Presentation of Clinical Material on Sexuality

The moderator introduced the presenter, Otto Kernberg, the discussants, and the reporter and invited Kernberg to read his paper ‘A severe sexual inhibition in the course of the psychoanalytic treatment of a patient with narcissistic personality disorder’. Mr F was a 45-year-old successful businessman who sought analysis for his incapacity to maintain a relationship with a woman. He was twice divorced as the result of losing sexual interest in the women shortly after marriage. He was promiscuous and proud of his sexual exploits with women. Professionally his aggressive, ironic, and intense style made him thrive while he evoked fear and respect in his colleagues.

The case presented the vicissitudes of oedipal conflicts in the advanced stages of the analysis of a narcissistic personality. Mr F's analysis showed the appearance, persistence, and resolution through interpretation of castration anxiety, impotence and severe inhibition of sexual desire during the termination phase. What made the analysis specially interesting was the analyst's enactment in the countertransference of the patient's projected castration anxiety.

Mr F's relations with people were superficial, as manifested by his inability to describe his friends. He was afraid women would be interested in his money and frequently concealed his prosperity. His friendly and humorous disposition gave way to abrupt derogatory behaviour when he was frustrated. He was the youngest of three much older brothers and resented their privileges and dismissive behaviour towards him. The father was a dissatisfied small businessman, distant from his children and unable to stand up to his overpowering suspicious, hypochondriacal wife, who was constantly concerned about real and imaginary illnesses in herself and the family. Both parents were described as suspicious, controlling and chronically irritated.

The first five years of analysis achieved a slow but successful working through of Mr F's narcissistic character st