1 Clinical Consequences of the Theory of Self Psychology

In this chapter, I would like to address some of the questions that have been raised about self psychology and to participate in a constructive dialogue with its proponents. In the Random House Dictionary of the English Language , dialogue is defined as “an exchange of ideas between two or more persons on a particular issue, especially political or religious, with a view of reaching an amicable agreement or settlement.” There are two aspects of this definition that we should not follow: We do not want our dialogue to have political or religious overtones, nor do we expect to reach agreement. In the words of Godfrey Turton (1967), “Harmony is a great good but there are others greater for whose sake it must in the last resort be renounced.” (p. 2) If we do not set harmony as our goal, we should at least strive for communication.

I have assumed that anyone sufficiently interested in reading this chapter will likely have a general grasp of the main propositions and concepts of self psychology as developed by Kohut and his coworkers. For that reason I will dispense with any introductory summary and immediately state the premise of my exposition, namely, that if applied exclusively and literally, the theoretical concepts of self psychology lead to a clinical approach that departs in certain important ways from essential elements of the psychoanalytic situation and process. Further, while such an approach may achieve demonstrable therapeutic change, it may be questioned whether such change can be considered as derived from the same personality processes and alterations as are set in motion in psychoanalytic treatment conducted along classical lines.

In order to demonstrate this point of view, I present two case vignettes offered in the literature by proponents of self psychology that offer an opportunity to examine some of the consequences of using that