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This book is the third in a series of books that the author has written on disorders of the self, or what are more commonly known as personality disorders. It addresses the psychodynamics, diagnosis, and treatment of the closet narcissistic disorder, a disorder that the author feels differs in significant ways from the exhibitionistic narcissistic disorder, the only narcissistic personality disorder described in DSM III-R. The genesis of this book is the author's work with patients with severe personality disorders who do not fit into the preexisting diagnostic categories, and whose dynamics and treatment needs differ.
The intrapsychic structure of the closet narcissistic disorder, according to the author, is of a grandiose self-representation fused with an omnipotent object representation. This disorder differs from the narcissistic exhibitionistic disorder in that the major investment is in the omnipotent object. The omnipotent object is idealized and projected onto others. Like other disorders of the self, there is a triad of self-activation leading to anxiety and depression, which leads to defense. In this case, defense is accomplished through idealization and projection of the object. These dynamics can be used to explain the clinical and symptomatic picture of this disorder, and can help to distinguish it from other disorders of the self, such as borderline and schizoid disorders.
The clinical sections in the book are informed by the author's theory of the genesis and dynamics of this disorder. In the chapter on “Therapeutic Neutrality, Frame, Stance and Task” the rationale for many traditional psychoanalytic techniques is explained in terms of the impact that they have on the treatment of closet narcissistic patients. For example, the therapeutic frame and the notion of neutrality is explored in terms of how it helps deal with the patient's projecting the omnipotent object onto the therapist, and with the resulting countertransference. This chapter also deals c