Contrasting Viewpoints Regarding the Nature and Psychoanalytic Treatment of Narcissistic Personalities: A Preliminary Communication

Kernberg's short paper, first given at a 1972 panel of the American Psychoanalytic Association on the treatment of narcissism, sets out where his understanding of narcissistic personalities parts from Heinz Kohut's, as stated in The Analysis of the Self (1971). He takes the clinical picture as broadly agreed and confines himself to theory and technique, aligning his own position with Edith Jacobson, Margaret Mahler, Joan Riviere, Herbert Rosenfeld and van der Waals. Where Kohut separates narcissistic personality disorders from borderline states and the psychoses, Kernberg holds that most narcissistic personalities share the defensive organization of borderline patients, with splitting and other primitive defences, while an integrated though pathological grandiose self lends them a smoother surface; some function openly at a borderline level. Where Kohut treats pathological narcissism as an arrest at a normal archaic stage, Kernberg sees a specific pathological structure: a grandiose self that condenses the real self, the ideal self and the ideal object, and protects against intense oral rage, envy and devalued images of self and others. He rejects Kohut's view that narcissism develops along a line of its own, apart from object love, arguing that the libidinal investment of self and objects, and the fate of aggression, cannot be separated. These differences carry into technique. Kohut advises letting the idealizing and mirror transferences unfold and accepting the patient's idealization as the revival of a normal developmental need. Kernberg reads that idealization as defensive and calls for systematic interpretation of the grandiose self as it is enacted in the transference, of the negative transference and of the envy and devaluation behind it. He warns that an approach which leaves the patient's aggression unanalysed may bring adaptation without lasting structural change.