Advanced Psychopathology

Saturday, April 01, 2006


Kelly: Bromberg and Kohut

Although Bromberg stresses the importance of empathy in the therapeutic stance with narcissism, his conceptualization of therapeutic action differs in several ways from Kohut (although, admittedly I’m struggling to clearly identify them). Bromberg maintains the active agents of therapy with the narcissist are both interpretation and internalization. In this way, treatment of the narcissist does not require a different set of therapeutic techniques; rather certain facets are relied on more heavily than others and at different phases in the treatment. Bromberg believes that in the initial stages of analysis, the narcissist actively wards off direct experience of the transference neurosis (therapist as an object of value). This transference, he believes is too threatening to the narcissist’s weak self structure or “mask” of grandiosity. Instead, the narcissistic transferences serve to maintain the patients mask allowing him to perform for the analyst. Bromberg warns against the analyst too hastily dismantling the narcissistic transference. However, for the patient to develop a more accurate observing ego and genuine sense of an autonomous self the patient must be able to internalize the analyst. So for Bromberg, a main aim of the therapy is to lessen the over-reliance on narcissistic transferences and replace these with a more reality based transference neurosis in which interpretation plays a more central role.

For Kohut, in the right therapeutic environment – “optimal responsiveness”- the narcissism will resolve and transform into healthy self assertiveness. Rather than focusing on the “target of the instinctual investments”, Kohut is more concerned with the “quality of the instinctual charge” (grandiose and exhibitionistic). In this way, Kohut believes the therapeutic action takes place within the narcissistic transference and the analyst as a selfobject. Here this is unlike Bromberg’s view that it is primarily as a defensive maneuver that walls off the potential for growth.

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