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In 1976 two books were published, one by Hyman Spotnitz, Psychotherapy of Preoedipal Conditions, and one by Hyman Spotnitz and Phyllis W. Meadow, Treatment of the Narcissistic Neuroses. These volumes updated modern analytic thinking on the treatment of narcissistic disorders, including Spotnitz's special interest in the psychotic character structure. My contribution to the second volume was to prepare two chapters on theoretical considerations, “Dream Analysis” and “Diagnosis Reevaluated,” and three chapters on technical considerations, “The Treatment Partnership,” “The Analyst Intervenes,” and “A Case Study,” on what happens between patient and analyst to bring about change. The conclusions: Only when the analyst can help the narcissistic patient develop an emotional relationship, in other words, a transference, can the patient be cured by analytic work. It is the emotional connection with the analyst that helps the patient to stay in treatment when feelings are painful; establishing that connection means overcoming powerful resistances.
Today I would like to update my thinking on how I try to be with patients, and perhaps say something about why I believe that this approach works. Also I would like to mention briefly the history of modern psychoanalysis and give those who are not familiar with modern psychoanalysis, some idea about what it is. Spotnitz's work in the late forties with adolescent girls, mothers, and children led to his first theory: that the fragile ego needs to be insulated in the analytic