The man with the bus symptom

This paper attempts to illustrate the clinical and technical vicissitudes of the psychoanalytic treatment of an adult male patient whose psychopathology alternated between a relatively stable phobic-obsessional structure and a perverse structure. The latter appeared in his life paroxysmally and took the form of riding the buses, when he would engage in various furtive sexual practices with small and adolescent girls. Both psychopathological structures were, of course, manifested in the relationship with the analyst. The description of their interplay in the transference-countertransference and of their relationship with the patient's life history makes up the first part of the paper. The gradual establishment of the perverse acting out in the therapeutic link led to a distortion of the setting which threatened the continuity of the analytic process, giving rise to a pragmatic paradox. This establishment of acting out in violation of the setting, coupled with recourse to the technique of reformulation of the setting, constitutes the main focus of this paper. The significant changes which ensued in the analytic process after this reformulation are then examined.