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Schwartz, L. (1973). Technique and Prognosis in the Treatment of Narcissistic Personality Disorders. J. Amer. Psychoanal. Assn., 21:617-632.

(1973). Journal of the American Psychoanalytic Association, 21:617-632

Technique and Prognosis in the Treatment of Narcissistic Personality Disorders

Lester Schwartz, M.D.

Martin Wangh, Chairman of the Panel, opened with a brief discussion of Freud's concept of narcissism as that portion of the libido which remains self-directed throughout life. According to Brenner, the term "pathological narcissism" includes hypercathexis of the self, hypocathexis of the object, and a pathologically immature relationship to the object. Annie Reich discussed cases of narcissistic neurosis standing midway between neurosis and psychosis. Wangh suggested that Kohut's concept of "self-object" now provides a bridge between normalcy, neurosis, and borderline and psychotic states. He noted that the reported increase in narcissistic disorders may reflect problems inherent in trends of anonymization in our families and in society at large. It is the very failure of healthy narcissistic development that seems to lead to "hypercathexis of the self" in later life. Wangh then discussed resistances to dealing with studies of narcissism. Geared to view self-centeredness as undesirable, we need to work through this resistance. Wangh expressed the hope that this Panel would contribute to that working-through effort.

Arnold Goldberg presented the first paper. Reviewing Kohut's position, Goldberg emphasized that narcissism is part of normal development, having primitive and mature forms as well as pathological ones. The narcissistic object, based on Freud's concept in his 1914 paper, is modeled upon an aspect of the self, performs a function for the self, or serves as a self-regulator. Development proceeds via the narcissistic object. Early stages preceding a coherent sense of self are postulated, in which mental and physical experiences are not yet integrated. Cohesion of the self thus depends upon a narcissistic object.

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