Article
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.
Main ideas
- Narcissistic personalities form a distinct group whose main disturbance lies in the regulation of self-regard, together with a specific pathology of object relations.
- Clinically they show heightened self-reference, grandiosity beside inferiority feelings, dependence on admiration, little empathy, intense envy, and a shallow emotional life without real sadness or mourning. They idealize those who can supply admiration and devalue those who cannot.
- Despite often good surface social functioning, they share the defensive organization of borderline personality organization: splitting, denial, projective identification, omnipotence and primitive idealization.
- Their core structure is a pathological grandiose self, formed by fusing images of the actual self, the ideal self and the ideal object. It protects against dependence and against an intolerable reality in relations with others, while unacceptable images of self and others are split off and projected.
- The structure arises from early relations with cold, indifferent yet overprotective parental figures, together with intense oral rage and envy. Often the child had some quality that marked them out as special within the family.
- Pathological narcissism differs in kind from normal infantile narcissism, and Kernberg opposes Heinz Kohut's view of it as an arrest in normal narcissistic development.
- In the transference the grandiose self is activated: the analyst is idealized, devalued or treated as nonexistent, an extension of the patient, and the countertransference is often one of boredom or of being used.
- Idealization of the analyst is to be interpreted as a defense against envy, rage and dependence, not accepted as a developmental need. The grandiose self and its negative transference are worked through systematically.
- Standard psychoanalysis is indicated for most narcissistic personalities, but those who function on an overtly borderline level need expressive psychoanalytic psychotherapy of the kind proposed for borderline patients.
- Prognosis depends on such factors as the degree of antisocial trends, the capacity to experience depression and guilt, and how far the patient functions at an overtly borderline level.
What it shows
- 1975
Otto F. Kernberg developed Narcissism
Kernberg distinguished normal from pathological narcissism, traced a gradient of severity from normal infantile narcissism to the narcissistic personality, and explained pathological narcissism as a defensive structure rather than a stage of development that has been arrested.
- 1970
Otto F. Kernberg reworked Grandiose self
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.