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April 10, 1973. VICISSITUDES OF NARCISSISM AND PROBLEMS OF CIVILIZATION. Freud Anniversary Lecture. Jeanne Lampl-deGroot, M.D.
Dr. Lampl-deGroot differentiates the working, or therapeutic, alliance and transference. The former, based on conscious, realistic, and ego-linked considerations, sustains psychoanalytic treatment in the presence of intensely disruptive transference pressures. The latter, allegedly more drive-determined, may permanently undo the working alliance with greater frequency than is usual. She suggests that the functional tenacity of the working alliance derives from early narcissistic strivings which are more powerful than the later, Oedipally organized transference. In the course of development, narcissistic types of object attachment and more mature object-directed libidinal investments merge in a variety of combinations, often rendering psychoanalytic evaluation difficult.
The author believes that patients with a predominance of narcissistic problems constitute the bulk of contemporary practice. In these character neuroses and narcissistic personality disorders, an underlying fixation or regression to the archaic narcissistic tie to the object causes uneven development of ego functions. In the most severe cases of this type, analytic treatment is proscribed; in those accessible to psychoanalysis, the patient uses the analyst not for the revival of object-directed strivings but for the inclusion of the analyst in a libidinal (i.e., narcissistic) state to which the patient has regressed or the developmental position at which he has become arrested. Anna Freud refers to this as a 'subspeciality of transference'; Kohut prefers the term, 'narcissistic transference'. Lampl-deGroot suggests the term, 'narcissistic tie'.
In treatment she recommends an attitude of tolerance and noninterference during the evolution of this phase and the interpretation of its historical appropriateness to the magical world of early childhood. Later its anachronis