Concept
Grandiose self
A structure of the self that holds an exhibitionistic sense of perfection and power. For Kohut it is a normal stage of the archaic self which, when the child's display goes unmirrored, persists unaltered and is revived in the mirror transference; for Kernberg it is a pathological fusion of the real self, the ideal self and the ideal object, built as a defence against rage and envy.
Development
1970
reworked by Otto F. Kernberg
Kernberg described the grandiose self of narcissistic personalities as a pathological fusion of the ideal self, the ideal object and the actual self-image, built to ward off dependence and envy, against Kohut's view of it as a normal stage of development that had been arrested.
In Borderline Conditions and Pathological Narcissism (1975);Factors in the Psychoanalytic Treatment of Narcissistic Personalities (1970)
1971
introduced by Heinz Kohut
Sets the grandiose self beside the idealized parental imago as the two archaic narcissistic configurations revived in analysis; he had first named both in a 1968 paper.
In The Analysis of the Self (1971)
Relations
- 1970 reworked by Otto F. Kernberg
Kernberg described the grandiose self of narcissistic personalities as a pathological fusion of the ideal self, the ideal object and the actual self-image, built to ward off dependence and envy, against Kohut's view of it as a normal stage of development that had been arrested.
- 1971 gave rise to Narcissistic transference
The mirror transference is the therapeutic revival of the grandiose self, as the idealizing transference is of the idealized parental imago.
- 1971 introduced by Heinz Kohut
Sets the grandiose self beside the idealized parental imago as the two archaic narcissistic configurations revived in analysis; he had first named both in a 1968 paper.
- gave rise to Malignant narcissism
Kernberg described malignant narcissism as the pathological grandiose self of the narcissistic personality infiltrated by aggression, so that cruelty and the wish to dominate become part of the inflated self-image.
Works
- 1970
Factors in the Psychoanalytic Treatment of Narcissistic Personalities
In this paper Otto Kernberg describes a group of patients whose central disturbance is the regulation of self-regard, bound up with a characteristic pathology of their object relations, and considers how they can be treated psychoanalytically. Narcissistic personalities show an unusual degree of self-reference, grandiosity alongside feelings of inferiority, an insatiable need for admiration, little empathy, intense envy, and an emotional life that is shallow and lacks the capacity for genuine sadness and mourning. They idealize those from whom they expect admiration and depreciate those from whom they expect nothing. Many of them function socially much better than other patients with severe character pathology, yet Kernberg argues that beneath this surface they share the defensive organization of borderline patients, dominated by splitting, denial, projective identification, omnipotence and primitive idealization. Their distinctive feature is a pathological grandiose self, a fusion of the actual self, the ideal self and the ideal object, which shields them from dependence on others while the devalued images of self and others are projected outward. He traces this structure to early experiences with cold yet overprotective parental figures and to intense oral rage and envy. He sets it against normal infantile narcissism and against Heinz Kohut's recent view of it as an arrest in normal development. In treatment, the grandiose self is activated in the transference: the analyst is alternately idealized and devalued or treated as nonexistent, and is often left bored or reduced to an extension of the patient. Kernberg recommends standard psychoanalysis for most of these patients, but for those who function on an overtly borderline level he proposes expressive psychoanalytic psychotherapy. In both he calls for the systematic interpretation of the grandiose self and of the envy, rage and fear of dependence it wards off, rather than accepting the idealization, and he reviews the factors that bear on prognosis.
- 1975
Borderline Conditions and Pathological Narcissism
Kernberg's first book gathers and reworks the papers he wrote in the late 1960s and early 1970s, largely out of his clinical and research work at the Menninger Foundation, into a single account of the patients who fall between the neuroses and the psychoses. Its first part argues that these patients have a borderline personality organization: a specific and stable structure, not a passing state on the way to psychosis. Behind a wide range of symptoms (diffuse anxiety, multiple phobias, perverse and impulsive trends, addictions, lower-level character disorders) Kernberg finds a common structure: nonspecific ego weakness, a pull toward primary-process thinking, primitive defences centred on splitting, and a pathology of internalized object relations that leaves the patient without an integrated identity, while reality testing is largely kept. He traces it to excessive early aggression, especially oral aggression, which prevents the loving and hating images of self and others from being brought together and draws pregenital conflicts into the oedipal ones. The book draws practical conclusions from this. It weighs the factors that make the prognosis better or worse, and sets out an expressive psychoanalytic psychotherapy for most of these patients: the primitive defences are confronted and interpreted as they emerge in the transference, the negative transference is taken up in the here and now, and acting out is limited, with the patient's life structured from outside when necessary. A chapter on countertransference argues for treating the analyst's whole emotional response as a source of knowledge about such patients. The second half turns to the narcissistic personality, which Kernberg sees as a special form of the same organization, its surface held steady by a pathological grandiose self that fuses the real self, the ideal self and the ideal object and wards off envy, rage and dependence. He distinguishes it from normal adult and normal infantile narcissism, describes its idealizing and devaluing transferences, recommends psychoanalysis proper with systematic interpretation of the grandiose self for those who do not function at an overt borderline level, and sets his views against Heinz Kohut's.
- 1984
Severe Personality Disorders: Psychotherapeutic Strategies
Severe Personality Disorders: Psychotherapeutic Strategies (Yale University Press, 1984) is Otto F. Kernberg's clinical companion to his earlier theoretical books on borderline conditions, pathological narcissism and object relations. Its stated aim is to make those formulations usable at the bedside: to give the clinician tools for diagnosing the difficult patient and for choosing and conducting a treatment. The book has five parts. Part One sets out structural diagnosis, which places a patient at a neurotic, borderline or psychotic level of personality organization according to identity integration, the kind of defences used and the state of reality testing, and the structural interview that elicits these features; it then applies the approach to adolescence and old age and to the classification of personality disorders. Part Two describes the treatment of borderline patients by a psychoanalytically based expressive psychotherapy centred on interpreting the transference, its adaptation for adolescents, a psychoanalytic form of supportive psychotherapy, and the indications for each modality. Part Three turns to narcissistic personalities, setting Kernberg's approach against other contemporary psychoanalytic views, above all Kohut's, and discussing technique, character analysis and the theory of self, ego, affects and drives. Part Four takes up severe regressions in treatment: stalemates, suicide risk, the incapacity to depend, superego pathology, paranoid regression and the syndrome of malignant narcissism, first formulated here. Part Five discusses hospital treatment, comparing philosophies of inpatient care, the therapeutic community model and long-term hospitalization of severe borderline and narcissistic patients. The book became a standard clinical reference, and its structural interview the basis of later assessment instruments.
See also
People
References
- The Analysis of the Self1971Evidence for a relation
- Borderline Conditions and Pathological Narcissism1975Evidence for a relation
- Factors in the Psychoanalytic Treatment of Narcissistic Personalities1970Evidence for a relation
- Severe Personality Disorders: Psychotherapeutic Strategies1984Evidence for a relation