Conflict and Deficit: Two Theories or One?

In a recent article in this journal titled “Psychoanalysis: Treatment of Conflict or Deficit?” Sugarman (1995) illuminated a major controversy in psychoanalysis. Sugarman not only pointed out the two different views of the etiology of psychopathology that were born out of these two models but pointed out two different views of the process of treatment that eventuate from this differentiation as well. These are not insignificant differences that evolve from the conflict-versus-deficit models; hence, the validity of this dichotomous way of thinking deserves to be examined as much as possible. That is one purpose of this article.

The conflict–deficit controversy stems from the work of Kohut (1984), who maintained that narcissistic pathology was not based on conflict, but on “deficit in his [the patient's] self-structure” (P. 209). The deficit model was further explicated in Stolorow and Lachmann's book Psychoanalysis of Developmental Arrests (1980).

Kohut articulates this difference, but does not present a rationale for his assertion; nevertheless, it has been presumed by self psychologists that he was correct. Consequently, for them, the conflict and deficit models constitute incompatible and mutually exclusive viewpoints. However, Sugarman joins the ranks of a growing number of those who are calling for a synthesis of these two models (e.g., Curtis, 1986; Glassman, 1988; Killingmo 1989; Markson & Thompson, 1986; Modell, 1984; Shapiro, 1977; Stolorow & Brandchaft, 1987; Wallerstein, 1983). However reasonable this recommendation might seem to be, no one has offered a rationale