The Narcissistic Transference and The Psychoanalytic Treatment of Narcissistic Personality Disorders - Coursework Example

The Narcissistic Transference and the Psychoanalytic Treatment of Narcissistic Personality Disorders Introduction Transference embodies one of the principal concepts of psychoanalysis and psychodynamic psychotherapy. In order to work with the patient towards a better mental health, analysts spotlight the patients’ transference by exploring the feelings induced by the patient and patient’s resistance towards saying everything. Transference can be defined as the projection onto the analyst of a person’s unresolved feelings and issues pertaining to significant others from the past. The patient experiences the analyst via lens of his or her relationships and experiences with the significant others in life. The patients experience their analyst as if the analyst is a significant figure from the past. Hence, the patient does not necessarily perceive the analyst as a separate and unique person from himself or herself. The analyst studies the patient in order to decipher what the patient’s formative years were like. The transference itself revolves around four critical components; how the patient feels about self, how the significant other, especially the primary caregiver felt toward the patient, how the patient felt toward the caregiver, and how the patient wished the caregiver felt towards him or her. Narcissistic transference infers a post-Freudian term advanced by Heinz Kohut. Narcissistic personality arises from inability of patients to form transference with their analysts. The narcissistic transference infers a breakdown in sufficient development of the self to such threshold that the individual is unable to experience dependable self-esteem. This necessitates the need to use the therapist as a primitive self object via who to obtain them. The theory of narcissism, which centres on a group of clinical phenomena observed during analytical treatment (Brenner 108). Freud’s analysis of transference highlights the transposition of object relationships. An analysis of Freudian ideas on transference and narcissism paints a perception that both concepts were such contrary ideas for him to the extent that they were meaningless in his eyes. Nevertheless, contemporary psychoanalysts have molded narcissism and incorporated it into the evolution of treatment. Phenomenology and Diagnosis Kohut’s View of Narcissistic Personality Disorder In the analysis of self (1971), Kohut explores various aspects of transferences. “Mirror transferences” encompass a reconstruction of the idealized grandiose self and can be summarized in the following sentence: “I am faultless and require you to validate it.” Mirror transference forges the materialization of a feeling of dullness or impatience in the analyst. One of the most apparent and archaic encompasses merger transference; the patient pursues an invincible and autocratic control over the analyst, projected as an extension of the self. Secondly, in “alter-ego transference,” the other is projected as analogous to the grandiose self. Lastly, in the event of mirror transference, the analyst experiences a function delivering the patient’s needs (Siegel 65). In the event that the patient feels recognized, the patient will experience sensations of well-being commensurate with the restoration of their narcissism. Kohut defines an “idealized transference” as the development of an idealized and invincible maternal image. This can be depicted by the phrase “you are perfect, but I am part of you.” This correlates with a struggle against feelings of insignificance and powerlessness. Kohut’s notion of some people being cathected as parts of the self in which they are integrated into the mental functioning of the patient himself, informed his construction of “self-objects.”This infers narcissistic transference as grounded in idealized self-object (Brenner 115). Heinz Kohut brought narcissism into relation with a broader entity of self rather than the restrictive ego. Similarly, he introduced the notion of a line of development of narcissism paralleling the growth of object-cathexes and interacting with it. As a result, narcissism and object-love are no longer in conflict with each other; rather, they complement each other (Spotnitz 198). Moreover, it became easier to easier to explore the concept of narcissistic transferences. Overview Do Therapists want a narcissistic transference to develop? Therapists, when starting treatment, create an environment that facilitates a narcissistic transference in order to first go through the patient’s narcissistic aggression. Therapists may want a narcissistic transference to develop because, in a negative and regressed state, a patient may envision the analyst as aping him or her or the analyst may not exist for him. Similarly, the synchronic sensation of togetherness is in essence curative one, while the feeling of solitude or withdrawn state is merely protective (Brenner 117). Treatment Narcissistic character pathology is broad while the reasons for seeking treatment are many. Similarly, the capacities and circumstances vary; thus, treatment must be customized to each case. Analysts should pay attention to aspects such as motivation, insight, and life circumstances when formulating treatment goals and plan (Brenner 122). Individual therapy The capability and enthusiasms of the patient are decisive to considerations when choosing and recommending forms of individual therapy. This incorporates measuring the patient’s general ego strength. This encompasses reviewing the quality of personal relationships, capacity for love and feelings of guilt, anxiety, impulse control, and tolerance, among other elements. The depth of a patient’s internal relationships with others and not the extent of involvement in social interactions shape a chief indicator of for the treatment that should be adopted (Spotnitz & Meadow 55). Psychoanalysis and psychoanalytic psycho therapy Self psychology Kohut envisions the narcissistic transference, inclusive of detachment and depression, as masked desires for acceptance by merger with and imitation of the therapist. According to this approach, the therapist should develop the capacity to allow the patient to construct a mirroring, idealizing or dual transference while avoiding premature interpretation of the patient’s grandiosity and narcissistic conflicts. This calls for empathic understanding and explanation instead of interpretation of defenses. Empathy infers an adjustment with the patient’s inner affective life that allows the therapist to comprehend what each situation portends, especially to the patient (Spotnitz & Meadow 56). An empathic therapeutic relationship rekindles the childhood hope for empathic responses to the narcissistic needs for confirmation, union, and imitation. This forms the basis for successful treatment. The therapist should demonstrate that he/she is in line with the patient’s disintegration anxiety and shame related to the patient’s insecurely established self. The therapist should establish a safe environment, which permits construction of the impulsively arising transference mobilization of the previous narcissistic needs. This might have been previously denied, hidden or repressed by the patient (Spotnitz & Meadow 60). This enhances the ability of the patient to experience the need for self-object acceptance of childhood grandiosity and an omnipotent surrounding. The maintenance of such an atmosphere in which long-buried needs are allowed to thrive transforms into ordinary self-assertiveness and ordinary devotion of ideals (Spotnitz 204). Kernberg’s view of Narcissistic Personality Disorders Bela Grunberger (1956) perceived narcissism as one of the motors of the analytic cure even among neurotics. He labelled Freud’s narcissistic transference as “narcissistic analytical relationship.” In this context, Grunberger outlines certain strategies such as analysts can create a double image of himself as well as projecting the ideal ego onto the analyst. Ego Psychology-object relations Kernberg highlights the pathological and defensive nature of the narcissistic individual’s grandiose self, inclusive of demands for mirroring and idealization of the therapist. Treatment in this case focuses on the establishment and interpretation of a narcissistic transference directed at uncovering the patient’s resentment and rage, as well as clarifying their link to yet to be fulfilled longing for the loving care from the primary care giver (Spotnitz & Meadow 60). Thus, the patient’s defensive narcissistic structure is relaxed, if not surrendered. It also enhances the capacity for intimacy and rewarding object relations. According to Kernberg, reliable interpretation of the negative transference is the outcome of effective analytic work with narcissistic patients. The negative transference, where the narcissistic individual perpetually devalues and denigrates the analyst, and the analytic work poses a danger of turning the analysis into a fraud or meaningless game. This may be manifested by pseudo-compliance or less subtle forms such as undoing one session of the work of the previous one. This may make the therapists experience themselves as ineffectual, inept, and invisible compounded by feelings of anxiety prior to commencement of patient’s sessions (Siegel 92). The therapist should recognize and effectively use counter transference in the treatment of the narcissistic patients. This arises from the fact that patients utilize the therapist as an extension of self whereby the patients may induce certain states in the therapists, which mirrors what the patient is struggling. Thus, the analysts should not reveal to the patient what their own reaction is, but should persistently recognize the hidden intention of the patient’s behavior (Etchegoyen 52). Idealizing of the therapist by narcissistic patients is perceived by Kernberg as a pathological process instead of a recreation of regular developmental stage. This idealization may be visualized as a construction of the patient’s ostentatious self onto the analyst, while disallowing the detachment of the therapist. This acts as a defense against feelings of rage or envy as well as a buffer against projected sadistic wishes that the patient experiences out of fear of attack by the therapist (Siegel 91). Adequate ego resilience on the part of the patient and appreciative attitude on the part of the analyst aids the patient in accepting the feelings, as well as experiencing the analyst and other persons in his or her life. The patient begins to view them as independent beings toward which he or she can project positive affections. The patient is now able to experience an enriched sense of his or her inner self (Etchegoyen 53). Conclusion A person’s original narcissistic balance is disturbed by unavoidable shortcomings of maternal care. Nevertheless, the child may attempt to save the original experience through assigning it on the grandiose and exhibitionist image of the self. Cotemporary psychoanalysts conclude that most of the difficulties experienced by many patients originate from pre oedipal period. Cotemporary analysts are equipped with skills pertinent to constructing transference on a narcissistic basis. This incorporates allowing the patient to mold the transference object in his or her own image. The patient is allowed to construct a picture of the therapist as someone like himself or herself into a person whom he or she will eventually feel free to love and hate. Although the two approaches on pathological narcissism and its treatment may seem to be competing, they are at time complementary. The two approaches shape a dual perspective on narcissistic personality disorder. The two approaches furnish the analyst with a complex but comprehensive way of listening to, understanding, and treating patients with anarchistic transference. The treatment of patients with narcissistic personality disorder should be flexible and individualized; they avail the therapist with treatment options tailored to respond to the patient’s case. Works Cited Brenner, Charles. Psychoanalytic Technique and Psychic Conflict. New York: International Universities Press, 1976. Print. Etchegoyen, Horacio. The Fundamentals of Psychoanalytic Technique. London: Karnac, 2005. Print. Spotnitz, Hyman. Modern Psychoanalysis of the Schizophrenic Patient. 2nd ed. Northvale: Jason Aronson, 1999. Print. Spotnitz, Hyman and Meadow Phyllis. Treatment of the Narcissistic Neuroses. Northvale: Jason Aronson, 1995. Print. Siegel, Allen. Heinz Kohut and the Psychology of the Self. London: Routledge, 1996. Print. Read More