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There is a spirited debate in progress on the other side of the Atlantic and it concerns the origins of narcissistic psychopathology. Dr. Masterson's corner in an ideological cosmos which includes such luminaries as Kohut, Kernberg, Spitz and Winnicott (with a nod in the direction of his true and false self) is secured by his espousal of what he calls ‘confrontive psychotherapy’ as a technique in the treatment of borderline patients. His present contribution is aimed at making a theoretical distinction between borderline patients and narcissists (something which he says Kohut failed to do) and then to illustrate with case histories the considerations of technique which flow from that distinction.
Doubtless we have not heard the last word from this author on the matter of the developmental theory which underpins his technique. It has been criticized as being simplistic (Kernberg) but it also manages, simultaneously and without paradox, to be complicated. We are introduced to a world of WORU's (Withdrawing Object Relations part-Units) and WORU's (Rewarding Object Relations part-Units) which the borderline patient acts out in the transference; while the narcissist is afflicted with equally unpleasant ‘defensive, grandiose, omnipotent, self-object fused-units’ or ‘underlying, empty, aggressive fused-units’ which he acts out in his transference. Rather suspiciously, Dr. Masterson's developmental theory seems to provide all the answers, at least in the case of the borderline patient. All, that is, except one: the developmental arrest of the narcissistic disorder can occur before that of the borderline, and yet in psychoanalytical terms the problems of the borderline patient are much more severe. Why?
In matters of technique this author has much to offer the practising therapist in diagnosing and treating pre-oedipally disturbed patients. He suggests a systematic analysis of narcissistic patients' grandiosity rather than collusion with their tendency to idealize the therapis