The short-term treatment of narcissistic and other self-disorders

Abstract

The term narcissism when used clinically, is broad and its boundaries are diffused. Freud first referred to narcissism to describe a libidinal position in which cathexes were invested in the subject's own ego and not in objects. Dynamically, significant advances have been made in the clarification of the methapsychological dimensions of narcissistic disorders. Two authors, Otto Kernberg (1984, 1986, 1998) and Heinz Kohut (1971, 1977), have advanced well-developed metapsychologies for these disorders and proposed comprehensive techniques for their treatment through appropriately modified psychoanalytically based interventions. In both cases, treatment is deemed to be plagued by problems, to last long, and to result in uncertain outcomes. The metapsychological clarity achieved by authors such as Kohut and Kernberg has so far not generated a proportionate therapeutic optimism.

In this paper, a review will be presented of the current status of the outcome of the treatment, through short-term dynamic psychotherapy, of a spectrum of psychoneurotic disorders, with special emphasis on the treatment of patients suffering from syndromes that reflect complex dynamic constellations resulting from the interaction of impulse problems and problems of object loss at key developmental moments, which affect the patient's relationships with developmentally key objects. Also presented will be techniques derived from this framework for the treatment of patients suffering from a range of narcissistic disorders, including Narcissistic Personality Disorder, as well as innovative techniques designed by the author to meet the unique treatment needs of self-disordered patients in shorter time frames than are common in the classically open-ended psychodynamic technique.