Concept
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.
Development
1987
introduced by Herbert Rosenfeld
In the Afterthought that closes Impasse and Interpretation, Rosenfeld distinguished thick-skinned narcissistic patients, who need firm interpretation, from thin-skinned ones, who may be retraumatized by premature interpretation of their destructiveness.
In Impasse and Interpretation: Therapeutic and Anti-Therapeutic Factors in the Psycho-Analytic Treatment of Psychotic, Borderline, and Neurotic Patients (1987)
Relations
- 1987 introduced by Herbert Rosenfeld
In the Afterthought that closes Impasse and Interpretation, Rosenfeld distinguished thick-skinned narcissistic patients, who need firm interpretation, from thin-skinned ones, who may be retraumatized by premature interpretation of their destructiveness.
Works
- 1987
Rosenfeld's last book, published shortly after his death as the first volume of the New Library of Psychoanalysis, looks back on a lifetime of work with psychotic, borderline and neurotic patients and asks why some analyses succeed and others reach an impasse. Its four parts treat the analyst's own contribution to successful and unsuccessful treatment, the influence of narcissism on the analyst's task, the influence of projective identification on the analyst's task, and a conclusion. Rosenfeld argues that an impasse is not necessarily a sign of the patient's incurability: it can arise from the analyst's misunderstanding, and it can be worked through. He gives more weight than in his earlier work to the patient's real trauma, warns that rigid or misplaced interpretation can repeat that trauma in the analysis, and distinguishes thick-skinned from thin-skinned narcissistic patients. The book caused controversy among his colleagues; a reviewer in the British Journal of Medical Psychology judged it useful both to the author's critics and to those who followed his approach.