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Clark, L.P. (1933). The Question of Prognosis in Narcissistic Neuroses and Psychoses. Int. J. Psycho-Anal., 14:71-86.

(1933). International Journal of Psycho-Analysis, 14:71-86

The Question of Prognosis in Narcissistic Neuroses and Psychoses

L. Pierce Clark

One of the criticisms of psycho-analysis is that it rarely can offer beforehand a reasonable judgement as to the possibilities of treatment. The very nature of the psycho-analytic attitude is to hold out no high hopes and to make no reassuring promises. In so far as the demand for some such assurance is part of the individual's wish for magic, there can be no doubt that a position of scientific uncertainty on the part of the analyst is sound. Nevertheless, early in the relationship we must decide for ourselves whether or not the patient is suitable for analysis, whether or not he has the capacity to gain from it, and how much advance is possible.

Formerly an individual was considered accessible to analysis if he was capable of maintaining an object-libidinal relationship with the analyst. The transference-neuroses, therefore, were open to influence by analysis; the narcissistic neuroses were regarded as inaccessible. Further investigations, however, have indicated that some degree of therapeutic progress is possible even in the narcissistic neuroses; and it is no longer wise to exclude them categorically from treatment by psycho-analysis. Since the narcissist cannot meet the requirements of the older methods of treatment, some modification in the analytic technique is necessary. Before considering the problem of prognosis, therefore, we must outline the details of the newer from of approach to the narcissistic neuroses.

First, there must be a giving of libido to the narcissistic patient. It is recognized that the narcissist's ego is weak, that he needs love and expects to get it by divine right, that he wishes to give little or nothing to the object-world. Moreover, this type of patient very rarely feels the need of treatment in the first place. To him his own narcissistic system is quite satisfactory; any difficulties he has had seem to have originated in the outer world, and his disease appears at most simply a mysterious affliction. For the most part he assumes no responsibility towards the treatment. In his fear and self-protectiveness, he enters the analytic situation with a resistance such as has characterized his attitude towards reality from his first contact with life in the outer world.

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