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This paper gives an account of the 31/2 year analysis of a latency-aged boy whose bizarre and restless behaviour, excessive self-preoccupation, and inability to tolerate the demands of the external world carried many of the hallmarks of a narcissistic disturbance. John's immersion in grandiose fantasy and his imperative demand that I be part of this fantasy were the most striking features of the analysis.
Initially, I focused on the content of his fantasies, with particular reference to primitive anxieties of annihilation and self-dissolution. Later, I learned to pay greater attention to the nuances of the particular kind of relationship he created with me — accepting his implicit requirements that I be part of his experience, yet noting and exploring his consternation and rage in the face of inevitable disappointment and discontinuity.
Kohut's concept of the grandiose self, with its demand for admiration and control, and of the narcissistic mirror transference were of especial relevance in following this case (Kohut, 1968). The provision of an affirming primary experience, the containment of narcissistic rage, and the interpretation of anxiety in terms of John's narcissistic vulnerability were crucial. This paper gives an impression of the therapeutic experience and approach and offers some evaluation of the effectiveness of treatment.
John was referred for psychoanalytic treatment at the age of 51/2. At that time he was on the point of being excluded from his infant school. Considerable concern was expressed about his hyperactivity; and the bizarre and odd nature of much of his behaviour and general demeanour caused much confusion and consternation. Two teachers were said to have been made quite ill by the wildness and unpredictability of his behaviour. “He never sits still or stands still. His desk and chair are continually turned over. He falls to the floor and crawls about under the desks, making unnatural noises, throwing his arms and legs about