Understanding the Fieldwork Experience: How Do We Know When Students “Get It” about Narcissism?1

An important contribution of modern psychoanalysis to the field of mental health treatment is its commitment to work with extremely regressed patients. To work with such a patient population depends heavily on therapists' understanding of their own reactions as well as of patients' dynamics. Training to achieve these goals is an essential aspect of becoming a professional in this field.

This paper examines the mental health fieldwork experience as described by students and faculty in two modern psychoanalytic training centers and proposes seven criteria by which the student therapist's growth in understanding the narcissistic patient can be measured. They are: the student's observation of the contact function; the student's interventions; the student's defenses and reactions to those defenses; the student's descriptions of the patient's symbolic and unconscious verbal and nonverbal communications; the student's reactions to the patient and an understanding of those reactions; the student's reactions to supervision;

the student's interactions with classmates. Vignettes that describe the criteria and a longer case study of one student's growth are also presented.