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One of the areas of liveliest interest, and controversy, in American psychoanalysis over the last fifteen years has been that of narcissism. (For the purposes of this paper I include both psychoanalysis proper and the adjoining field of psychoanalytic psychotherapy). The two major voices have been those of Otto Kernberg (1974) and Heinz Kohut (1977). Each has constructed an extensive theory of how the narcissistic aspect of human character develops, what is internally amiss in serious narcissistic difficulties and what therapeutic strategies are best calculated to put it right.
It is intriguing that this debate, often boisterous at close range, has had few reverberations in Britain or Europe. One could put this down to the inevitable national parochialism which plagues psychoanalysis, or to the ways in which narcissism seems a quintessentially American concern and is less culturally, and thus clinically, prominent elsewhere. But also important, it seems to me, is the way in which Kernberg and Kohut represent attempts, complex and useful attempts, to introduce into American ego psychology some theoretical and technical emphases which are already familiar in the British school of psychoanalysis.
Kernberg is forthright about his debt to the work of Melanie Klein and he has laboured quite effectively to integrate some Kleinian notions into American ego psychology (this has been done in the face of what has often seemed a ritual reflex of denigrating Klein on the part of American analysts). Both by connecting Kleinian concepts to the developmental and structural theory of ego psychology and by writing about it all in the precise and objectified style which has characterized the classical theory in America, he has detoxified and made respectable an important set of ideas. The Kleinian aspect of Kernberg comprises, to take just the major elements: an emphasis on early mother-child relationships (two person and “pre-Oedipal” rather than triangular); a belief in the importance