Freud's Treatment of a Narcissistic Patient

The newly-published correspondence between Freud and Ernest Jones reveals Freud's views on the treatment of a severely narcissistic patient in 1922, just prior to his writing 'The Ego and the Id'. His formulation centres on 'a deep sense of guilt … a conflict between Ego and Ideal … whenever it is revived she projects her self-criticism to other people, turns her pangs of conscience into sadistic behaviour'. He aims toward 'reconciliation of her Ideal to her Ego', and emphasises her need for his friendly support in order to tolerate the analytic process. Freud's views, expressed in his formulation, coincide with ideas that the author has put forward over the past two decades in regard to the vicious cycle of punitive unconscious self-criticism, self-deprivation, and excessive demand (narcissistic entitlement) and the need to maintain functional neutrality by providing support. The discussion addresses the contrast between Freud's therapeutic activity and his published recommendations, emphasising Freud's mistaken belief in the analyst's 'objectivity' in the analytic situation and his passionate commitment to maintaining the scientific respectability of psychoanalysis, with its consequences in the minimalist austerity of 'classical technique'.