Some Comments on Kohut's “The Two Analyses of Mr. Z”

In an effort to consolidate the clinical understanding of self psychology, Kohut (1979) described the psychoanalytic treatment of a patient, Mr. Z., which took place in two separate phases—the first when Kohut was adhering to classical technique and the second as he was attempting to apply his concepts of the self to the therapeutic situation. Mr. Z. first entered analysis while in graduate school in his mid-20s presenting with somatic complaints, a difficulty in relating to young women, and a sense of academic underachievement. Masturbation, begun at age 5 and “addictively pursued” since early adolescence, involved masochistic fantasies of submission to a powerful, phallic-like woman. From 3¹/₂ to 5 years of age, his father was away from the home due to a serious illness that necessitated lengthy hospitalization, after which the father lived with the nurse who had taken care of him. During this time, Z., an only child, had occupied his father's bed in the parental bedroom.

For the first 12 to 18 months of this analysis, with a maternal transference predominating, Kohut's interpretations were directed at Z.'s “narcissistic delusions” of specialness and entitlement—interventions that were met with continuous resistance in the form of recurrent outbursts of rage. The remainder of the analysis was taken up with oedipal themes, most of which were associated with primal-scene trauma.

As a result of this analysis, Z. was able to forego masturbation, move away from his mother's home where he had been living, begin to date, and—for the first time—engage in heterosexual relations. Appraising the outcome, Kohut (1979) wrote: