Adolescent Psychiatry: Developmental and Clinical Studies. V, 1977: Psychoanalytic Perspectives on Adolescence, Psychic Development and Narcissism. Peter L. Giovacchini. Pp. 113-142.

In this rather complex, thought-provoking paper, Giovacchini addresses himself to two separate but related issues: 1) a definition of "narcissism" in adolescence, both pathological and healthy, and 2) approaches to the psychoanalytic treatment of people with severe narcissistic character pathology (not necessarily adolescent, although this form of pathology often manifests itself in adolescence). The author considers and compares Freud's and Melanie Klein's theories of infantile narcissism. He views pathological narcissism as the outcome of fixation at the prementational stages of early development when self and object world are not yet clearly differentiated. In adolescence, when character structure must be consolidated and the individual must adapt to the outside world, basic ego defects can no longer remain hidden. Symptoms then develop, such as rebellious acting out, confusion, attempts to simplify the outside world, sometimes psychosis. Giovacchini feels that, through classical psychoanalytic therapy which takes into account the need first to help the patient through prementational stages of relating, true ego growth can be promoted.