Discussion - Evidence Based Psychoanalysis: An Imperative and an Opportunity

Freud published his ''On Narcissism: An Introduction'' in 1914. The writing has many levels, including, among other things, Freud's criticism of his former colleagues, Adler and Jung. Psychoanalysts received the essay with reservations. Ernest Jones, among others, expressed his concerns in his history of psychoanalysis. The aim of this study is to place Heinz Kohut's ideas about narcissism into the context of the history of ideas. Especially, the paper explores, at a theoretical level, the status of the castration complex both in self psychology and Freud's essay as well as seeks reasons why the discussion on narcissism should be continued.     

Dual realities – The search for meaning: Psychodynamic therapy with physically ill people

Abstract

We summarize Kohut's (1971) bi-polar self which enables counsellors to understand and treat narcissistic behaviours and narcissistic personality disorders in a psychoanalytic framework. After Patton and Meara (1992), we describe Kohut's formulations regarding self-development and disorders of self and how such formulations inform critical components of psychoanalytic counselling with particular emphasis on the explicit and implicit strategies and characteristics the counsellor brings to the process. Finally, we suggest that a promising arena for future theorizing and applications of Kohut's ideas is consultation with parents, teachers and other community leaders to help prevent or remedy psychological self-injuries with systemic interventions outside short-term counselling or long-term therapy.

We have suggested that Kohut's self psychology is a good vehicle for understanding what brings a client to counselling: namely, disorders of the self or self-injury. We review strategies and ‘ways of being’ a counsellor must bring to and offer in the counselling encounter if the work is to succeed. We also examine implicit qualities (beyond the achievement of a mature bipolar self) we believe a counsellor or any facilitator must have if counselling or other helping relationships are to be effective. We purpose further conversations and empirical analyses which specifically and conceptually link critical components of psychoanalytic counselling to self psychology and to essential counsellor traits or virtues that seem intrinsic to good counselling practice.     

Trauma,narcissism and the two attractors in trauma1

In this paper, the author sets out to distinguish anew between two concepts that have become sorely entangled‐‘trauma’ and ‘narcissism’. Defi ning ‘narcissism’ in terms of an interaction between the selfobject and the self that maintains a protective shield, and ‘trauma’ as attacks on this protective shield, perpetrated by bad objects, he introduces two attractors present in trauma‐‘the hole attractor’ and the structure enveloping it, ‘the narcissistic envelope’. The hole attractor pulls the trauma patient, like a ‘black hole’, into a realm of emotional void, of hole object transference, devoid of memories and where often in an analyst's countertransference there are no reverberations of the trauma patient's experience. In the narcissistic envelope, on the other hand, motion, the life and death drive and fragments of memory do survive. Based on the author's own clinical experience with Holocaust survivors, and on secondary sources, the paper concludes with some clinical implications that take the two attractors into account.     

The non-mirroring mother and the missing paternal dimension in a case of narcissistic disturbance

SUMMARY

Heinz Kohut (1971, 1972, 1977), has developed an innovative framework for understanding the dynamics and genesis of disturbances in the sense of self — broadly speaking, the area of narcissistic disturbance. He has emphasized the failure of the primary objects (in his terms ‘selfobjects’) to be available as responsive mirroring figures who can also be idealized. The role of oedipal conflict is specifically de-emphasized. In this paper a patient is described for whom the factors noted by Kohut were relevant, but as well as these, issues related to a failure to negotiate the oedipal position and a denial of the primal scene were also crucial. These phenomena are not described in Kohut's writings. For this patient, the exclusion or foreclosure of the ‘paternal dimension’ (Chiland 1982) left her with a fundamental defect in psychic structure with profound ramifications. In addition various features of the transference pointed to a failure of early communication via projective identification and maternal containment, of the kind described by Bion (1962). This process is compared with that subsumed by Kohut's concept of mirroring.     

Fons et Origo:A Darwinian View of Selfobject Theory and the Arts

Four important themes in self psychology as developed by Heinz Kohut are remarkably congruent with current theoretical constructs in the field of evolutionary (Darwinian) psychology: (1) the concept of narcissism, (2) the claim for the innate human capacity for empathy, (3) the recognition of the importance of group cohesion, and (4) the belief that individual psychological distress is produced by a changed environment rather than a dysfunctional self. By recasting Kohut's themes in a Darwinian framework and interpreting them with personal views of the phylogenetic origin and nature of the arts (Dissanayake, 2000), I describe and make clear the central importance of art experience to the developing selfobject relationship as well as to the evolution of the human species.     

Positive Self‐regard and Claim to Leadership: Two Fundamental Forms of Self‐evaluation

The present article examines the common factor structure of various self‐evaluative personality constructs. Consistent with previous research, we found considerable redundancy between constructs. Two basic forms of self‐evaluation could be distinguished: Positive Self‐regard (PSR) reflects people's contentedness with themselves in comparison with their own standards. Constructs such as depression, self‐esteem and neuroticism have very high loadings on this factor. In contrast, Claim to Leadership (CTL) reflects the subjective conviction that one is called to take charge and lead others. This conviction is often called ‘narcissism’. PSR mainly reflects an intra‐personal kind of self‐evaluation, whereas CTL reflects an inter‐personal kind. Both forms of self‐evaluation independently predict intellectual self‐enhancement, but only one of them (PSR) also predicts self‐reported mental health. Moreover, the two forms of self‐evaluation are differentially associated with self‐reported and peer‐reported inter‐personal traits (Dominance and Affiliation). Finally, the concepts of ‘Grandiosity’ and ‘Vulnerability’ from narcissism research may easily be reframed in terms of CTL and PSR. The two‐dimensional framework may help overcome the conceptual confusion that exists around different forms of self‐evaluation and streamline the field for future research. Copyright © 2013 European Association of Personality Psychology     

Untangling the Links between Narcissism and Self‐esteem: A Theoretical and Empirical Review

The links among narcissism, explicit (deliberate, controllable) self‐esteem, and implicit (automatic, uncontrollable) self‐esteem are unclear despite numerous attempts to illuminate these links. Some investigations suggest that narcissism reflects high explicit self‐esteem that masks low implicit self‐esteem, but other investigations fail to replicate this pattern. Here, we place the ‘mask’ model of narcissism in historical context and review the existing empirical evidence for this model. We then discuss three possible issues that might shed light on the inconsistent findings that have emerged from tests of the mask model. These issues include the unreliability of implicit attitude measures, narcissism's different associations with agentic versus communal self‐views, and distinctions between grandiose and vulnerable narcissism subtypes. We also summarize several alternatives to the mask model of narcissism. Throughout, we offer suggestions for improving the study of narcissism and self‐esteem and point to directions for future research on this topic.     

Soteriological dimensions in the work of Heinz Kohut

A framework of theological inquiry is utilized to illuminate soteriological dimensions implicit in Heinz Kohut's psychology of the self as expressed in his most recent work,The Restoration of the Self. Kohut's new formulations involve the unfolding of a saving approach that through its broad application seeks to overcome “the psychological danger that puts the psychological survival of modern Western man into the greatest jeopardy.” The theological inquiry employed asks: What is the essential nature of man? How has man fallen away from his essential self? By what means is he to be saved from his broken condition? Kohut's implicit and explicit “answers” are summarized by dealing with four cardinal issues in his book: definitions of the self: the relationship of a psychology of the self to other psychologies; theory concerning the selfs structure, development, and restoration; and the centrality of the empathic response.     

Commentary on “deconstructing difference: Gender,splitting, and transitional space”;

This essay identifies Kohut's major contribution as methodological: that psychoanalytic inquiry entails the sustained empathic immersion in the patient's psychological experience. Kohut's consistent employment of this method enabled him to discover that it was not instinctual drive derivatives but selfobject needs that were central to all psychological relationships. This discovery was the basis for the transformation of analysts’ approach to the “narcissistic”; aspects of a wide variety of disorders—a transformation whose theoretical and therapeutic importance rivals the revolutionary approach taken by Freud to the vicissitudes of psychosexuality and its disturbances. The author describes the major areas of progress in self psychology—much of which centers on the growing recognition that the health and vitality of the self depend on complex relational, or intersubjective, selfobject experiences. He indicates how this recognition is changing our perspectives on transference and countertransference and is improving our ability to respond optimally to our patients. He describes how optimal responsiveness constitutes the guiding principle for therapeutic work, and how it may both constitute, and be different from, “being empathic.”;     

The social unconscious in persons,groups and societies,volume 1: Mainly theory,edited by Earl Hopper and Heim Weinberg

This paper looks at some instances of young children learning in a school setting, and suggests that ‘emotional learning’ is an integral part of the apparently ‘cognitive’ learning that takes place in school. The paper uses object relations psychoanalysis in order to explore some of the more-or-less hidden emotional states of mind that accompany difficulties and successes with school learning. Three extracts are presented from observations of young children coming to terms with reading and writing. Each of these is then discussed, with the aim of showing how learning always takes place in a dynamic, relational emotional context. From the theoretical perspective outlined in this article, all learning involves unconscious ‘object relating’. Things to be learnt about, and people requiring learning, or assisting with it, are the bearers of the learner's vivid unconscious ‘transferences’. Such transferences colour the learner's emotional experience of the people and things around him or her, constituting a dynamic, internally experienced, ‘emotional context’ for learning. While this emotional context may be partly subjective, it is also more or less affected by others' feeling states, pulling the learner into a shared learning environment which is emotionally complex and inter-subjective.     

Food and violence: Childhood violence and emotional abuse as complicating factors in the inpatient treatment of eating disorders

SUMMARY

This paper considers the treatment, on an inpatient eating disorders ward, of patients who have suffered violence and emotional abuse during childhood. The complex web of relationships surrounding these patients is discussed, and it is suggested that there are multiple transferences — to the institution, to various members of staff, and to other patients — and that splitting of these transferences is inevitable. Staff experience powerful countertransference feelings, related to the patient's violent history. A central task for the staff team as a whole is to understand and contain the patient's disturbance — taking on, tolerating, and processing the projections. This demands the close working-together of the members of the multidisciplinary team, so that staff can together openly examine the patient's interaction with them and their own emotional responses to the patient and to other members of staff. If these responses are not understood by the ward staff, they can lead to conflict and inappropriate decisions. On the other hand, if the staff team together can build up a picture of the patient's relationships on the ward, and their meaning for the patient, this picture, like a particular projection of the world in an atlas, provides a ‘map’ of the patient's inner world. This ‘map’ can be used by the staff team in navigating their interactions with the patient. It can also assist the psychotherapist in her work to help the patient recognise and, eventually, own the split-off parts of herself.     

The deconstruction of primary narcissism

The author examines Winnicott ’s contribution to Freud ’s concept of primary narcissism. In Mourning and melancholia, Freud laid the foundations for this contribution, but it was Winnicott who turned it into a clinically useful concept. There are three of Winnicott’s ideas that can be seen as preliminary stages to his theory of transitional phenomena and illusion. They serve as an introduction to thinking about the analysis of the analysand ’s primary narcissism and the theoretical prerequisites that make the interpretation of primary narcissism possible. Through the exploration of three main points in Winnicott’s writings the author shows how Winnicott’s conceptualizations are both new and a continuation of Freud ’s thinking. His ideas are thus part of the overall theoretical pattern of Freud ’s metapsychology. The three main points are as follows: 1. In bringing maternal care and the presence of the psychic environment into the construction of primary narcissism, Winnicott made it possible to analyse narcissism. His ideas enable us to stand back from the characteristic solipsism of narcissism, which holds that everything comes from the self and only from the self. The latter concept tends to eliminate the role of the object and environment in the construction of the self. At the same time, by deconstructing the way in which the self is infiltrated by a certain number of narcissistic postulates, Winnicott made it possible to interpret the theory of narcissism itself. 2. Between the individual and the sense of self, Winnicott inserted the maternal object and her function as a mirror of affects who acts as a medium for the organization of self-identity. Primary identity is established through the construction and elimination of a narcissistic identification that becomes meaningful in the context of a primary homosexual relationship functioning as a ‘double’. 3. A process of differentiation that governs the discovery of the object is in a dialectical relationship with narcissistic identification. That process can be understood only in terms of the responses made by the primary psychic environment to the baby’s primary aggression.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

Generation Me,the Origins of Birth Cohort Differences in Personality Traits,and Cross‐temporal Meta‐analysis

Birth cohort, or generation, differences in personality include views of the self (increases in self‐esteem, narcissism, assertiveness, and agentic traits, leading to the label ‘Generation Me’) and mental health (externality in locus of control, increases in depressive symptoms). The origins of these trends lie in culture, including changes in women's roles, parenting, media, and social connections. Birth cohort should be considered as an environmental influence on individual personality traits. Challenges to cross‐temporal meta‐analysis are discussed, including response bias, changes in college populations, data from the University of California campuses with major confounds, sampling issues, and the misperception that the ecological fallacy is committed.     

Western ‘sincerity’ and Confucian ‘Cheng’

In philology, both ‘sincerity’ and ‘cheng’ primarily mean, ‘to be true to oneself’. As a philosophical term, ‘sincerity’ roots in Aristotle's ‘aletheutikos’. In medieval Europe, it is regarded as a neutral value that may either serve or disserve for ‘truth.’ As for Romantics, it is a positive value, and an individualistic concept whose two elements ‘true’ and ‘self’ refer to a person's ‘true feeling’ and ‘individuality’. In contrast, both ‘self’ and ‘true’ in Confucianism are universalistic concepts, meaning ‘good nature’ common to all humans, and ‘true feeling’ distinguishing them from beasts. Cheng itself means to face one's universal self with universal true feeling.     

Reply to Reynolds

Abstract

How should we read Foucault's claims, in his late work, for the relevance of ‘aesthetic criteria’ to politics? What is Foucault's implicit understanding of the nature of aesthetics and the autonomy of the aesthetic sphere? Would an ethics which gave a place to the aesthetic legitimize a politics of manipulation, brutality and aggression ‐ in short, a ‘fascist’ politics ‐ as some of Foucault's critics argue? In this paper, I examine key accounts of the fascist ‘aestheticization of politics’ ‐ from Walter Benjamin's classic essay, ‘The Work of Art in the Age of Mechanical Reproduction’ (1936), to Philippe Lacoue‐Labarthe's work on the relation between Heidegger's philosophy and the fascist theme of politics as the plastic art of the state. Through a discussion of Foucault's late work, the paper demonstrates the connection between Foucault's turn to ancient Greek ethical practices and his call for a contemporary renewal of the idea of ethics as an art of living. The aim of the paper is to show in what ways the ethico‐political position which is presented in Foucault's late work, far from contributing to a fascist politics, in fact provides ways of thinking about the relationship between the aesthetic and the political which avoid both mindless radicalism and totalitarian narcissism. In doing so, the key question is, ‘What's aesthetic about Foucault's “aesthetics of existence"?’     

Collective Narcissism: Political Consequences of Investing Self‐Worth in the Ingroup’s Image

This article proposes a new theoretical framework for the reviewed state‐of‐the‐art research on collective narcissism—the belief that the ingroup’s exceptionality is not sufficiently appreciated by others. Collective narcissism is motivated by the investment of an undermined sense of self‐esteem into the belief in the ingroup’s entitlement to privilege. Collective narcissism lies in the heart of populist rhetoric. The belief in ingroup’s exceptionality compensates the undermined sense of self‐worth, leaving collective narcissists hypervigilant to signs of threat to the ingroup’s position. People endorsing the collective narcissistic belief are prone to biased perceptions of intergroup situations and to conspiratorial thinking. They retaliate to imagined provocations against the ingroup but sometimes overlook real threats. They are prejudiced and hostile. Deficits in emotional regulation, hostile attribution bias, and vindictiveness lie behind the robust link between collective narcissism and intergroup hostility. Interventions that support the regulation of negative emotions, such as experiencing self‐transcendent emotions, decrease the link between collective narcissism and intergroup hostility and offer further insights into the nature of collective narcissism.     

Two cheers for Tanhā

The central character in Sartre's 1938 novel La Nausée, Antoine Roquentin, has lost his sense of things, and now the world appears to him as utterly unstable. Roquentin suffers from what he calls ‘nausea,’ a condition caused by an ontological intuition that the self, as well as the world through which that ‘self’ moves, lacks a substantial nature. The novel portrays Sartre's own philosophical account of the self in La transcendence de l'égo. Here Sartre argues that Husserl's account of consciousness is not radical enough; the ‘I’ or ego is a pseudo-source of activity (and Sartre thus draws very close to a particularly Buddhist account of personal identity). My essay questions Roquentin's response to his ontological insight: why is this the occasion for ‘nausea’? Why doesn't Roquentin (as King Milinda famously does) celebrate and embrace his ‘non-self’? I argue that Sartre's depiction of Roquentin's ailment, and the unsatisfactory solution he provides, misunderstands both the aggregate nature of things as well as authentically rendered consciousness-only (vijñaptimātra).     

Working with chronic and relentless self‐hatred,self‐harm,and existential shame: a clinical study and reflections (Paper 2 of 2)

This second of two papers focuses on the shame which emerged in the first 14 years of analysis of a woman who was bulimic, self‐harmed, and repeatedly described herself as ‘feeling like a piece of shit’. To explore this intense and pervasive shame I draw on Jung's and Laplanche's emphasis on experiences of unresolvable, non‐pathological ‘foreignness’ or ‘otherness’ at the heart of the psyche. Images, metaphors, elements of clinical experience, and working hypotheses from a number of analytic traditions are used to flesh out this exploration. These include Kilborne's use of Pirandello's image of shame as like a ‘hole in the paper sky’ which, I suggest, points to a crack in subjectivity, and reveals our belief in the efficacy of the self to be illusory. Hultberg's observations on shame as having an existential mode (function) are also explored, as is the nature of analytic truth. Using these ideas I describe my patient's process of finding some small but freeing space in relation to her shame and self‐hatred. Through enduring and learning from her shame in analysis she realized that it was part of a desperate unconscious attempt to draw close to her troubled father and so to ‘love him better’.     

The Group Psychotherapy Literature 1958

This study applies Kohut's self-psychology toward an understanding of the self-functions that membership in a religious cult group (Divine Light Mission) provides for the narcissistic personality. It is proposed that there exists a psychosocial fit between the appeal of the cult group's structure and process and the needs of the narcissistic personality. The cult group offers reparative and substitutive functions to the follower who seeks an idealized selfobject to stabilize a defective sense of self. The special relationship of the follower to the Guru bears a close resemblance to the “idealizing transference” which arises between certain narcissistic patients and their group therapist. The therapeutic use and misuse of the “idealizing transference” in group therapy is explored and suggestions are made for its appropriate clinical management.