Modern Psychoanalysis and Intimacy: Treatment of the Narcissistic Personality*

Ever since Joseph Breuer, after witnessing Anna O. in the throes of an hysterical pregnancy, fled from her house “in a cold sweat,” and abruptly terminated his previously devoted treatment of her—leaving for a second honeymoon with his wife the next day—psychoanalysts have had reason to be concerned with the striving for and the fear of intimacy in both patient and analyst. As Breuer discovered (and as subsequent practitioners have regularly confirmed), the talking cure can arouse in one or both participants deep longings for intimacy along with the most powerful libidinal and aggressive impulses. The psychoanalytic treatment setting, in which a patient is invited to communicate his deepest feelings, memories, and thoughts to an empathic analyst over an extended period of time, is itself an intimate situation and elicits intense desires, both situational and transferential, for further closeness. Many patients since Anna O. have desired to make babies with their analysts, and longings for other kinds of intimate contact are regularly experienced. Patients want physical as well as emotional contact; they want to recreate intimate relationships from the past; they want to know the analyst as a real person, to become a lover, friend, or child; or at a more primitive level they want to merge, engulfing and being engulfed by the analyst.

But awakening these desires also activates negative or ambivalent feelings that reflect the patient's earliest experiences with intimate