The Psychoanalytic Treatment of Narcissism

This paper discusses the need for change in emphasis from metapsychological debate to a sharp clinical focus on the complex nature of narcissistic pathology. Narcissism is viewed as a dimension of psychopathology found at all levels of psychic functioning, at the core of which are characteristic ego and superego deficits around self-cohesion, self-continuity, and self-esteem regulation. It is argued that, if the definition of conflict is not viewed too narrowly, traditional Freudian or ego-psychological techniques are applicable and that the treatment of narcissism does not require a new theory, separate from that of object relations. Clinical material is presented to illustrate that all psychological phenomena are over-determined and contain aspects of unresolved preoedipal and oedipal conflicts. There are critical selfhood aspects at each stage of development which must be understood and interpreted, in addition to the traditional structural conflicts. It is stressed that highly developed skills in listening and in interpreting are required in order to discern the narcissistic and object-relations aspects of the clinical material and that the countertransference around the analyst's own narcissism needs particular attention.