Advanced Psychopathology

Monday, April 03, 2006

 

Sheila's Reaction: Kohut & Bromberg on Narcissism

Kohut normalizes narcissistic rage as natural part of maturation and provided that the environment is appropriate, asserts that it should result in a healthy sense of self-confidence and assurance. The self is then capable of maintaining stability, as it understands itself as both a part of and simultaneously distinct from the world. Bromberg, too, believes that narcissism can appear in either a healthy or pathological fashion. Drawing upon the work of Mahler, Bromberg, points out what is a central issue in pathological narcissism: the problem of being both separate from and “fully in” the world. However, he suggests that the potential for either type of narcissism is present as early as birth. Kohut’s timeline, on the other hand, is extended past the first few months of life and into the child’s second through fourth years. This is the period in which it is believed the critical conversion of grandiosity into ambition occurs by means of adequate mirroring.

Where Kohut and Bromberg differ most, perhaps, is not as much in their conception of narcissism as in their approach to the narcissistic individual in the analytic situation. Kohut’s therapeutic method would welcome the patient’s idealization of the therapist, favoring the establishment of an environment in which narcissism is essentially supported. In his view, the best therapeutic atmosphere for narcissistic individuals is one in which the therapist is very highly attuned and refrains from interpretation. Bromberg, too, emphasizes the importance of empathy in the treatment. Yet he takes issue with what he perceives as Kohut’s use of it as a “technical maneuver” to basically infantilize the patient in an attempt to heal developmental deficiencies. For Bromberg, narcissistic adults are just that: adults whose ego functions are not fully mature.

Bromberg’s approach to the therapeutic relationship is decidedly more confrontational than that of Kohut. He maintains that interpretation is indeed possible and productive, as long as one’s definition of it is not restricted to examining only transference resistance. Bromberg advocates strongly for an affirming, understanding environment, particularly at the outset of treatment. The goal is for the patient to gradually develop an observing ego and to visualize himself as part of an interpersonal process. Optimally, the therapist seeks to increase the patient’s tolerance of anxiety and confrontation while still providing warmth and understanding. Bromberg holds that Kohut’s view of the transition into this “new phase” of treatment is simpler than is actually the case for most individuals with a narcissistic personality. In truth, Bromberg believes that the therapist needs to “push” the patient to activate his newly formed observing ego and use it to explore not only his external reality but also the narcissistic transference.

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