as a separate entity. His looking into the bathroom and at the tub was his wish to unite with me as he did with his mother. If we were connected then he would feel whole, not fragmented and/or anxious. His acknowledgment that I would not do that to him was his recognition that I would not take his penis, his manhood, and leave him as a fragment of a helpless human being. It was the first transference to me, the wished for good mother.

While I was the wished for good mother, S tried to give to me what his own mother wanted of him. He would, for example, come to a session after a successful performance and attribute to me all of his success as a professional musician. For example, he would say, "The performance went very well. The conductor acknowledged my position of leadership in the section and complimented me on my work. You (meaning, the analyst) deserve all the credit for my performance last night."

We struggled with this kind of material for years. He consistently tried to give me what he thought I needed and wanted. This was his attempt to preserve me and continue the underlying symbiotic bond. This constant attempt to give me what was his, would, simultaneously, undermine and infantilize him. It helped me understand the counter-transference trap in which the previous therapist found himself I attempted to have S maintain the satisfaction and gratification he earned from his independent activity and at the same time attempted to question his apparent desire to credit me for his accomplishments.

While S seemed pleased at my not accepting what was not mine and what he clearly earned for himself, he never really seemed to internalize it. I later suspected that he was condescending, passively giving in to me and thus giving me what I wanted. My inability to pursue this important thread was the interaction of my inexperience with my counter-transference reaction.

The wished for good mother was not the same transference as the symbiotic mother transference. The symbiotic mother featured S having to give her everything, to remain connected to her. The wished for good mother would not exploit him in this way.

The struggle over separation-individuation was extremely intense. S could not please himself and mother at the same time. The only way S could maintain his very tenuous ego boundary was to not please himself. S knew if he did not please himself he also did not please mother. This compromise formation would allow him to work using his musical skills, but not in the kind of work that really pleased him or his mother. Thus he was not a "Broadway or opera star" but he was all extremely successful recreation counselor/ music therapist. He could be the star recreation-activity worker using his charismatic personality and musical skills to work effectively with an aged population. This was not the most satisfying work for him, but that also served him because this work did not gratify his mother either. S wanted to be a working performer, but this was not possible because that is also what his mother wanted.

Although he wanted to be a performer, i.e., "star," and a separate person, neither wish could be sustained. S had a fantasy that clearly exemplified this struggle. S reported, "I could see myself on stage in a leading musical role. While performing, I look out into the audience and see my mother sitting in the front row looking and smiling at me. I feel an overwhelming surge of anxiety, along with a growing inability to continue."

S is trapped. He feels the developmental thrust to move forward, but separation means his own and his mother's destruction. S is a victim of what Shengold termed Soul Murder. Freud (1920), writing about trauma, formulated that it was the intensity of the stimulus as well as psychic unpreparedness caused by surprise that led to overstimulation, paralysis of ego functions, and psychic helplessness. Psychic separation from mother causes overwhelming anxiety for S. This is a major threat, one that Anna Freud (1936) termed ego disintegration, Fenichel (1937) formulated as the collapse of the ego, and Kohut (1977) designated as annihilation anxiety.

At one point in treatment S decided to pursue his music on a full time basis. He reported the following dream that both embodies his desire to be separate and annihilation anxiety. "I was a fat cat sitting on the window sill looking out the window. I think the windowsill was in my mother's bedroom. I see the world outside, it is rich and inviting with a lot of activity. I somehow manage to push open the window. The world is there. I know I can be part of it. I want to be part of it. I jump out and then suddenly everything goes black and I wake up in a panic, feeling terribly anxious."

S's associations to the dream reflect his struggle in resuming his normal developmental growth. S sees himself as the fat cat. Implicit in this wonderful imagery is the range of gratifications he receives from the maternal incest; including the sexual gratification, the gratification in being the oedipal winner, the gratification from the symbiosis, and the gratification that he is saving and preserving his mother's life.

S strove to separate, to break the incestuous maternal bond that held him. The struggle was evident. He could remain in his mother's bedroom at the price of sacrificing his manhood and life, or leave her and risk separation. The jump out of the window was the symbolic move away from mother. The separation culminated in the blackness that was the annihilation or fragmentation of his ego.

Hurvich (1991) wrote: During the early phases of ego development some frightening and overwhelming situations will be traumatic. It is here assumed that these experiences will increase the likelihood of later vulnerability to annihilation anxiety, with major individual differences. This does not rule out the possibility that such anxieties can arise from later periods. The kinds of noxious over-stimulation at the beginning of and during the phallic phase described by Shengold (1967, 1971) such as severe and repeated beatings, sexual seduction and primal scene stimulation, over intrusion in the form of body violations, force feeding enemas, and interference with the child's self initiated activity - all tend to be associated with the massive defensive efforts that often cover annihilation fears. Generally speaking, too much sexual, aggressive or even sensory stimulation during tile early years can lead to the kinds of developmental arrests and ego weaknesses that increase the likelihood of annihilation anxieties [p. 148].

S maintained a delicate balance between separation annihilation and being a part object for his mother. Unfortunately, S did not and cannot identify with a protective, loving phallic father figure who would have strengthened his capacity to break the mother's regressive hold. Instead, his father remained passive, distant, and threatening. S interpreted his father's passivity as "mother must always be pleased."

S has never and cannot successfully negotiate the separation individuation phase and is unable to maintain a phallic identification; he has a strong passive, feminine identification. S's masochistic pleasure continues to involve being a part object for his mother and is an indication of a remaining disturbance in the phallic oedipal phase. Although the incest has ended, it continues to live in his unconscious. The ongoing gratification he continues to experience unconsciously from the incest is the fuel that feeds these current and singularly recalcitrant resistances. They have become the anchor against which the developmental thrusts tug.

The maternal transference was stable but it did shift with regularity from the wished for good mother to the symbiotic mother. What was relentless and consistent were my counter-transference feelings. I was constantly being drawn to both infantilize and to treat S in some manner that would make him feel special. These powerful counter-transferences occurred throughout the analysis. I had no doubt that these extraordinary strong counter-transference forces were also experienced by the previous therapist and were probably the reason for his atypical interventions. In addition I was elevated to the level of a God. As the symbiotic mother I was praised and flattered at every opportunity. I was told, for example, that nobody had ever understood him and worked as successfully with him as I had. S felt he could not find the words to express the essence of the sessions. As mentioned earlier, S tried to credit all of his success as a musician to me.

I soon learned that I was not the only person who was experiencing strong counter-transference feelings. Some doctors would dramatically reduce or waive their fees for S. Hospital personnel would treat S as if he were a major celebrity when he was not. Clinics would offer S special services. People who barely knew S would do extraordinary things for him. Restaurants would cater to his desires. It was an extraordinary example of S's ability to infantilize himself and manipulate people to gain special favors and treatment.

During one session, the transference shifted from an object transference to that of a self or narcissistic transference. Unexpectedly, I represented S, while the patient represented his mother. I was initially unaware of this shift in the transference. At the end of the hour I simply stated we had to stop for today. S looked at me, paused, and then continued. S said that he was not finished with what he was saying and was going to continue. I must have looked surprised, as indeed I was, by his response. Observing my expression, S said that I looked like a frightened, out of control little boy. Therefore he would be the adult in the room and would take charge. He continued speaking.

It took me several minutes to work through my surprise, my feeling of helplessness and anger, and also to sift through the material to develop an understanding and formulate a response. I responded by telling S that in making me the child while he became the adult, he was doing to me what his mother did to him. I could understand his confusion about not knowing when to stop as his mother did not know when to stop. I added that I could also understand his not knowing what was his to take and what was not, because his mother did not understand that either. Now I could better appreciate what he felt like when she, did this to him. I did not like it any more than he did.

The incident took about ten minutes before he left. I knew that what had occurred was significant and needed to be addressed as such in the next session. This was the first time the repetition compulsion was expressed in a reenactment of the intrusive mother who would do and take what she wanted. My experience with the projective identification was intense. I had experienced both helplessness and intense anger. I knew I needed to respond to protect S and to stop her. Nobody had ever intervened to protect S from his mother.

In the next session I told S that I was not angry with him today, but there was a real difference between asking and taking without permission. I told S that in the previous session he had taken from me that which he had no right to take. I continued and informed S that I intended to take back what he had taken. I planned to use a treatment parameter that I recognized would have to be addressed and analyzed in the future. I ended the session ten minutes early.

The shift in the transference was immediate and dramatic. No longer was I the helpless little boy without a penis, nor did either maternal transference return. For the first time I became the wished for father. S began speaking about how he wished his father had stayed in the house when his mother wanted to bathe him. He spoke about how he wanted his father to teach him to use his tools, so that S could also repair and build items around the house. He spoke about how he wanted his father to have played baseball with him and to watch sporting events with him in the way S did with his grandfather. For the first time S produced material about his desire to be close to his father and how much he missed his father.

Margolis (1984) reported on a case of mother-son incest and noted that his patient, whose father had died, missed his father, felt sad on Father's Day, and missed his father's counsel. The similarity of the yearning of both male patients speaks directly to the heart of the issue: the unavailability of a loving phallic father and the inability of these sons to identify with one. Both are necessary for continued ego development. What was interfering with this normal process of identification?

S has never relinquished the actual possession of his mother. The reality is that mother preferred and valued S and his penis over that of his father. S has been victorious over his father in the oedipal competition for mother. He can only identify with the passive father, but not with the loving phallic (mature and competent) father. S fears his father's retaliation (i.e., castration) if he is perceived by his father as anything but inadequate or as a little boy.

Margolis (1977, 1984) reported that his patient felt like "King of the World" after intercourse with his mother. Margolis's patient, John, began sleeping with his mother after his alcoholic father and mother were separated and before their divorce. As with my patient, John's mother was seductive. She would dress and undress in front of John and wear sheer "shortie" nightgowns while caressing him. At one point Margolis (1984) reports, that after entering John's room she said, "I bet you want to have intercourse with me. As long as you're going to have it anyway, you might as well go ahead and get it over with" (p. 360). In addition, John noted that his mother was always lubricated and ready for coitus.

Shengold (1980) also reported the seductive behavior of his patient's mother. The patient's mother wiped his anus until he went to school. Mother also arranged to have her son taken care of by a male baby-sitter with known homosexual interests, who forced him to engage in anal intercourse. Mother would walk in on her son while he was in the bathroom and enter his bedroom in the morning when he would wake up with an erection and uncovered. Mother would expose herself to her son after she was bathing. Shengold (1980) reports:

One day, on coming home from school, he found himself as usual alone with his mother. She had just emerged from a bath, and had left the bathroom door open. As he approached she bent over as if to wipe her feet with a towel. She gave him a look of invitation and again bent over, presenting another open door. He was overwhelmed with excitement and, penis erect advanced toward her "as if in a trance." He penetrated her vagina. She had an orgasm. He was not yet capable of ejaculation, but there was a kind of orgasm. It was felt as a wonderful experience [p. 467].
All three male patients felt the extraordinary gratification from the sexual contact with their mothers. All three sons were invited by their mothers and were gratifying their mothers' unconscious needs. All three sons were overstimulated and were passively submitting to their mothers. These three sons all experienced the sexual contact with their mothers as exceptionally powerful; they were chosen over their fathers and were all oedipal winners. Margolis (1984) reported that his patient said with an embarrassed smile, "that sex with his mother had been more exciting than had been the case with any other woman" (p. 368).

S's inability to identify with a loving phallic father was reenacted with me in the transference. Thus, he would retreat from feeling like a man. S has never had any sexual contact with any female other than his mother. However, when he began talking about his interest in women, he became visibly very anxious in the session. He made it clear that he felt there was only room for one man in the family and only room for one man in the session consultation room, and that man would not be S. I became his father in the transference and the patient retreated from me by abruptly terminating.

Father was aware of the interaction between his wife and son. Father defended against the enormous loss of self-esteem and the devaluation of his masculinity by viewing his son as a "little boy" or an inadequate male. Father defended against the. reality of being the oedipal loser by infantilizing his son. Father rationalized the incestuous relationship between his wife and son when he said that S did not understand a mother's love for her son.

S could not engage me directly in any aspect of the phallic-oedipal struggle. His castration anxiety would become overwhelming and the threat made it impossible for him to continue. S could not directly confront his passive yearnings. These yearnings were indirectly accessible during the analysis of S's homosexuality.

S left treatment on several occasions. Each of these terminations occurred when S began to developmentally progress into the phallic phase. It was only at these times that his interest in women clearly changed and became sexual. His presentation and demeanor appeared more manly and less boyish. Unfortunately, the anxiety created by this normal healthy move into the phallic-oedipal phase was overwhelming and could not be contained. At this point S would abruptly terminate. This cycle was repeated on two separate occasions. The first time S developmentally moved into a more phallicoedipal configuration he started to flirt with prostitutes. S became very anxious and fearful of me. The more interested and flirtatious he became with the prostitutes, the more impossible it was for him to be in the same room with me. S terminated under the guise of protecting his budding masculinity. After approximately 3 years S returned but could only afford weekly psychotherapy. During the three years S had significantly regressed and was again safe being the little boy. He had lost his job and was again dirty and barely able to maintain himself. After four years of psychotherapy we were again moving into the phallic oedipal phase. He was socializing with more appropriate women. He longed to go out on a date and did on one occasion. S brought his date back to his apartment and engaged in some "petting." S experienced overwhelming castration anxiety. Again S could not tolerate being in the same room with me. I again became the dangerous castrating father in the transference. The threat was so significant, the castration anxiety flooded the working alliance and S again abruptly terminated. Although S has telephoned me whenever there has been a serious crisis, and there have been several, he has never returned. We would spend a few minutes on the phone and I would get a sense that he was touching base or refueling if you will. I did learn that he had make several attempts at psychotherapy. In fact when we last spoke he was in psychotherapy. And yet, it was me he telephoned when he had a life threatening medical crisis. It was my referral he sought and accepted to see a psychiatrist because his medication was causing him significant difficulty. It has been over eight years since his last termination.

Margolis (1984) also reported premature terminations with his patient.

It was clear to me, however, that he was terminating treatment because of his anxiety in regard to dealing more directly with phallic oedipal conflicts. Castration anxiety of enormous proportions had long been in evidence. He still would not deal openly with his feminine passive yearnings in the transference, nor could he work through his competitive, murderous impulses towards me, against which his passivity had been erected as a massive defense [p. 365].

When S began working with me he was barely maintaining himself outside a hospital. S did not have any friends. He would lie in bed and compulsively masturbate most of the day. His personal hygiene was minimal. S's clothing was disheveled and dirty. He ate poorly and erratically. His only outside activity was going to a choir twice a week and coming to his sessions. S was utilizing several psychotropic medications in an attempt to reduce his anxiety and "control" his behavior. Although S wanted to be heterosexual, his unconscious object choice was male, which greatly displeased him. S desperately wanted to have a wife, family, and particularly be a father.

During treatment S utilized his music and became economically self sufficient. S discontinued his disability benefits. All psychotropic medication was terminated and he remained free of medication for more than five years. S secured his own apartment and furnished it, purchased new clothing, and began socializing and making friends. His personal hygiene improved greatly, although he could not bathe in his own home. S's eating improved in that he ate regularly but not properly and could not cook for himself. S's unconscious object choice shifted to female.


Conclusion
Freud (1905) wrote, "In view of the importance of a child's relations to his parents in determining his later choice of sexual object, it can easily be understood that any disturbance of those relations will produce the gravest effects upon his adult sexual life" (p. 268).

I believe it was the actual sexual relationship, the maternal incest, that has made S's resistances so intransigent. The overstimulation of the ego caused profound structural and developmental damage. The sexual gratification received during the incest became the fuel that continues to feed the resistances and fosters their intransigence. While there has been considerable progress toward resolving the symbiosis, breaking the maternal hold, and allowing for movement toward phallic identification, this step has been met with anxiety and regression. The sexual and emotional gratification derived front the incest is so deeply satisfying that the renunciation of his mother as primary gratifying object is weakened but not relinquished. It is yet to be determined if it will ever be.


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