The Case of Gayle and Discussions: Introduction

In their introduction to the volume of Contemporary Freud: Turning Points and Critical Issues, devoted to Freud's classic paper “On Narcissism,” the editors refer to Freud's thinking as “opening up our understanding of motivation as stemming from something other than instinctual gratification, and presaging not only structural theory but object-relations theory, as well as the importance of the self concept as opposed to the ego” (p. ix). Heinz Kohut (1966) also acknowledged his indebtedness to Freud for having paved the way as pathfinder and bold explorer, and he used Freud's conceptual organization as he broke narcissism down into two major tributaries—one connected with drives, exhibitionism, and grandiosity; the other connected with the ego ideal and the idealized parent imago. Thus, for psychoanalysis in general, and self psychology in particular, the study of narcissism has yielded a rich lode of precious ore in the form of new clinical ideas. Kohut's study of the narcissistic personality disorder launched self psychology, which in turn spawned the contemporary off-shoots of motivational systems and affect theory, intersubjectivity theory, interpersonal and relational theory, and nonlinear, developmental systems theory. Since it all began with the study of narcissism, today we are returning to that same topic as a way of gauging how far we've come, where we are going, and how self-psychologically informed clinicians working today think about the narcissistic patient.

Dr. Hazel Ipp was asked to share with us clinical material from a patient who might have fit Kohut's definition of the narcissistic personality disorder, to remain close to clinical phenomenology in her