For Heinz Kohut and the school of self psychology that he founded, the narcissistic individual is known by the transference he or she forms. Kohut opened the world of narcissistic pathology to psychoanalytic treatment by turning Freud’s view of the narcissistic neuroses on its head. Whereas for Freud, patients with narcissistic neuroses failed to form a transference attachment and therefore were unamenable to psychoanalytic treatment, Kohut argued that people with narcissistic pathology do form transference relationships but that their transferences are characterized by aloofness, seeming uninvolvement, and a mode of treating the therapist as an extension of the patient rather than as a distinct and separate individual.
Kohut formulated the concept of the “selfobject” to account for these transference phenomena. The selfobject is someone who performs a necessary function in the development and maintenance of a coherent and healthy sense of self. For the infant and child, the parents are the major selfobjects. They serve as mirrors of acceptance and confirmation of the child’s early exhibitionism and wish for acknowledgment, thus shaping the development of the child’s basic strivings for power and success. They also are the objects of the child’s idealizing needs, thus reinforcing the child’s development of values and goals. They function as well as essential models for imitation and thereby create a sense of alikeness and belonging, or twinship, between child and parent. These primitive selfobjects serve to build and consolidate the basic structures of the self - its ambitions, skills, and ideals. Healthy narcissism - an inner sense of “freedom and vitality” and the knowledge that “the feelings and wishes one experiences are a part of one’s self” - evolves from an environment in which the parental selfobjects adequately fulfill these functions.
In the early stage of narcissistic development, the selfobject is experienced as part of the self and therefore is treated with an expected degree of control usually reserved only for one’s own body and mind rather than for another person. With healthy development of the self, selfobject needs themselves mature, becoming less absolute and uncompromising, more flexible, and more easily satisfied internally or endopsychically. In more mature individuals, the selfobject is granted full autonomy and the needs of the other are acknowledged, while the object is perceived as a necessary part of one’s inner life, providing bolstering of the self. We never outgrow our need for selfobjects.
In primary disorders of the self, such as narcissistic personality disorder, defects in the structure of the self are manifested in the transferential use of the therapist as a primitive or archaic selfobject. The narcissistic character forms one of three pathognomonic transferences, corresponding to the three fundamental types of selfobject: 1) a mirror transference, 2) an idealizing transference, or 3) a twinship transference. The patient treats and seeks to control the therapist as an extension of himself or herself, 1) as an admiring mirror of the patient’s exhibitionistic strivings, 2) as an ideal object with whom the patient wishes to merge as a source of strength and calmness, and/or 3) as an alter ego through imitation of whom the patient can achieve a sense of belonging and coherence.
Otto Kernberg’s description of the pathological narcissistic individual centers around a set of paradoxes: self-inflation existing alongside a limitless need for praise, a charming and engaging surface covering a ruthless interior, and a persona of self-sufficiency defending against underlying feelings of intense envy .
For Kernberg, the diagnosis of the narcissistic character also depends on the quality of the person’s object relations and the pattern of his or her intrapsychic defenses. Narcissistic individuals experience their relationships with others as exploitative and parasitic. They divide the world between those who contain something that they can extract and those who do not. They distinguish between extraordinary people on the one hand - in association with whom narcissistic individuals experience a sense of greatness themselves - and mediocre or worthless people on the other. Narcissistic individuals idealize the former and are contemptuous of the latter. Yet those they idealize they also fear, as they project onto them their own exploitative wishes and experience them as potentially attacking and coercive. They thus are unable to rely on any object and fear dependence on another person, rendering all their object relations empty and dissatisfying.
Like the borderline character, Kernberg’s narcissistic individual uses primitive defenses of devaluation, projective identification, omnipotence, and primitive idealization in his or her efforts to preserve self-esteem and self-coherence and to combat the intense feelings of envy and rage that threaten to undermine them. The narcissistic individual is distinguished from the borderline individual by his or her sense of object constancy, better impulse control, and better social and professional functioning, although these too may be fragile and hollow beneath a surface of apparent solidity. Although splitting as a defense is found in narcissistic pathology, its use is less prominent than in borderline pathology.
The grandiose self further differentiates the pathological narcissist from the borderline personality. In Kernberg’s theory, the grandiose self represents a pathological fusion of the ideal self, the ideal object, and the real self. It is a defensive structure designed to maintain self-admiration and avoid dependence on any real object by effectively eliminating a need for it from intrapsychic life. Although often toxic in its effects on interpersonal relationships, the grandiose self serves to maintain the narcissist’s otherwise tenuously coherent sense of self.
Arnold Cooper has explored the intimate interweaving between narcissism and masochism in both normal development and pathological character. He argues for the union of the two categories into a single “narcissistic-masochistic character”. He illustrates the ways in which masochism is used to defend against and repair narcissistic injuries by turning passively experienced frustrations into actively sought-after mastery over pain. This mastery in turn becomes a major source of narcissistic gratification, and therefore narcissistic pleasure is pursued through masochistic defeat and frustration. A self-reinforcing cycle is thus established. Whether the surface clinical presentation appears more overtly narcissistic or more overtly masochistic, a short period in treatment
will reveal that both types share the sense of deadened capacity to feel, muted pleasure, a hypersensitive self-esteem alternating between grandiosity and humiliation, an inability to sustain or derive satisfaction from their relationships or their work, a constant sense of envy, an unshakable conviction of being wronged and deprived by those who are supposed to care for them, and an infinite capacity for provocation.
Cooper also has emphasized the pathological harshness of inner conscience - the superego - in patients with narcissistic personality disorder. The defensive grandiosity that characterizes these patients creates an unending series of discrepancies between their inflated fantasy goals and achievements and the actuality of their accomplishments, even when the latter are at a very high level. In effect, the voice of conscience tells them, “You are a failure. You did not deliver all that you promised. You are not as big and strong as you pretend to be.” The incapacity of narcissistic individuals to defend against these charges is a major source of their inability to sustain interest and pleasure in their activities or in the objects that are close to them. Nothing they do or have measures up to their grandiose fantasies. The inner denigration of their accomplishments often results in guilty depression and is commonly projected as denigration of the therapist, usually after a brief initial idealization. Furthermore, a considerable portion of the provocative, self-defeating behavior of narcissistic patients represents their feeble efforts to defend themselves against their superego. These patterns may be modified with consistent awareness and interpretation of the severity of conscience and of the patient’s inability to defend against inner self-reproaches. The therapist, whether viewed as a selfobject or as an auxiliary ego, helps provide the initial strength needed to cope more successfully with the barrage of inner criticism.
Summary
The diagnosis of narcissistic personality disorder involves the use of several types of data: observable behaviors such as arrogance, entitlement, contempt, shame, or shyness; manifest, covert, or unconscious fantasies and feelings, such as grandiosity, uniqueness, and envy; and a quality of object relations manifesting itself in the transference and in the life history as unempathic, exploitative, devaluing or idealizing and in which the therapist is treated as an extension of the patient.
We again caution against viewing every grandiose fantasy, expression of envy, or devaluation of the therapist as a sign of narcissistic personality disorder. Narcissistic disturbances will be present in all psychopathology, but only in the narcissistic character will a pervasive pattern of these features be found.
From the same website as the above three articles:
NPD-clinical presentations(click the title of this article to read other articles concerning NPD)
What brings individuals with narcissistic personality disorder to a psychiatrist’s or psychotherapist’s office? A range of symptoms and precipitants, which revolve around a threat to or breakdown of the person’s defensive grandiosity, generally lead to the initial consultation.
The spoiling or impoverishment of interpersonal relationships, resulting from the narcissistic individual’s exploitation and lack of empathy, may lead to the loss of the admiring other and a painful sense of rageful emptiness.
For example, a highly successful 27-year-old banker who had already earned his first million had developed a false story about his upbringing in a foreign country. The story evolved from a series of nondelusional “slidings away from the truth,” which are frequently used by narcissistic patients to support their grandiosity. Fully aware of its falsehood, he elaborated on the story to friends and acquaintances, as well as to the woman with whom he lived and planned to marry. On introducing her to his family, however, his duplicity was (predictably) revealed, and he entered treatment ashamed and panic-stricken after the loss of his admiring girlfriend. Although he acknowledged that her anger with him was justified, he was shocked with self-righteous fury when she actually decided to leave him.
A professional or creative setback also may threaten the grandiose self-image of a narcissistic individual and bring him or her to treatment. For example, a 35-year-old physician who was viewed by his seniors as having a promising second career in medicine (after having left a promising first career as a humanities professor before the tenure decision) sought treatment for feelings of depression and hypochondriasis after failing his specialty board examination. He had not prepared for the examination because he had considered it beneath him, and he felt contemptuous of his peers who had spent time preparing. He could not believe that he had failed and was enraged at the examiners. This was the first academic failure he could recall, and he felt deeply ashamed and exposed by it. He withdrew into reveries of revenge and sexual conquest. He avoided the mentors he had once idealized and began to blame them for his failure.
The stress of aging or illness and the attendant loss of beauty, strength, or cognitive function can undermine narcissistic fantasies of invulnerability and limitless power. It may lead to an empty, depleted collapse on the one hand or a frantic search for compensatory thrill-seeking on the other, both of which are described in the classic “midlife crisis”. Later-life crises, such as one experienced on the eve of retirement, also may reflect narcissistic pathology. For example, a 62-year-old married man was referred for depression by his internist after a month-long course of fluoxetine had failed to improve his symptoms. He was a successful self-made businessman, married with grown children, but for almost a year he had experienced a general lack of zest, anhedonia, and a sense of detachment from his loving wife. His appetite and sleep were undisturbed. On closer examination, his mood was not depression but pessimism tinged with bitterness and resentment, an affective tone frequently encountered in narcissistic individuals. He was bitter that he had never pursued a dreamt-of career as a theater actor. He had a narcissistic decompensation rather than a clinical depression.
Each of these vignettes describes a crisis that brings an otherwise well-functioning, socially successful individual to treatment as a result of narcissistic injury. Although the presenting clinical situation is suggestive of narcissistic personality disorder, further life history and the nature of the transference often are necessary to confirm or rule out the initial diagnostic impression.
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