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To be needy and helpless is one of the most dreaded experiences we are subjected to. If no one is available to hear our cries and to recognise and respond to our needs, we face the anxiety of abandonment and persecution. This fear relates to the helplessness and prolonged dependence of early infancy and is directly expressed through the need to find and get through to an available object. The patient needs to reach and to make an impression on an object who is able to contain his anxieties — that is, one who is able to be emotionally responsive and able to understand rather than enact. When anxiety is high, the patient communicates his needs through projective identification at a concrete level, and in analysis these concrete projections may make containment difficult since they provoke action rather than understanding.
Containment is therefore always partial. When it fails, powerful defences are mounted. The most common defensive pattern is one in which neediness is denied and replaced by a narcissistic type of object relationship. The needy, helpless, and deprived self is projected and disowned, and the patient identifies with a parental object who is expected to provide rather than to receive help. In this role the patient feels obliged to look after a neglected and reproachful object who demands to be restored and is often driven to use manic and omnipotent mechanisms to keep despair at bay. The patient’s apparent helpfulness to others is primarily directed to restoring his own wounded ego. It is rarely successful and is usually not appreciated by the object. When his efforts fail, the helper commonly feels resentful, frustrated, and furious. This seemed to me to be close to
what Kohut (1972) has called narcissistic rage, which arises when narcissistic grandiosity is thwarted and the patient feels humiliated and degraded. Kohut suggests that the patient attempts to soothe an internal narcissistic wound and restore a sense of self-worth by re-establishing a nar