Reflections on Kohut's Theory of Self Psychology and Pathological Narcissism—Limitations and Concerns

Kohut's theory of self psychology, centered on the concept of narcissism, has vastly influenced the way narcissism is perceived in the psychoanalytic community. Yet while significantly contributing to the psychoanalytic discourse, his theory gives rise to some issues and concerns. This article deals with the problematic aspects of Kohut's theory, specifically with reference to the identification, diagnosis, and treatment of pathological narcissism. The article discusses the conceptual ambiguity surrounding Kohut's proposed model of narcissism vis-à-vis his notion of the self. I suggest that this conceptual ambiguity could lead to an erroneous attribution of narcissism to patients who are not necessarily narcissists but who have failed to develop a mature sense of self. I would further argue that Kohut's diagnostic method, primarily based on selfobject transferences, is not only inadequate, but potentially misleading, since such selfobject transferences are commonly observed in patients who are not suffering from narcissistic personality disorder. Two clinical case studies illustrating my point are presented next. Finally, I explain my critique of Kohut's view of narcissism, which highlights self-selfobject relationships rather than the relationship with a separate other and fails to take into account the complex and dynamic inner world of the narcissist and the defensive function of narcissism.