Payment as perverse defense.

A case is discussed in which the patient's management of aspects of the payment process is seen as a focal point in a perverse defensive structure operating in the treatment. Detailed process material is examined with attention to transference and countertransference components of this defensive process. Recent literature on perverse thought and defense is reviewed in order to understand this case in the context of current thinking, to generate new ideas about the nature of perverse defenses, and to consider the potentially special role that money may play in the operation of such defenses in psychoanalysis.