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Kernberg, O.F. (1975). Further Contributions to the Treatment of Narcissistic Personalities: A Reply to the Discussion by Paul H. Ornstein. Int. J. Psycho-Anal., 56:245-247.

(1975). International Journal of Psycho-Analysis, 56:245-247

Further Contributions to the Treatment of Narcissistic Personalities: A Reply to the Discussion by Paul H. Ornstein Related Papers

Otto F. Kernberg

I am grateful for Dr Ornstein's thoughtful and lucid discussion (Ornstein, 1974) highlighting some of the essential disagreements between Kohut's (1971), (1972) and my viewpoints (Kernberg, 1970), (1974). Space limitations require that I reply to only parts of this discussion.

Regarding the patient population included in our respective studies, what I have referred to covers a broad range of narcissistic personalities, from those functioning on an overt borderline level where psychoanalysis is usually contraindicated to relatively well-adjusted narcissistic people who, because of absence of symptom formation and the important secondary gain of their character pathology, neither seek nor accept treatment. I think Kohut probably refers to a more restricted range for whom psychoanalysis is the treatment of choice; so far as I know, he has not discussed the differential prognosis and treatment of the full gamut of narcissistic pathology. In my paper (1974) I analysed similarities and differences between ordinary borderline personality organization and narcissistic personalities proper. The study of narcissistic personalities functioning on an overt borderline level readily permits the analysis of the vicissitudes of primitive aggression and object relations that underlie the psychopathology of all patients with narcissistic personality but are less immediately apparent in the better functioning ones.

Ornstein, in agreement with Kohut, thinks that the narcissistic mirror transference corresponds to a normal narcissistic development, in contrast to the regressive, pathological features of the merger and twinship transferences.

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