The Implications of Early Psychopathology for the Analysability of Narcissistic Personality Disorders

This paper explores the influences of early psychopathology on questions of analysability in general and upon the analysability of narcissistic personality disorders in particular. Because various theoretical perspectives influence the meanings attributed to genetic and analytic data and may shape the emergence and unfolding of the data, current definitions of analytic process and analysability are reveiwed. Work with two unanalysable narcissistic personality disorders is presented to facilitate an inquiry into the influence of their early psychopathology on their egos' limited capacity to become involved in an analytic process. This inquiry is pursued by exploring these subjects' character organizations, life histories and analytic and therapeutic experiences from four complementary perspectives: First, the relationship of their early life experiences to their ego development is examined with particular emphasis on the integration of their self-representations and the development of their capacity for fantasy, self-observation and creative sublimation. Second, the influence of process versus shock trauma in the genesis of their character pathology is delineated. Third, the development of trust in relationship to a variety of alliances with the analyst is considered in relationship to the assessment of analysability. Fourth, the question of their diagnosis is explored.