ABSTRACT
Objective
Although problematic pornography use (PPU) has received increasing research attention in recent years, clinical studies examining its psychological functions and the changes that occur during long-term psychotherapy remain limited. This study aimed to explore the process of long-term psychodynamic psychotherapy with a client who sought treatment for PPU.
Method
The study was designed as a qualitative single-case study. Data were obtained from a long-term psychodynamic psychotherapy process comprising 90 sessions conducted over approximately 2 years. The first 60 sessions were conducted online and the remaining sessions were conducted face-to-face. The formulation was primarily informed by self-psychology, with separation-individuation and defensive functioning used to clarify specific developmental and relational aspects of the case.
Results
The findings suggest that PPU served affective and relational functions beyond sexual gratification. Reductions in pornography use were accompanied by greater psychological autonomy, an increased capacity to identify and reflect on the emotional states preceding acting out, improved tolerance of aloneness and the development of more reciprocal interpersonal relationships. The client also demonstrated a more coherent and less externally dependent sense of self.
Conclusion
In this case, therapeutic change was associated with increased tolerance of aloneness, greater psychological autonomy and a more coherent and less externally dependent sense of self.