Paranoia and Narcissism in Psychoanalytic Theory: Contributions of Self Psychology to the Theory and Therapy of the Paranoid Disorders

In a very short period of time, the school of self psychology has come to represent one of the most important paradigmatic shifts in the history of psychoanalysis. Though initially Heinz Kohut and his followers were primarily interested in the problems of narcissism and the narcissistic personality, The Restoration of the Self (1977) heralded a new project. “Psychology of the self in the broad sense” now advocated a more fundamental revision of psychoanalytic metapsychology. In place of the central role of drives, Kohut asserted the central role of the self in its matrix of selfobjects. In place of a perpetually ambivalent and conflicted individual, Kohut saw a basically unified person who was more likely to suffer defeat than conflict. Instead of self-representations viewed as contents of the psychic apparatus, Kohut developed the concept of the bipolar self as the center of the person's psychological universe. Structural deficits replaced conflicts as the primary locus of psychopathology.

However, it may be that Kohut's most important contributions lie in the clinical realm. He described the significance and meaning of certain interactional modes (the self-object transferences) within therapy and the countertransferential responses they characteristically evoke (Wallerstein, 1983). Mirroring and idealizing transferences and selfobjects have crept into the vocabulary of even non-Kohutian therapists. Kohut legitimized the clinical focus on the narcissistic developmental line, that is, on the vicissitudes of self-esteem, feelings of depletion and fragmentation, use of others to