Thick-skinned and thin-skinned narcissism

Herbert Rosenfeld's distinction, set out in the closing chapter of Impasse and Interpretation (1987), between two kinds of narcissistic patient. Thick-skinned patients seem impervious, are dominated by destructive parts of the self and need firm, persistent interpretation of the transference if an impasse is to be avoided. Thin-skinned patients are hypersensitive and easily hurt; for them, careless interpretation of their destructiveness can repeat an early trauma and leave them humiliated, so the analyst should help them see the conflict between the destructive and loving parts of the self and preserve what is positive in their narcissistic organization. Later writers, among them Anthony Bateman and Ronald Britton, held that both states can alternate within one person, and the pair is now often linked to grandiose and vulnerable narcissism.