Pathological narcissism and addiction: A self-psychology perspective

Following Kohut's schema of self-psychology, addiction may be considered as a form of pathological narcissism. Narcissistic transferences stemming from an archaic and fragile self are frequently observed in the addictions. Such patients typically experience others as an extension of the self. A clinical example of the emergence of ‘mirror’ and ‘idealising’ transferences is presented with a patient who was dependent upon alcohol. Kohut's insights on narcissism provide an approach to both comprehension and therapeutic intervention in enabling such patients to develop a more cohesive self.     

The application of self-psychology to short-term counselling

Abstract

This article explores how key aspects of Heinz Kohut's self-psychology can inform short-term counselling work. Initially a summary is offered of Kohut's developmental theory, his understanding of the nature and causes of psychopathology and his view of the analytic cure. The application of his ideas to short-term counselling is then discussed. Specifically, it is suggested that short-term therapeutic work based on self-psychology involves a stronger emphasis on the curative aspects of the selfobject transference between client and therapist, a more limited notion of the role of interpretation, and a different understanding of working through to that of long-term self-psychological analysis.     

The addiction to negativity.

In this paper, we have described a type of resistance that has attracted increasing psychoanalytic attention in recent years. Patients exposed to intense negativity during early life may develop an addiction to negative experience as adolescents and adults, and this may constitute a central organizing feature of their personality. In almost all patients, however, some moments of negativity may be observed. We have traced the developmental origins of an attachment to negativity, drawing especially on psychoanalytic investigations of preoedipal pathology. Manifestations and derivatives of early negativity include anhedonia, attachment to physical pain, fear of success, masochism, deprivation of self and others, and negative voyeurism. In discussing the dynamic functions of negativity, we place particular emphasis on two motives: the patient's desires for revenge against early objects that have been a source of deprivation and frustration; and the defensive function of negativity in helping to express as well as ward off dangerous wishes to merge with the object. Deviant forms of autoerotism are likely to be used by these patients to deal with the reactivation of early experiences of neglect and rejection. When negativity is used as a defense or method of relating to others it can lead to a severe disruption of the psychotherapeutic relationship. We have reviewed suggestions for the management of extreme negativity in treatment. Resolution of the therapist's countertransference reactions, especially induced feelings of frustration, rage, and helplessness, is crucial. Emphasis also has been placed on the patient's desires for revenge against self and object, and the manner in which these may be understood and eventually resolved. Only when patient and therapist begin to investigate the adaptive functions of extreme negativity can this pathological symptom be resolved and the patient's awareness of self and sense of autonomy be enhanced.     

The treatment of addiction by aversion conditioning with apomorphine

An account is given of the techniques employed in using apomorphine for the treatment of chronic alcoholism, addiction to other drugs and addiction to cigarette smoking. No evaluation is made here but each technique is illustrated by the report of a case in which the result is considered, after a reasonable follow-up period, to be highly satisfactory.     

Applications of object relations theory and self-psychology in current group therapy

In an effort to explore how group therapists can apply psychoanalytic theory in the group modality to advantage, two major developments in analytic theory are examined. 1) Kernberg stresses the neutral interpretive stance and utilizes concepts of protective identification and splitting in dealing with borderline pathology. This paper illustrates concretely how such theory can be used by the group therapist to encourage working through in the group situation. 2) Kohut's work stresses the empathic, nurturant analytic stance and focuses upon idealization, the grandiose self and the self-object. An understanding of these concepts helps the group therapist avoid obstacles in the treatment of narcissistic patients and can enrich the therapeutic work. The paper concludes that treatment of the difficult patient may be enhanced by the group situation in combination with specific psychoanalytic concepts.     

冲动性对不同成瘾行为发展的调控及其神经机制

近年来越来越多的研究证据提示, 个体冲动性在成瘾疾患发生发展机制中具有关键作用, 可能成为成瘾行为的潜在易感标记以及早期识别和干预的重要靶点, 但冲动性对不同成瘾行为变化发展的调控机制尚不明确。项目拟综合跨成瘾谱系比较、纵向追踪设计、冲动行为干预等研究途径, 采用人格测量、神经认知、神经影像等技术, 首先比较尼古丁依赖者与网络游戏成瘾者的冲动性结构及其在前额叶–纹状体环路的结构功能改变; 然后采用混合分组设计筛选出具有高低冲动性的非成瘾青少年进行连续追踪研究, 考察冲动性对尼古丁依赖与网络游戏成瘾的预测效力; 并采用认知行为训练, 对吸烟成瘾者与网络游戏成瘾者进行冲动干预, 考察行为干预对冲动性水平及前额叶–纹状体环路功能的改变, 以及对不同成瘾行为发展的抑制后效。旨在探索冲动性作为成瘾的潜在易感标记及干预靶点的效力。     

The psychometric properties of the internet addiction test.

There is growing concern about excessive Internet use and whether this can amount to an addiction. In researching this topic, a valid and reliable assessment instrument is essential. In her survey of Internet addiction, Young designed the Internet Addiction Test (IAT), which provides a basis for developments. The IAT has high face validity, but it has not been subjected to systematic psychometric testing. This study sought to replicate and expand Young's survey, and to examine the IAT more systematically. A questionnaire that existed as a Web page was devised, consisting of the IAT and 15 other questions regarding the respondents' demographic information and Internet usage. Participants were recruited through the Internet, yielding 86 valid responses (29 males and 57 females). Factor analysis of the IAT revealed six factors--salience, excessive use, neglecting work, anticipation, lack of control, and neglecting social life. These factors showed good internal consistency and concurrent validity, with salience being the most reliable. Younger and more recent users reported more problems, mainly concerning the neglect of work and social life. We expected interactive Internet functions to be more addictive; however, this was not found to be so. Overall, the IAT is a valid and reliable instrument that may be used in further research on Internet addiction.     

The moral of her story: exploring the philosophical and religious commitments in Mary Whiton Calkins' self-psychology

Over the course of 3 decades, from the turn of the century to the late 1920s, Mary Whiton Calkins articulated and defended a system of self-psychology that held that psychology as a field should be organized as the science of selves. Calkins' system was far from popular at the time, which leads one to question why she persisted in dedicating herself to the cause of defending it. Previous research has sought answers to this question through examination of Calkins' experience as a faculty member at Wellesley College. In this article it is additonally argued that Calkins was not prepared to abandon her system of self-psychology because it was intricately connected to her ideas about ethics and morality.     

Brief residential treatment for nicotine addiction: a five-year follow-up study.

Relapse is a major problem with nicotine addiction. This study investigated the long-term abstinence rate and effectiveness of a five-day residential nicotine treatment program. Questionnaires were mailed to all clients who completed the program between 1991 and 1996. 47% of the questionnaires were returned. Of these, 65% of respondents reported being abstinent from nicotine for an average period of 120 weeks. Of this group, 15% reported at least one relapse before a sustained abstinence. The primary relapse triggers for both the abstinent and nonabstinent groups were coping with "strong emotional feelings". Over 50% of the sample was comorbid for other addictions, depression or anxiety disorders.     

干预胆碱M受体对药物成瘾的影响及其与多巴胺的关系

药物成瘾是一类精神及行为障碍, 涉及到中枢神经系统的病变。毒蕈碱受体(Muscarinic receptor, M受体)属于胆碱能受体, 分5种亚型。行为学研究表明, 干预M受体能有效影响药物成瘾行为, 但其神经机制还亟待探索。阿片类药物与精神活性药物均能激活中枢多巴胺系统, 而M受体与多巴胺系统在多个脑区产生了交互作用。其中激动M2及M4受体抑制了多巴胺系统功能, 而激动M5受体增强了多巴胺系统功能, 与干预M2、M4、M5受体对药物成瘾行为的影响相对应。以上证据提示, 干预M受体可能通过影响多巴胺系统对药物成瘾起作用。     

The role of the bereavement group in the face of 9/11: a self-psychology perspective

The sudden traumatic loss of a spouse equates to an assault on self and the loss of both an internal and external self-object. Mourning requires compensatory self-objects to help in the restoration of self and in the creation of new self-structure. The catastrophe of 9/11 not only assaulted thousands with unanticipated traumatic loss, but also devastated the usual networks of support. In this light, the bereavement group became a valuable venue for self-restoration and recovery. In her group work with 9/11 corporate and uniformed service widows, the author applies a self-psychology perspective that considers that empathic immersion not only affords safety and stabilization, but the opportunity to have self-object needs met in a process that restores and develops self-structure. She proposes the bereavement group as a cohesive self-object milieu serving mirroring, twinship, and idealizing needs. Drawing upon clinical examples, she illuminates the capacity of the group to establish safety, regulate affect, reduce isolation and shame, rekindle memory, and foster coping skills. As such, the group affords a restoration of the assaulted self, an integration of the loss, and an emerging redefinition of self.