Narcissistic adolescents' object relations.

This article describes how narcissistic adolescents' needs for admiration and fusion are driven by primitive fears of annihilation and dependency. Freudian, British object relations, and interpersonal views of extreme adolescent narcissism are compared, and a case vignette is presented to emphasize the importance of an active analytic engagement with narcissistic adolescent patients. These adolescents unknowingly fear and seek being held in awe in the analytic relationship. Family psychopathology perpetuates the narcissistic adolescent's defensive reliance on grandiosity, entitlement, and the addiction to being admired. In contrast to the less disturbed adolescent, the severely disturbed narcissistic adolescent uses the admirer to sustain grandiosity and to maintain body image cohesion and ego integrity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narcissistic issues in therapists: Diagnostic and treatment considerations.

Examines narcissistic issues with which therapists are likely to struggle, including extreme audience sensitivity, pathological parentification, perfectionism, and impostor feelings. It is suggested that many therapists were, as children, raised by narcissistic parents, and these children learned to respond to parental needs at the expense of their own development. Unresolved narcissistic issues may contribute to therapist burnout as well as to a tendency to vicariously gratify needs through one's clients. An object relations approach to treatment emphasizes resolving dependency conflicts and developing more resilient self-esteem. Clients are provided insight through interpretations and a corrective interpersonal experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Islam and Its Effect on My Practice of Psychoanalysis.

Religion is an important constituent of a person's identity, whether it be a personal identity or an ethnic one. The ethnic religious identity is the seat of deep narcissistic attributes and could be a source of basic character flaws. Analysts and patients enter the analytic relationship with identities that have religious backgrounds, and their religions can have noticeable impact on their relationships. Although each religion has its own characteristics, all religions share some common features that affect the analyst and the analysand's reactions. The author approached Islam as a text that requires and invites a hermeneutic analysis. This approach distinguished it from psychoanalysis and lessened its impact on his practice. However, the author's approach to Islam was instrumental, in a profound way, in clarifying aspects of the classical theory of psychoanalysis, which would not have been easy to reach without taking Islam seriously as a subject of study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Shame and the self.

Reviews the book, Shame and the self by Francis J. Broucek (see record 1991-97963-000). Broucek's Shame and the Self synthesizes ideas from psychoanalysis, neo-Darwinian affect theory, developmental psychology, existential phenomenology, and cultural theory in explaining the connections among shame, the self, and narcissism. In this review, Auerbach details Broucek's revision of the problem of narcissism and the self. Narcissism, whether normal or pathological, is a relational concept that refers to a propensity to treat others primarily as objects (i.e., as narcissistic extensions of oneself) and not as subjects (i.e., not as selves with their own desires and needs). It is additionally, in Broucek's formulation, a representational concept that entails reflexive self-awareness. Broucek similarly overreaches himself in discussing the narcissistic elements of the psychotherapeutic process and of modern culture. Nevertheless, his discussion of these issues is always intriguing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narcissistic needs of the self and perceptions of interpersonal behavior.

A total of 78 mental health clients participating in therapy groups completed self-report measures corresponding to narcissistic personality defects derived from a self-psychology perspective and ratings of themselves on a checklist of interpersonal behavior. Also, pairs of group leaders were asked to rate clients on interpersonal behaviors. Results indicated a clear convergence of narcissistic needs and self-perceptions of interpersonal behaviors: Those with strong grandiose–exhibitionistic needs viewed themselves as having both dominant and friendly behavior, whereas those with strong idealizing needs viewed themselves as being submissive and moderately hostile. Therapist ratings of interpersonal behavior did not yield as many significant correlations with self-ratings of narcissistic needs: Those with grandiose–exhibitionistic needs were observed using dominant behavior and those with idealizing needs were observed using submissive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward helping child analysands observe mental functioning.

Discusses the emphasis on developing the technical implications of the structural model by modern literature on classical psychoanalytic technique and the importance of P. Gray's (1986) work in this resurgence of classical technical writings. In this article, the author applies Gray's work to child analytic technique and suggests ways in which his approach may prove useful in the difficult task of helping child patients to gain insight. A case of an 11-yr-old boy is presented as a heuristic example of how one might go about analyzing the child's defensive use of superego functions in the way that the author understands Gray to suggest. It is hoped that such an example can further attempts both to understand the nature of the child analytic process and to clarify further the technical implications of modern-day classical thinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the transitional realm as an organizer of analytic process: Transitional organizing experience.

[Correction Notice: An erratum for this article was reported in Vol 26(2) of Psychoanalytic Psychology (see record 2009-04869-002). The author’s name was incorrectly printed in the toc and in the author byline. The author’s name should read Joseph A. Cancelmo, PsyD, FIPA, Institute for Psychoanalytic Training and Research (IPTAR)] D. W. Winnicott's construct of the transitional realm of human experience has been widely applied and creatively extended since its introduction more than half a century ago. The author describes the extension of this construct beyond its roots in the phase-specific need for the transitional object to a paradigm for psychic structuralization. He then considers a larger implication of this construct as an organizer and vehicle of transformation in analytic process via the transference. In this more elastic use of Winnicott's construct, the analytic process becomes organized along the lines of the earliest transitional experiences: the developmental progression from a nascent to a separate self, the organization of drive experience via the other, and the sorting out of one's own mind in terms of subjectivity and objectivity. Transitional organizing experience is used as shorthand for these far-reaching structural and dynamic transformations that take place within and between patient and analyst in the dyadic interplay of the analytic process. Via familiar dynamic constellations that emerge within the analytic process, the analytic dyad comes to reexperience (as a 2-person psychology) and reorganize (as a 1-person psychology) toward less "pathological" transitional forms of experience, allowing for a resumption in development of creative transitional space. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Difficulties on the pathway to establishing an analytic process: On some vicissitudes of self-reflection during the opening phase of psychoanalysis.

The beginning of a psychoanalysis attempts to establish those aspects of the treatment that define the situation and process as uniquely psychoanalytic. From a classical perspective this entails the creation of a particular therapeutic ambience that encourages the patient to expand his or her capacity for self-reflection on the transference experience. In the present article, the author considers 3 major types of patients for whom the potential for establishing such a situation and process is compromised by various characterological difficulties. Clinical material is used to illustrate the particular way the analytic process is impeded in each of these types, and an attempt is made to systematically relate their difficulties to specific anxieties each experiences in reflecting on transference experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamics of Race and Culture in the Supervisory Encounter.

The rapid increase in racial/ethnic minority populations in the United States implicates the necessity of implementing new approaches to the training of psychologists. The author proposes that the integration of racial and cultural diversity related issues in clinical supervision is an essential component of clinical and teaching competence, which has important implications for the provision of services to ethnic minorities and, more broadly, to better addressing the full realm of clients' intrapsychic and interpersonal worlds. Psychodynamic aspects of the supervisory encounter, such as the narcissistic struggles of the supervisor and supervisee and racial and cultural elements in transference, contribute to supervisory interactions around race and culture. Clinical illustrations are discussed to elaborate these dynamic processes. Recommendations for supervisors on how to explore race and culture in a safe supervisory space are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The role of the transitional realm as an organizer of analytic process: Transitional organizing experience": Correction to Cancelmo (2009).

Reports an error in "The role of the transitional realm as an organizer of analytic process: Transitional organizing experience" by Joe Cancelmo (Psychoanalytic Psychology, 2009[Jan], Vol 26[1], 2-25). The author’s name was incorrectly printed in the toc and in the author byline. The author’s name should read Joseph A. Cancelmo, PsyD, FIPA, Institute for Psychoanalytic Training and Research (IPTAR). (The following abstract of the original article appeared in record 2008-19341-002.) D. W. Winnicott's construct of the transitional realm of human experience has been widely applied and creatively extended since its introduction more than half a century ago. The author describes the extension of this construct beyond its roots in the phase-specific need for the transitional object to a paradigm for psychic structuralization. He then considers a larger implication of this construct as an organizer and vehicle of transformation in analytic process via the transference. In this more elastic use of Winnicott's construct, the analytic process becomes organized along the lines of the earliest transitional experiences: the developmental progression from a nascent to a separate self, the organization of drive experience via the other, and the sorting out of one's own mind in terms of subjectivity and objectivity. Transitional organizing experience is used as shorthand for these far-reaching structural and dynamic transformations that take place within and between patient and analyst in the dyadic interplay of the analytic process. Via familiar dynamic constellations that emerge within the analytic process, the analytic dyad comes to reexperience (as a 2-person psychology) and reorganize (as a 1-person psychology) toward less "pathological" transitional forms of experience, allowing for a resumption in development of creative transitional space. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma of illness--crises in self concept regulation by cancer patients

Oncological diseases often represent a psychic trauma, which leads affected patients into a narcissistic crisis. Starting from the concept of narcissistic regulation system (Deneke, 1989), the origins of the destabilisation of the self are described, and parallels to persecution trauma will be drawn. The longing of the patients for symbiotic relationships are investigated in their double sense. On the one hand they serve the patient to stabilise his self, on the other hand they involve the danger of traumatisation within an object relation. The consequences for the process of mourning and integration will be discussed.     

Mistakes.

Psychoanalysts frequently make mistakes, but these errors often go unacknowledged because of the analyst's sense of shame. This is regrettable because mistakes are widely recognized to contain new and very useful clinical information. In three clinical vignettes the author describes the kinds of clinical errors he has made: errors associated with a defensively false analytic self, mistakes based on his narcissistic investment in the patient, and errors made in transference/countertransference enactments. These clinical vignettes demonstrate a method of repairing mistakes that involves disclosure, the selective communication of countertransference, and apology. A visual metaphor is used to describe the process of mistake and reparation: The analyst's “mis-take” is a failure to “see” an aspect of the patient's subjectivity. After expressing distress at feeling “unseen,” the patient helps refocus the analyst's vision. Through this mutual process of refocusing a therapeutic symbiosis develops that causes the patient to relax his or her defenses and thereby bring into vision previously unconscious aspects of him or herself, creating an expanded sense of self. Paradoxically what began as a mistake becomes therapeutic through its reparation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The ambiguity of the psychoanalytic situation and its relation to the analyst's reverie.

This article is about ambiguity in psychoanalysis, an ambiguity that is particularly striking in the psychoanalytic relationship between patient and analyst. The analyst is a professional in his consulting room, in his chair behind the patient, but he is at the same time a figure in the patient's realization of his inner world of objects. The analyst is a transference figure, but he is also a real person with his own inner private reverie and a subjective contribution to the analytic process. For some patients, the ambiguous analyst is an enormous challenge or threat. This article describes parts of the analytic process with one such patient, a man with an early history of severe trauma who at the start of his treatment completely denied this ambiguity and felt every reminder of his analyst being anything else but professional as a threat to his sanity. The author tries to show how the improvement of the patient's tolerance for ambiguity depended on the work done in the analyst's private reverie, a quite demanding process for the analyst. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Spinal cord injuries: psychological, social, and vocational rehabilitation.

Reviews the book, Spinal cord injuries: Psychological, social, and vocational rehabilitation, 2nd Edition by Roberta B. Trieschmann (1988). Despite the extensive rewriting and reorganization, however, the clarity and readability of the first edition has not been sacrificed. Owners of the first edition may want to obtain this one as well. In addition to presenting the information on psycho/social/vocational dimensions of spinal cord injury (SCI) in a developmental manner, from acute onset through rehabilitation and long-term adjustment issues, the author also discusses in depth such issues as traumatic brain injury, locus of control, substance abuse, independent living, and so on. Some of the topics covered in this edition that are not dealt with in the first edition are athletics, biofeedback, community integration, gender issues, quality of life, parenting, and respirator dependency. Some topics such as aging, attitudes, family issues, and sexuality are dealt with more completely. In addition to the empirical, critical analysis of the research on SCI that the first edition was known for, the second edition also suggests ways in which the research needs to be improved and supplemented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problems in falling in love

Certain patients enter psychoanalysis because of their inability to love another person. Often they report a repetitive erotic pursuit of desired partners, without being able to experience or maintain loving feelings. Kernberg has understood such difficulties as representing effects of early narcissistic disappointments and/or of difficulties in resolving oedipal conflicts. In this paper, Lacanian concepts of the mirror phase and symbolic love are employed to develop these issues. Sexualization of problems in mirroring may be fused with oedipal conflicts in some cases. An extended vignette is presented to illustrate the technical and theoretical issues.     

Narcissism in two forms: Implications for the practicing psychoanalyst.

There has been a great deal of controversy expressed in the recent psychoanalytic literature as to the etiology and treatment of patients with narcissistic personality disorders. The most intense disagreement has been centered around the largely contradictory theories of Heinz Kohut and Otto Kernberg. The clinically important distinctions between these two theories are outlined in this article. They include the differential importance each theory places on aggression in the etiology of narcissism and resistance in the treatment of narcissistic patients. A basic difference between these theories is the model they adopt for the understanding of the development of narcissistic pathology generally; with Kohut advocating a developmental arrest point of view, and Kernberg advancing a theory more consistent with classical psychoanalysis, that of an instinctual or structural conflict. This article contends that the understanding of the narcissistic patient can be greatly aided by recognizing that each of these theories correctly assesses and treats a specific form of narcissistic pathology. Clinical data from the psychoanalytic treatments of two narcissistic patients are presented. As is indicated by this clinical material, cues that the practicing psychonalyst can employ in making... (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cupid's misses: Relational vicissitudes in the analyses of single women.

Addresses the interface between adult needs for intimacy and the psychoanalytic process between a certain population of single female patients and their male analysts. Relational vicissitudes of this patient–analyst pairing are discussed from a perspective that is both psychoanalytic and psychosocial. Influences of gender differences, sociological factors, and the existential nature of prolonged unchosen singlehood on the female analysand's subjective experience are discussed. This discussion is followed by an exploration of the ramifications of singlehood for the analytic process and for the analytic relationship. The concepts of primary intimacy and a primary relational void are introduced, and clinical illustrations are incorporated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Self and Object Representations of Narcissistically Disturbed Children: An Empirical Investigation.

The aim of this study was to demonstrate a correlation between the clinical assessment of narcissistic personality disorder in children and underlying self and object relationships. D. Westen's Social Cognition and Object Relations Scale for the Thematic Apperception Test (1995; D. Westen, N. Lohr, K. Silk, K. Kerber, & S. Goodrich, 1985) was used to compare the object representations of two groups of referred latency-aged children, one for whom narcissistic issues were thought to be primary. Support for the clinical literature, which describes these children as lacking in empathy, struggling with self-esteem regulation, and in poor control of their impulses or aggression, was found. Additionally, a tendency to have a vulnerable sense of identity and to be preoccupied with seeking out and developing relationships with others was found to differentiate these children from peers with similar behavioral and diagnostic profiles. Results obtained have potential implications for the assessment and treatment of narcissistically disturbed children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Narcissism and intimacy: Love and marriage in an age of confusion.

Reviews the book, Narcissism and intimacy: Love and marriage in an age of confusion by Marion F. Solomon (see record 1988-98781-000). This book presents a rather unique blend of theoretical explorations and clinical case material which provides the reader with an extremely valuable look at issues facing the survival of marital relationships in our present culture. Beginning with a sociological perspective of how our culture has come to value autonomy and self-fulfillment, the author then identifies a series of "narcissistic myths" and goes on to explore how these myths impact on realistic perspectives of marriage and intimate relationships. The reviewer believes that this book has a wealth of readable theoretical material along with clinical case examples which bring the theoretical perspectives alive and translate them into tools for effective treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy integration in Portugal.

In answering five questions regarding the status of psychotherapy in Portugal, predominant theoretical orientations, standing of psychotherapy integration, and cultural issues, the author draws a brief sketch of the situation of psychotherapy in Portugal. It is stressed the increasing number of patients seeking therapy as well as the increasing number of professionals providing it, and a growing dialogue between psychologists and psychiatrists. In terms of theoretical orientations, the dominant ones are the analytic/dynamic and the cognitive-behavioral with an increasing number of therapists leaning towards integration. In terms of cultural issues relevant to psychotherapy, it could be said that a significant number of patients deal with issues related to the question of balancing "cooperation/proximity" and "agency/competitiveness," as well as matters of unassertiveness. From the standpoint of the author, major lessons learned from being in Sepi are flexibility, humility, sharing, and something close to the "bearable lightness of being..." (PsycINFO Database Record (c) 2010 APA, all rights reserved)