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The schizophrenic child has libidinal and destructive impulses directed against itself. Moreover, it is unable to cope with its excessive libidinal and destructive impulsivity toward others. To prevent itself from being stimulated to injure itself or any other person, the child sacrifices its ego. It maintains its ego in a 'perfect' state, objectionable and 'crazy' impulses must be shut out, and it resorts to pathological narcissism so as not to feel, think, and act on its destructive impulses.
The use of ego re-enforcement in treatment requires thorough understanding of the contact functioning of the child's ego. ('Contact function' is the child's method of establishing contact with the therapist and evoking his response.) 'Ego re-enforcement' is the process whereby the therapist reflects these attempts at contact to mirror or re-enforce them. The psychotherapist can help the narcissistic child to use its wishes, fears, and projections for re-enforcing the narcissistic ego. After the therapist reveals himself to the child as a person both rational and irrational, perfect and imperfect, the child comes to accept the wide range of its own emotions as part of human existence. The therapist may at times find it necessary to act out or talk about the repudiated, imperfect, or 'crazy' ego structure of the child. The child is helped to externalize the 'imperfect' element of its personality by finding in the therapist a person whom it can battle with and also love.
Pathological narcissism appears to be a defense against the acting out of preoedipal and Oedipal strivings, especially destructive ones. It is vital that the schizophrenic child have enough control of those destructive impulses to be able to express some of them, first in fantasy and later verbally, with appropriate affect. Such control is effected by pathological narcissism, but this inadequate barrier can be discarded when the child's ego is re-enforced by the presence of an understanding therapist.