Analysis of a Narcissistic Patient

In Section I (see Chapter 3, pp. 32-42), I have already discussed some of the implications for our understandings and formulations concerning the PRP research population that might stem from the conceptual advances in theoretical and clinical understandings between the state of the field in the 1950s, when these case studies were originally formulated, and the state of the field today in the 1980s. Of particular moment to this concern have been the formulations about the borderline personality organization and its treatment (Kernberg, 1975, 1976, 1980); the formulations about the narcissistic disorders and the derived theoretical perspectives of self psychology (Kohut, 1971, 1977); and the object relations and developmental personality perspectives (see Jacobson, 1964, in regard to object relations theory, and Mahler , 1975, in regard to separation-individuation theory). I have stated in the earlier discussion (see pp. 33-34) why I feel that there is less substantial difference than might at first be thought between the emphases and formulations reflected in our case write-ups of that era, which have been drawn upon for the presentations in this volume, and the ways in which those same cases might be formulated and described if studied de novo today. Certainly the concept of “borderline,” in much the way that Kernberg later came to delineate and articulate it, inheres in our PRP clinical thinking, partly because (as already indicated, pp. 33-34) it was out of the history and clinical milieu of The Menninger Foundation, and the treatment of the PRP patients within it, that Kernberg began to develop his formulations about borderline personalities and the object relations perspective as a means of understanding them. Later, as I describe more fully the treatment courses with the sicker PRP patients, this complete congeniality between the original ways of conceptualizing and describing the patient population and the ways they wou