2 How Kohut Actually Worked

There is widespread curiosity among those who are interested in self psychology about how Heinz Kohut actually worked in the clinical situation. Both students and senior colleagues frequently ask questions such as, What did Kohut consider a fragmentation? How did he work with dreams? How did he deal with frank oedipal or preoedipal material? What are some specific examples of the repair of empathic failures leading to transmuting internalization?

While Kohut has written a great deal and has answered these questions, at least in part, the answers are scattered throughout the body of his work. The Psychology of the Self: A Casebook, edited by Arnold Goldberg, is a valuable contribution and answers many of these questions. Nonetheless, many analysts and candidates remain intensely curious about Kohut's actual specific teachings. This chapter attempts to answer some of these questions.

I was fascinated by my reading of The Analysis of the Self, wrote to Kohut, and arranged to begin consultations with him in November 1978. I saw him for a total of 23 double-length sessions between then and July 1981. Our work was interrupted from time to time because of his several severe illnesses and our last meeting occurred less than 3 months before his death. I believe I had a view of the final stages of the development of his thinking.

At the time I began my consultations with him, I was an experienced analyst, having been practicing for nearly 16 years. I presented in some detail the last 2 years of a successful 5-year analysis. We followed this patient through the termination phase, and most of the examples I will give in this chapter are drawn from that work. I also presented to him the first 2¹/₂ years of a beginning analysis and, also, made various “spot” presentations of interesting clinical instances.

The patient on which this chapter is primarily based was a highly successful man in his 30s when he first consulted me. He was married and the father of several children. The patien