A Reconsideration of Psychotherapy of Narcissistic Personality Disorder

Using the concepts formulated by Kohut, this paper represents an attempt to review the treatment of a 35-year-old woman presenting a narcissistic personality disorder. This case was treated a few years before the publication of Kohut's major works and followed the theoretical position of Mahler and developmental ego psychology. In retrospect, because of the unmistakable narcissistic injuries sustained by the patient at the preoedipal stage of development, certain modifications in technique following Kohut's orientation would seem applicable. While therapy enabled the patient to attain symptomatic relief and a general enhancement of her personality, the results of the treatment are felt to be less than optimal because of the lack of knowledge and awareness of the specific narcissistic configurations. An attempt will be made to show how the patient's specific narcissistic deficits might have been handled following the theory and technique proposed by Kohut. The data were drawn from process notes over two and a half years of analytic psychotherapy twice weekly and include the patient's life history, a discussion of her personality structure in the light of developmental traumata, the manifestations of the transference, and dream material with associations and interpretations.

Mary, a 35-year-old woman, married 17 years, and mother of four children, came self-referred for therapy because she was undergoing numerous stresses which were causing her anguish. Her husband was threatening to leave her, she was disillusioned over a relationship with a friend, and she was uncertain about returning to school. She desired caring and security