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Dr Masterson is Clinical Professor of Psychiatry of Cornell University and Director of The Masterson Group for the treatment of Character Disorders (Adult & Adolescent). He feels that there are key differences between the narcissistic and borderline disorders both in the clinical picture, the intra-psychicstructure, and the developmental levels involved. An understanding of these distinctions leads to the realisation of how therapy will vary and how it can become more appropriate and effective. While agreeing with much of Kohut's work, he thinks that his view of diagnosis blurs the dissimilarities and that cases described by Kohut as narcissistic disorders he and others would consider borderline. What Kohut describes as fragmentation of the self and defences against it, Masterson would understand as abandonment depression and its defence.
In narcissistic personality disorders Masterson believes that there is a true developmental arrest or fixation before the rapprochement crisis, because of the persistence of infantile grandiosity and omnipotence and fusion with an omnipotent object. This defends against an underlying aggressive or empty object relations fused unit, and minimises depression. He thus disagrees with Kernberg's ‘regressive refusion’ theory.
In the borderline disorders the developmental level primarily concerned is the subphase of rapprochement. The rapprochement crisis has never been resolved and the patient behaves ‘as if all life were one long unresolvable rapprochement crisis’ (p. 133). Self and object representations are not fused but separate and split into rewarding and withdrawing part units, whose projection alternates.
The key issue in the aetiology of borderline disorder is ‘the mother's libidinal unavailability for the child's separation-individuation needs; the unavailability itself can be due to a variety of reasons. The child responds to the unavailability as an absence or withdrawal of vital need and introjects it as a withdrawing maternal