Further Contributions to the Treatment of Narcissistic Personalities

This paper continues my earlier studies of the diagnosis and psychoanalytic treatment of a specific constellation of character pathology, that of the narcissistic personality (Kernberg, 1967), (1970a), (1971a). In recent years, a consensus has been gradually developing regarding the definition of this pathological character structure and the indication of psychoanalysis as the treatment of choice (Jacobson, 1964); (P. Kernberg, 1971); (Kohut, 1966), (1968), (1971); (Rosenfeld, 1964); (Tartakoff, 1966); (E. Ticho, 1970); (van der Waals, 1965). However, despite the evolving agreement about the descriptive, clinical characteristics of this constellation, divergent views have developed regarding the underlying metapsychological assumptions and the optimal technical approach within a psychoanalytic modality of treatment. In particular, Kohut's approach to the psychoanalytic treatment of narcissistic personality disorders (1971) is very different from the approach I outlined in an earlier paper (Kernberg, 1970a), which is more closely related to the views of Abraham (1919), Jacobson (1964), Riviere (1936), Rosenfeld (1964), Tartakoff (1966) and van der Waals (1965). Therefore, in this paper I will focus particularly on those aspects of my approach to the understanding and treatment of narcissistic personalities which highlight agreements and disagreements with Kohut's approach.

With respect to clinical characteristics, there is agreement between Kohut's view and that of the other authors whom I have mentioned as representing an alternative view and myself. I describe patients with narcissistic personalities as presenting excessive self-absorption usually coinciding with a superficially smooth and effective social adaptation, but with serious distortions in their internal relationships with other people. They present various combinations of intense ambitiousness, grandios