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This paper describes the 10-year psychoanalytic treatment of a man suffering from a severe narcissistic personality disorder. I will emphasize the effect of two “moments of meeting” in the analysis that led to a profound shift in the analysand's habitual way of being, particularly in the area of his enslavement to the needs and wishes of others. I will also discuss the implication of the handling of these so-called “now moments” in the treatment of personality disorders in general and of patients with enduring structures of pathological accommodation in particular.
My interest in this subject has been stimulated by the recent writings of the Boston Process of Change Study Group , which has studied the process of change in psychotherapy, with special attention to the “something more” (than insight) which produces change in psychotherapy and by the writings of Bernard Brandchaft (, ) on systems of pathological accommodation.
Drawing on clinical and development observations, the Process of Change Study Group proposed that interactional processes from birth onward give rise to a form of procedural knowledge regarding how to