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Ornstein, A. (1974). The Dread to Repeat and the New Beginning: A Contribution to the Psychoanalysis of the Narcissistic Personality Disorders. Ann. Psychoanal., 2:231-248.

(1974). Annual of Psychoanalysis, 2:231-248

V Clinical Psychoanalysis

The Dread to Repeat and the New Beginning: A Contribution to the Psychoanalysis of the Narcissistic Personality Disorders

Anna Ornstein, M.D.

This paper deals with a particular aspect of psychoanalytic treatment, namely, with the manner in which defense organizations participate in the process of working through in the analysis of narcissistic personality disorders. Because the theory of treatment in psychoanalysis is based on the theory of the psychoneuroses, there is a circular feedback between the recommendations for technique and the psychoanalytic theory of the neuroses. The relatively narrow limits provided for psychoanalysis by the model of the psychoneurosis have limited contributions to the theory of psychoanalytic treatment.

Innovative ideas regarding the theory of treatment have been contributed by Kohut in his recent book The Analysis of the Self (1971). These contributions are based on the fact that Kohut could not accommodate his observations to existing clinical theories. He described his clinical observations as transference-like phenomena: transferences that were narcissistic in nature and could therefore not be understood in the context of the theory of the psychoneuroses. While differentiated from the patients with phallic-oedipal transference neuroses, this group of patients also has to be differentiated from those suffering from psychotic and borderline disturbances.

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