'You are my Standard of Time … A Winged Victory Holding a Clock…': an Evolving Understanding of an Unfolding 'Narcissistic Transference'

This presentation will be of the early months of my work with a patient during my analytic training, several years ago. Although it represents a lesser degree of experience and perhaps sophistication than I have today, I should like to share this as the work of a student—attempting to grapple (with the considerable help of my supervisor, Dr M. Robert Gardner) with some ideas which this patient presented to me. The patient had a particular kind of narcissistic pathology which fostered active reflexion on the understanding and treatment of such cases. Since then I have come to see that he presented, in bold relief, issues which have much wider relevance, for patients with a variety of clinical pathology. I had at the time read Kohut's studies and thought about them, but it was another matter to apply them clinically. In this paper I shall not attempt a theoretical review of these ideas, nor will I focus particularly on the unfolding genetic material of the patient. It is, rather, of a student's groping attempt to learn what it is about.1 To this end, I shall present some of the first seven months of work with this young man, whom I shall call Mr A.

I first saw Mr A. at the age of 20, as a college sophomore. He had sought psychiatric help in his senior year of high school, in his home city, for symptoms of urinary urgency associated with considerable anxiety. It was suggested that he seek Institute analysis in Boston, where he was readily accepted as a first or second control patient with a diagnosis of 'anxiety hysteria in hysterical character'. He spent a number of sessions talking with the student analyst who first saw him for the possibility of analysis with her, after which they agreed that his ambivalence was so great that he was not ready to begin. He withdrew his application and reapplied a year later, at which time I saw him. He had by now only two years left of college and an uncertain future to follow. I saw him in May and even then he did not ch