The Treatment of Narcissistic Neuroses and Psychoses

What has psychoanalysis to offer in the way of therapy for the narcissistic neuroses and psychoses? In many instances we have had to recognize that our technique is unable to penetrate into the deeper layers of the disease-formation, and the result of attempted treatment has been merely to strengthen our appreciation of the need for better methods. Possibly the ultimate successful approach to these difficult conditions will lie outside the field of psychoanalysis. But at the present time it seems as though mental science has opened up new means for understanding the nature of the problem; and to derive from this insight a theory of treatment would seem to be the first step towards testing and applying our formulations.

One's first thought would be that some degree of success should result from following the methods found to be so helpful in the transference neuroses. As Freud has indicated, however, experience definitely shows that some radical modification in technique is necessary if the narcissistic situation is to be influenced. According to our theories, the depth of the fixations involved, their source in the very earliest periods of development, and the characteristic rigid aloofness of the narcissist are factors which baffle the usual methods of psychoanalysis. Thus while we may learn a great deal about narcissism by applying the technique of ordinary analysis, we fail to help the narcissist. It is, of course, true that in the narcissistic neuroses there are many other elements involved in addition to the narcissism. Innate tendencies of the ego or inhibitions in its development must constitute an important factor, as do the problems of the super-ego and the many possible fixations of libido—of which the narcissism is only one. Nevertheless, it is the narcissistic trend which is most outstanding in these disorders, and it is the narcissim which constitutes the first great barrier to any therapeutic approach or possible