The Analysis of the Self: A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders by Heinz Kohut M.D

Author:Heinz Kohut, M.D. [Kohut, Heinz, M.D.]
Language: eng
Format: epub
Publisher: The University of Chicago Press
Published: 1971-11-17T05:00:00+00:00

CLINICAL CONSIDERATIONS

There are some patients in whom the differentiation between idealizing transference and mirror transference is not easily established since either the oscillations between the two positions occur very rapidly, or the narcissistic transference is itself a transitional or mixed one, with features of idealization of the analyst and the simultaneous presence of demands for mirroring, admiration or of an alter-ego or a merger relationship to him. Instances of this type, however, are not as frequent as those in which, at least for long periods during the analysis, a clear differentiation can indeed be made. In the transitional cases—particularly in those instances where rapid oscillations between the activation of the grandiose self and the idealized parent imago do not allow a sharp focusing of interpretations—it is advisable for the analyst to dwell neither on the fleetingly cathected grandiose self nor on the idealized parent imago but to focus his attention on the shifts which occurred between these positions and on the events which precipitated them. In certain cases at least, the rapidity of the oscillations seems to be in the service of a defensive denial of vulnerability. Whenever the patient extends a vulnerable tendril of idealization toward the analyst, or whenever he shyly attempts to exhibit his own beloved self and invites the analyst’s admiring participation, he quickly veers back to the opposite position and—like the turtle in the fable—has been there all along and the analyst cannot catch up with him.

Another practical matter is the form of the interpretations which focus on the narcissistic transferences, especially in the mirror transference. Two antithetical pitfalls may become impediments in the course of the analysis of narcissistic personalities. The one concerns the analyst’s readiness to take on an ethical, or ethically tinged, realistic stance vis-à-vis the patient’s narcissism; the other concerns his tendency toward abstractness of the relevant interpretations.

In general it can be said that the triad of value judgment, reality ethics (cf. Hartmann’s concept of health ethics [1960, p. 64]), and therapeutic activism (educational measures, exhortation, etc.) in which the analyst feels that he must step beyond the basic (i.e., interpreting) attitude and become the patient’s leader, teacher, and guide is most likely to occur when the psychopathology under scrutiny is not understood metapsychologically. Since under these circumstances the analyst has to tolerate his therapeutic impotence and lack of success, he can hardly be blamed when he abandons the ineffective analytic armamentarium and turns to suggestion (offering himself to the patient as a model or an object to identify with, for example) in order to achieve therapeutic changes. If repeated lack of success in areas that are not yet understood metapsychologically is tolerated, however, without the abandonment of analytic means and without a turning to therapeutic activism, then the occurrence of new analytic insights is not prevented and scientific progress can be made.

Another related phenomenon can be observed in areas where metapsychological understanding is not lacking altogether but is incomplete. Here analysts tend to supplement their interpretations and reconstructions with suggestive

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