The first stage of treatment with the conduct disordered adolescent: Overcoming narcissistic resistance.

Presents an approach to treating the conduct-disordered adolescent (CDA) that emphasizes confronting the patient's narcissistic resistance in the early treatment stage. For CDAs, their parents have served neither as ideals for them nor as checks on their natural narcissism, and CDAs remain dominated by self-love. CDAs deny differences between adults and children; the therapist must challenge this denial of differences through a narcissistic injury. For the therapist to present himself or herself as superior to the patient and also as someone the patient can hope to emulate, there are 3 steps: identifying with the patient, challenging the patient's infantile grandiosity, and responding to the patient's anger. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shame and gender issues in pathological narcissism.

Discusses the importance of monitoring the emotion of shame, which is closely linked to identity, in psychoanalysis. Shame is distinguished from guilt, and its relationship to pathological narcissism is discussed. A typology of narcissistic pathology is also described, which is mediated by the extent to which grandiosity is consciously experienced by the patient. Specifically, where grandiosity is conscious and central, there is a distinct shame avoidance quality. Males tend to be overrepresented in this category. Where grandiosity is disavowed, although unconsciously present, there is a heightened sensitivity to shame. Women seem to cluster here. Case illustrations of each type are included, and theoretical approaches to treatment are discussed. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narcissism and parenting styles.

Investigated D. Baumrind's (1966) authoritative, permissive, and authoritarian parenting styles in the context of H. Kohut's (1977) psychology of the self. 324 undergraduates' perceptions of their parents were correlated with measures of self-functioning in order to test the hypotheses that (1) perceived parental authoritativeness would be associated with less narcissistic maladjustment, (2) permissiveness would be associated with immature grandiosity, and (3) authoritarianism would correlate with inadequate idealization. All 3 suggestions received empirical support. Some evidence suggested that authoritarianism might be incompatible with immature grandiosity. Parenting characteristics of the mother were more strongly correlated with self-development than were those of the father. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hidden grandiosity in bulimics.

A hidden grandiosity in bulimics, with supporting case material (with adult female clients) and a theoretical framework, is described. The author describes its relation to social pressures, its masked manifestations, how it functions in the bulimic's psychic economy, how it emerges in therapy, and treatment strategies. The trait is described as relevant to well-known features of bulimia, such as black-and-white thinking, perfectionism, different rules for self and others, and specialness. Of particular relevance are the connections to borderline personality disorder, narcissistic injury, and ego deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Initial construction and validation of the Pathological Narcissism Inventory.

The construct of narcissism is inconsistently defined across clinical theory, social-personality psychology, and psychiatric diagnosis. Two problems were identified that impede integration of research and clinical findings regarding narcissistic personality pathology: (a) ambiguity regarding the assessment of pathological narcissism vs. normal narcissism and (b) insufficient scope of existing narcissism measures. Four studies are presented documenting the initial derivation and validation of the Pathological Narcissism Inventory (PNI). The PNI is a 52-item self-report measure assessing 7 dimensions of pathological narcissism spanning problems with narcissistic grandiosity (Entitlement Rage, Exploitativeness, Grandiose Fantasy, Self-sacrificing Self-enhancement) and narcissistic vulnerability (Contingent Self-esteem, Hiding the Self, Devaluing). The PNI structure was validated via confirmatory factor analysis. The PNI correlated negatively with self-esteem and empathy, and positively with shame, interpersonal distress, aggression, and borderline personality organization. Grandiose PNI scales were associated with vindictive, domineering, intrusive, and overly-nurturant interpersonal problems, and vulnerable PNI scales were associated with cold, socially avoidant, and exploitable interpersonal problems. In a small clinical sample, PNI scales exhibited significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Time on my hands: The dilemma of the chronically late patient.

In this article the author discusses the problems and dilemmas created by patients who are chronically late for analytic hours or frequently absent from them. The discussion focuses on a single case study, in which this phenomenon was a predominant feature of the analytic process. The author explores some of the issues, dynamic and defensive, underlying such behavior as well as motivational components involving unresolved oedipal issues and powerful unsatisfied narcissistic needs. The temporal difficulties of patients such as this one demonstrate the role of time as a point of conjunction of aspects of the analytic relation involving the temporal dimension of the real structure of the analytic situation and its intersection with transferential and alliance considerations. The analytic task is to balance the temporal requirements of the analytic process against the array of the patient's infantile and narcissistic needs on one hand and legitimate claims for autonomy and freedom on the other. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The grandiose character, primary type

In this article I have elucidated the diagnostic entity of the grandiose character, primary type. The concept of the primary grandiose character has been around for a long time but has not been formally elucidated. The primary grandiose character is contrasted to the reactive grandiose character, which is the type normally considered in the literature. The primary grandiose character is someone who was treated with such anticipation and succor by the parents that he learned to feel no way but good and to demand succor when he did not feel good. The reactive grandiose character is someone who originally moderated his primary grandiosity but re-intensified it in order to defend against later appearing pain, particularly of a narcissistic sort. The primary grandiose character develops a large array of fears and depressions as he learns little developmentally except how to demand. In the face of these increasing anxieties and depressions, he simply demands more and more. When he appears in treatment, he shows himself as an anxiety- and depression-ridden individual, with a strong need for help (succor). The analyst tries to help with the anxieties and depressions but the treatment goes round and round because the patient does not cathect the observing function of his own ego, only that of the analyst's ego: the analyst is to know what is wrong (observe it) and fix it. When the analyst does not fix it (although he might, for a while, observe it), the analysand's grandiose rage breaks through and he shows himself for what he is, a grandiose character, primary type. Now the task is clear but the treatment formidable. The analysand must come to observe that he is grandiose and that he has foresworn the observing function. This process, which comprises a major portion of the working through, is replete with grandiose rage, working through, grandiose rage, and working through. Ultimately the patient discovers the great strength that comes from decreased reliance on the observing ego of others and increased reliance on his own observing ego. A number of diagnostic entities and clinical behaviors are shown to have a primary grandiose base. And rather than some of these depending upon repression as the basic defense, it would seem that they depend on a pre-stage of repression, akin to the concept of biological irritability. The concepts of secondary grandiosity, partial grandiosity, and developmental grandiosity are natural corollaries to the concept of primary grandiosity.     

Brief psychotherapy of narcissistic disturbances.

Applies recent psychoanalytic theories of normal and pathological narcissistic development (the psychology of the self) to the brief psychotherapy of the narcissistically disturbed patient. The author discusses treatment goals, strategies, phases, and the typical transference–countertransference reactions that occur in treatment, illustrating with 4 case studies. The therapist's use of him/herself as a narcissistic object for the patient to reestablish a sense of self and self-esteem is described. The therapist's involvement, positive mirroring, and implicit permission to be idealized provide the patient with a vehicle for accomplishing the principal goal of brief psychotherapy: the reattainment of self-esteem and a positive self-image. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoanalytic considerations of right extremist orientation of male adolescents

Giving a case example of an male adolescent with radical right-wing attitudes, the lack of male identification as well as in unresolved dyadic fixation to the mother will be shown. Though the radical right-wing orientation the adolescent tries on the basis of a phallic narcissistic conflict to establish bordes against an unresolved dyadic fixation to his mother.     

From the laboratory to the hospital, adults to adolescents, and disorders to personality: the case of psychological reactance

Study 1 assessed whether trait reactance in disturbed adolescents (ages 12 to 17) is part of the same constellation of personality variables associated with reactance in adults, and Study 2 examined whether reactance predicts inpatient treatment duration and outcomes. Correlations between reactance and MMPI-A variables among 76 inpatients (41 girls) showed that reactance is associated with oppositional, nonaffiliative, and narcissistic traits in disturbed adolescents as well as adults. Reactance predicted longer hospital stays among 176 adolescents (90 girls), and also changes in aggression, mood problems, and substance abuse among those in middle (n=89) but not early (n=87) adolescence. Additional analyses identified "typically male" and "typically female" patterns of reactance-change relationships. The clinical significance and utility of these findings are discussed.     

The vital role of adaptive grandiosity in artistic creativity

The artist needs adaptive grandiosity in order to create. Adaptive grandiosity is an ego-state that derives from primary narcissism and a partial resolution of the positive Oedipus complex, with the ego-ideal merged with the ego. It functions as a manic defense to overcome the artist's annihilation anxiety when confronting the blank canvas or other aspects of creativity which unconsciously represent separation from the maternal introject. Because of it fragile, defensive nature, adaptive grandiosity can readily degenerate into maladaptive grandiosity (omnipotence), which can block creativity. Clinical examples are used to illustrate the differences between adaptive grandiosity and omnipotence.     

Interpreting sex.

Manifest references to sex issue from varied levels of psychic function, and they serve many functions in the patient's construction of the here-and-now analytic relationship. Once explored psychoanalytically, with special reference to transference and countertransference, that manifest material often leads into the unconscious fantasies characteristic of the paranoid-schizoid position, as described by Kleinian analysts. Resolution of sexual problems then requires working through the primitive narcissistic trends on that level. Clinical examples are included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent attachment and psychopathology.

The relationships among attachment classification, psychopathology, and personality traits were examined in a group of 60 psychiatrically hospitalized adolescents. The concordance of attachment classification was examined in 27 adolescent-mother pairs. Both adolescent and maternal attachment status were overwhelmingly insecure and were highly concordant. Adolescents showing a dismissing attachment organization were more likely to have a conduct or substance abuse disorder, narcissistic or antisocial personality disorder, and self-reported narcissistic, antisocial, and paranoid personality traits. Adolescents showing a preoccupied attachment organization were more likely to have an affective disorder, obsessive-compulsive, histrionic, borderline or schizotypal personality disorder, and self-reported avoidant, anxious, and dysthymic personality traits. The results support a model of development of psychopathology based partially on relational experiences with parents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of background similarity and trait structuring on the perception of a taped therapist.

Examined the effects of the following factors on attraction to a taped therapist: (a) type of s (48 normal 10th-12th graders vs. 32 disturbed adolescents in a residential treatment center), (b) trait structuring (warm vs. Cold), and (c) structured background similarity (therapist had or had not had treatment as an adolescent). Measures obtained following the playing of the taped therapy session reveal that, as with previous samples, normal and disturbed ss were more attracted to a therapist previously described as warm rather than cold. In addition, ss were more attracted to a therapist described as being similar to themselves in treatment background. (23 ref.) (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)     

Social influence and counterinfluence within families of four types of disturbed adolescents.

Investigated factors in the intrafamilial environment which may explain variations in the forms of adolescent psychopathology. Social influence messages were elicited from 24 disturbed boys and 8 disturbed girls, median age 16 yr., and their parents. These messages were used subsequently in a simulated interaction task. Application of a social influence coding system to the influence statements, expectations of others' responses, and actual responses and shifts in responses following awareness of expectations differentiated families of 4 types of disturbed adolescents. 2 parameters of parental behavior were significant in differentiating among the adolescent problem groups: (a) the overtness or assertiveness used in exerting parental social influence, and (b) the focus of power in 1 or the other parent. The interaction of these variables is discussed in relation to the types of disturbance shown in the adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inconsistent communications and psychopathology.

Investigated the presence of possible incongruity between verbal and nonverbal components of parental messages to a disturbed child. Video-taped family interactions of 2 groups of families in which there were 2 degrees of psychopathology of an adolescent member were employed. There were 2 different measures of incongruity between attitude conveyed in verbalizations and posture. Findings did not support the hypothesized relationship between incongruity and degree of pathology. Results did however indicate a relationship between degree of negative attitude conveyed by parental messages and rated psychopathology of the adolescent in the family. It was found that parents of the more disturbed adolescents verbally communicate more negative attitudes toward the adolescents than parents of the less disturbed adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The draining fantasy in male schizophrenics and in normal Sambia males.

Demonstrates that the draining fantasy (DF, the association of semen with milk and the fear of being drained of this "semen/milk" during intercourse) exists both in some male schizophrenics and in normal men of the Sambia tribe in New Guinea. The multiple causes of the DF are elucidated. For male schizophrenics, the DF is traced to oral trauma and fixation, impaired self-other boundaries, and sexually-tinged narcissism. For Sambia males, the DF is traced to an oral fixation stemming from early overgratification and to desires and fears of being re-engulfed by the mother. The DF among the Sambia is also fueled by male narcissism and castration fears. Although the Sambia occupy a higher developmental level than schizophrenics (roughly narcissistic to oedipal, as compared to early oral to narcissistic, respectively), there is sufficient overlap between the groups to account for manifestations of the DF. (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)