Comments on the Treatment of a Narcissistic Patient

In this work I propose to illustrate some aspects of my way of understanding and conducting the psychoanalytic process and also my way of interpreting resistance and transference. In order to do this I will present clinical material describing my treatment of a patient with a markedly narcissistic personality. At the same time, I will also discuss the relationship observed in this patient between narcissism and the psychotic side of the personality, as understood in the sense described by Bion when he divides the personality into its neurotic and psychotic aspects. I will attempt to show that psychotic functioning is a tactic used by the narcissistic self to deny reality—i.e. the existence of and need for an object and the self's dependency on that object—in order to be able to sustain its omnipotent role.

In the course of my first interviews with the patient, a young bachelor I will refer to as Mr A, he told me that, albeit unwillingly, he had felt different from other children since his early adolescence. He said he felt unhappy and indifferent and did not really want to live. He explained that he also felt very worried by his tendency to turn to pornographic magazines and videos in order to achieve sexual arousal. He also told me he had neither the ability nor the drive to get ahead in the world of work as he would have liked. At that time, he was doing a job that was far beneath his true professional training but did not know how to achieve a more satisfactory level. He also said that he had been smoking a lot of cigarettes every day for years and as a result suffered from throat problems and irritations. He often tormented himself with the idea that he would get cancer as a result of this habit but despite this he still could not seriously think of giving up.

Mr A displayed anxiety when he spoke to me of his parents. Their relationship, he said, had been cold and distant. This was especially true of his father, whom he criticized for working too hard d