Self-regulatory and narcissistic grandiosity and vulnerability: Common and discriminant relations

In three studies we examined the unique relations of narcissistic grandiosity and vulnerability with the self-regulatory factors of promotion, prevention, assessment, and locomotion. We found that grandiosity has unique positive relations with promotion, assessment, and locomotion but is unrelated to prevention (Study 1). We also found that vulnerability has a unique positive relation with assessment, a unique negative one with promotion, and is unrelated to locomotion and prevention (Study 2). Study 3 replicated these findings and demonstrated that they do not derive from the self-regulatory factors’ or grandiosity and vulnerability’s associations with self-esteem. The results indicate that grandiosity and vulnerability have self-regulatory underpinnings and provide evidence of their specific discriminant nature. Further, they indicate that the critical evaluations associated with strong assessment concerns are a significant vulnerability for both narcissism presentations.     

Object-related vs. narcissistic depression: a theoretical and clinical study.

This paper has focused on the sense of helplessness as an essential component of a depressive reaction. By inference, a sense of mastery and ability to achieve goals seems essential for a sense of well-being. Both patients presented here revealed infantile fantasies that hampered their exercising this mastery, and the path to well-being was the analysis of these fantasies. The treatment plans differed, though, in the locus of the fantasies. In an object-related depression such as Mr. Janson's, the fantasy involved the inhbition of functioning--that is, the inability to express aggression--and the treatment aimed at removing the inhibition. In a narcissistic depression such as Miss Gaynor's, the helplessness was not due to inhibited functioning per se. Rather, her goals were unrealistic, unattainable, and based on unconscious fantasies. Here the aim of treatment was the development of more reality-adapted and attainable objectives and the concommitant internalization of a more realistic sense of her own worth. Thus the common denominator in both depressive reactions was a sense of helplessness, and the path toward increased self-esteem was by way of the development of a sense of mastery and competence.     

The senior therapist's grandiosity: Clinical and ethical consequences of merging multiple roles

Grandiose senior therapists who knowingly foster treatment relationships that run counter to the wisdom and ethics of the field of psychotherapy can do harm to their patients. When practitioners merge the boundaries of treatment they simultaneously violate professional ethical codes and violate the frame of the analysis. Multiple role relationships often exploit patients' dependency while gratifying the narcissism of the senior therapist. The focus of this paper will be to explore the motivation and personality of senior therapists who are socially involved with their patients. The convergence of ethical and clinical problems related to multiple role relationships will be addressed also. Professionals may be able to resolve the problem through group process.     

Conditioned reinforcement: Experimental and theoretical issues

The concept of conditioned reinforcement has received decreased attention in learning textbooks over the past decade, in part because of criticisms of its validity by major behavior theorists and in part because its explanatory function in a variety of different conditioning procedures has become uncertain. Critical data from the major procedures that have been used to investigate the concept (second-order schedules, chain schedules, concurrent chains, observing responses, delay-of-reinforcement procedures) are reviewed, along with the major issues of interpretation. Although the role played by conditioned reinforcement in some procedures remains unresolved, the results taken together leave little doubt that the underlying idea of conditioned value is a critical component of behavior theory that is necessary to explain many different types of data. Other processes (marking, bridging) may also operate to produce effects similar to those of conditioned reinforcement, but these clearly cannot explain the full domain of experimental effects ascribed to conditioned reinforcement and should be regarded as complements to the concept rather than theoretical competitors. Examples of practical and theoretical applications of the concept of conditioned reinforcement are also considered.     

Self-criticism and unconscious grandiosity: transference-countertransference dimensions

The problems posed in understanding and working through the patient's layers of self-criticism are challenging for both patient and analyst. In particular, this paper explores some countertransference phenomena related to underlying grandiosity embedded in self-criticism. For patients who are self-critical, analyzing grandiose elements may create further grounds for self-reproach or open up new modes of self-experience and freedom. The paper tries to focus on how the analyst's experience of the patient's self-criticism often shifts over the course of analytic work. It is important for the analyst to not be crippled by a fear of considering the relevance of underlying grandiosity in relation to self-reproach. Understanding this dimension of self-reproach can help elucidate why it is so durable and refractory to interpretation. The patient has a stake in holding on to this self-punishment because it perpetuates self-regulatory fantasies. These fantasies sometimes relate to the feeling that the patient will be more successful or better loved by holding on to aspects of self-reproach. Sometimes these fantasies are based in competitive or dominant strategies related to winning out or retaliating over parents or siblings.     

Dual diagnosis: Clinical issues in substance abuse treatment

Dual diagnosis within the context of alcohol and substance abuse has become the focus of considerable interest, particularly when related to anxiety and depression. Depressive symptomatology is frequently associated with substance abuse and chemical dependency and numerous studies report a high concordance with these diagnostic entities and major affective disorder (Galanter,Casteneda, & Ferman, 1988). Depressive symptoms are also related to post treatment of alcohol and substance abuse with reported occurrences of 75 percent occurring with patients who have experienced relapse (Biedermann, Newcome, & Sprich, 1991).     

Pharmacological interventions in autism: theoretical and practical issues

Focused on issues of drug treatment in relation to autism. Pharmacological treatment studies in autism are complicated by various factors including a tremendous range of syndrome expression, a lack of robust animal models of the disorder, and various methodological problems. Theories have tended to follow treatments, and various neurochemical systems have been the focus of study. Neurochemical systems potentially implicated include those involving dopamine, norepinephrine, serotonin, and neuropeptides. The dopaminergic system has been the most extensively studied. Treatments developed are effective relative to certain disabling symptoms but "core" problems (e.g., in social relatedness and communication) appear less responsive to medications. The development of new approaches to assessment, including integration of behavioral and pharmacological approaches, is an important research priority.     

An overview of the treatment of severe narcissistic pathology

This paper provides an overview of narcissistic personality disorders as they present clinically along a spectrum of severity ranging from the best functioning forms of pathological narcissism to the most threatening to the patient's psychosocial and physical survival. It proposes a general interpretive psychoanalytic stance with all these clinical syndromes that range from standard psychoanalysis to a specific psychoanalytical psychotherapy for the most repressive and life threatening conditions that may not respond to standard psychoanalysis proper. This general psychoanalytic approach is placed into the context of related developments in contemporary psychoanalytic understanding of pathological narcissism and its treatment.     

Methodological and theoretical issues in neuropsychological assessment

While there are philosophical and theoretical differences between neuropsychologists and behavior therapists, it is suggested that a significant reconciliation can be achieved in regard to assessment and treatment of the brain-damaged patient. While brain damage is often viewed as an irreversible disorder, there is evidence that substantial recovery of function can occur, particularly when adequate retraining is provided. There are practical and empirical considerations that suggest that neuropsychological tests are currently the best tools available for behavioral assessment of brain-damaged patients. However, the results of these tests can be used not only diagnostically but also to identify target behavioral deficits that may be rehabilitated through systematic retraining efforts. Such rehabilitation efforts can be optimally planned, implemented, and evaluated through an alliance between the neuropsychologist, who identifies the ability and deficit pattern, and the behavior therapist, who devises and evaluates the retraining program. It is possible that the successes of behavior therapy in numerous clinical and educational applications can be repeated in the cases of brain-damaged patients. However, such success would appear to be contingent on appreciation of the high degree of specificity often seen in neurological deficit patterns and the great complexities involved in the relationships between brain function and behavior.