'But enough of this kind of horror!’: psychoanalytic psychotherapy and perverse sexual fantasy

The clinical treatment of sexual perversion remains poorly defined. This is partly due to the treatment of perversion as a unified phenomenon that includes various modes of behavior, fantasy, arousal, relationships and unconscious determinants. There is, nevertheless, a lack of sustained attention paid to specific aspects of perversion. This thesis sought to remedy this gap by approaching a particular aspect of perversion: perverse sexual fantasy. This thesis aimed to offer a critical reconceptualization of perverse sexual fantasy, a concept largely neglected in psychoanalysis, psychiatry and psychotherapy. Defined here as conscious sexual fantasy with perverse content, perverse fantasy has often been pathologized, dismissed, or conflated with behavior, rather than explored as a meaningful psychic formation. Through a narrative literature review, the thesis traces the discursive history of perverse sexual fantasy, interrogating how it has been marginalized across various intellectual traditions and proposing a more nuanced, clinically relevant framework for understanding and working with perverse fantasy in psychotherapy. A framework is proposed for working analytically with perverse fantasy, one that avoids moralization or pathologization, and instead allows for perverse fantasy to remain connected to the work of meaning. In doing so, the thesis repositions perverse fantasy as a legitimate object of psychotherapeutic inquiry and extends the field’s capacity to think with rather than against the fantasy life of the perverse subject.