Advanced Psychopathology

Sunday, April 02, 2006


Narcissism, Joshua's Response

Though theoreticians differ as to how it is established, at the heart of narcissism is an internal structure referred to as the “grandiose self,” whose role it is to maintain an air of perfection and independence. According to Bromberg and Kohut, this grandiose self and “illusion of self-sufficiency” serve to disguise the narcissist’s lack of a fully individuated self-identity.
According to Kohut, narcissism and narcissistic rage are developmentally normal. Pathological narcissism, then, is reflective of developmental arrest or fixation at a primitive level of omnipotence or grandiosity. In normal development, the separation-individuation process the infant marks the beginning of the loss of this sense of omnipotence. When the mother is empathetically responsive to her infant, sharing of omnipotence or power occurs and the infant’s self and object differentiation and experience of individuation and efficacy are strengthened. Pathological narcissism, fixation at this stage of omnipotence, occurs when the infant’s mother is empathetically unresponsive to her infant’s needs. Therefore, Kohut believed that analysis with narcissistic patients should allow for the emergence of mirror and idealizing transferences, which reflect the unmet infantile need having an empathetically responsive love-object. Therapies that allow for the emergence of this need will “unlock” the point of fixation and allow for the continuation of normal development. In this way, the early stages of analysis are dependent upon the analyst’s capacity for mirroring, rather than interpreting.
Contrary to Kohut, Bromberg believed that interpretation was necessary in all stages of analysis with narcissistic individuals, including the early stages. He identified two forms of “interpretation” appropriate to and necessary during the early stages of therapy. The “structuralizing interpretation” encourages the patient to identify parts of his character structure (i.e. the patient’s use of detachment to avoid feelings of inadequacy) without pathologizing. The second “interpretation” involves encouraging the patient to identify the minute details of interactions with others, details that, in an effort to manage appearances, would not normally be attended to or disclosed. Exploring these details, or simply being aware of one’s resistance in providing them, may further elucidate to the patient aspects of his character. The second stage of analysis involves interpreting and addressing the issues that identified in the first stage of the analysis transferentially.
Where Kohut’s approach emphasizes the importance of empathy and mirroring during an interpretation-free period of therapy, Bromberg stressed the importance of interpretation from the start of therapy. However, here the word interpretation is used loosely and appears to be more closely tied to guided discovery as the patient is made aware of aspects of his character.

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