Kohut enlivened the psychoanalytic world by bringing narcissism into the center of its modern theory, and creating a significant paradigmatic shift. Kernberg, joined Kohut in a significant role albeit with a slightly different emphasis than Kohut in his theory of narcissism. Nonetheless, by making narcissism’s positive dimensions more central to treatment, Kohut and Kernberg were able to demonstrate better outcomes than their psychoanalytic predecessors.
Dr. Ron Lee, my mentor and supervisor, explored the need for distinct, experience-near Self Psychologically-based ‘strategies’, particularly in the first phase of treatment. Efficacious clinical approaches, based on the key characteristics of the specific narcissistic configurations, were developed using a nuanced application of Somatic Intersubjective Self Psychology (SISP). It was found that this attuned, empathic, and intersubjective approach regularly led to a deepening of the therapeutic relationship and a diminishing of the narcissistic behaviours.
Additionally, once therapeutic relationship deepened, mirror hungry needs, as previously hypothesized by Heinz Kohut, began to emerge irrespective of the initial presenting behaviours. This mirror hunger is a deeply buried unmet need which emerges only after a deep, meaningful bond had been established. Our finding suggests that a client’s peripheral self-organizing is an adaptation for survival during development when empathic attunement from caregivers is unavailable. If the first stage of treatment is successful, realising that it can be quite prolonged, a client’s self-organizing increasingly shifts from costly anti-social survival patterns to growth-oriented relational experiences.
A corollary observation related to the need for mirroring, is the therapy can fail when mirroring is introduced too soon. In a grandiose/expansive presentation, premature mirroring can be brushed aside or dismissed with haughty contempt. Where emotional neglect has been significant or severe, premature mirroring can create confusion or even shame. And in other presentations, an impasse or stagnation in the therapy feeling similar to addiction can result.
The cases described in this text focus primarily on the nuances of the early phase of treatment and reveal how an appropriate co-created therapeutic relationship can shift narcissistic patients from “survival strategies” to “adaptive growth.”
The six narcissistic configurations discussed in this text include
- Grandiose Expansive Narcissism
- Mirror Hungry Narcissism
- Constricted Deflecting Narcissism
- Hostile Aggressive Desperate Narcissism
- Envious Rageful Narcissism
- Paranoid Revengeful Narcissim
The book should be published in Late 2027