Kohut views pathological narcissism as disturbed or incomplete narcissistic self structures that stem from early developmental failure by selfobjects to respond appropriately to the child’s normal, narcissistic needs. Selfobject failure specifically results from insufficient (or absent) mirroring and idealization, or from a premature confrontation with reality over the idealized self-object’s fallibility before the child is able to process this. This results in the development of five narcissistic personality types: the mirror-hungry personality, the ideal-hungry personality, the alter-ego personality, the merger-hungry personality, and the contact shunning personality. All are characterized by an on-going search for external affirmation and acceptance, and a deficient and incomplete self-structure.
Kohut promotes an interpersonal therapeutic process that seeks to help the narcissistic patient complete his disrupted development. This approach starkly differs from traditional psychoanalytic procedures in that it relies on the therapist to take on the role of the selfobject through the means of empathy and mirroring, rather than providing insight and interpretations. This notion also fundamentally contrasts to Kernberg’s more confrontational approach. Kohut’s supportive technique is premised on the idea that the narcissistic patient will be able to internalize the faux selfobject (played by the therapist) and in doing so, repair his depleted self-structure.
Bromberg, in contrast to Kohut, does not entirely cite selfobject failures as the source of narcissism. While he acknowledges that the narcissist does not have an individuated self-identity, he does not fully blame this on early object failure, though he still attributes its source to developmental failure. He accounts for it, I believe, in more ambiguous (and less object blaming) terms— by attributing it more to the infant’s denial of the self-individuation process, and to the infant consequently erecting a defensive structure that allows him to maintain his grandiose self image. For the most part, Bromberg agees with Kohut regarding the ineptitude of classical interpretation in achieving success with narcissistic clients, especially because of their inability to examine their own narcissitic transferences before having established a more coherent self-structure via an empathic mirroring experience with the therapist. However, he feels that a certain type of empathic interpretation (not in the classical sense) is necessary so that the patient can view himself as engaged in an interpersonal process. Gradually, as the patient’s ego capacities are strengthened, and reality is brought into clearer focus, the interpretations will become more confrontational. The patient will tolerate this because by now, he trusts his selfobject replacement, the therapist. One caveat Bromberg points out is that not all patients with pathological narcissism are analyzable, especially those with particularly deficient ego development.