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.     

Parenting a damaged child: mourning, regression, and disappointment

This paper is an examination of the long-term parenting experiences of parents who have given birth to CNS damaged infants. In particular, the focus is on the mourning, regression, rage, and depression that frequently attend these parents throughout their lives and can become pathological and pathogenic interferences with the provision of good-enough parenting. Several clinical vignettes were presented, each of which illustrated the usefulness of different psychoanalytic clinical theories about normality and pathology of parenting and parent-child interaction. The now-classical contribution of Solnit and Stark (Mourning and the Birth of a Defective Child, 1962) is reviewed along with Benedek's and others' psychoanalytic theories about normal parenting. The thinking of these writers is within the framework of structural/libidinal theory and seems to be useful in describing certain parenting problems that concern the mourning and regressive aspects of parenting. However, it was proposed that some of the adaptive coping and pathology encompassed by Solnit and Stark's explanations is not comfortably illuminated by the structural clinical theory of conflict and drives. Freud's discussion (1917) compares mourning and melancholia, which he differentiated as related but dynamically distinct clinical phenomena. This work is briefly recalled as an earlier point in theory building where structural theory was not sufficient to explain clinical depression and rage that exceeds normal mourning (as in Freud's melancholia). It is felt that an additional theoretical perspective on parenting provided by self psychology can fill in some of the gaps left by structural theory explanations. The self psychology perspective is particularly helpful with understanding the rage, ambivalence, and chronic depression often experienced by parents of damaged children. According to this perspective, the damaged child is a disappointing selfobject for the parent, and the parent's self organization will give him the resources to cope adaptively or to develop narcissistic pathology. Three types of intrapsychic problems for a parent are described: mourning the lost object, the fantasied perfect child; experiencing and recovering from regression to early identifications with his own parents; withstanding tension and regulating one's self (experiencing chronic depression and rage) when confronted with a great disappointment in a selfobject (represented by the damaged child). It is important when designing intervention strategies in a hospital or pediatric clinic setting to clarify which type of problem is the major focus of the parent's struggle.(ABSTRACT TRUNCATED AT 400 WORDS)     

Don't get stuck in the mother: regression in analysis

This paper was part of an afternoon workshop on regression. It re views the author's recollections of her own analysis and clinical work with the purpose of discovering the sources of her own ideas on regression. Two specific forms of regression are then delineated – negative therapeutic reaction as described by Rosenfeld and 'umbilical transference' as a possible future development.     

A teenager revisits her father's death during childhood: a study in resilience and healthy mourning

"Debbie," 14, was 8 when her father died. During 4 interviews over 3 months, Debbie described the impact of his death as she progressed from childhood to adolescence. Themes drawn from her experience were related to theories of development, bereavement, and resilience. Triangulating interviews with her mother and brother established validity. Results indicated that Debbie experienced healthy mourning--without depression or other debilitating effects--due to supportive people in her family, her strong self-concept, and her capacity to think through her experiences positively. Evidence of protective factors, notably Debbie's relationship with her mother, contributed to her resilience. The author concludes that childhood bereavement studies and resilience research can be mutually informative and that dialogue between their practitioners should increase.     

The origins of mother blaming: Historical perspectives on childhood and motherhood

This article presents a historical review of society's changed perceptions of the values of childhood from the first century a.d. to the present. Factors that have influenced the responsibilities subsequently placed on the mother because of her “natural and instinctual” abilities are discussed. Until the 20th century, children received little attention from the scientific community. There is now much empirical evidence to guide practitioners in addressing the physical and psychological needs of children. However, assumptions are made by clinicians that the primary, if not critical, responsibility for the child's growth, development, and behavior should be placed on the mother. This can result in mothers being blamed for the behavioral errors and problems of their children.     

The narcissistic personality inventory: applicability in a Swedish population sample

A Swedish translation of the 40-item Narcissistic Personality Inventory (NPI) was mailed to 410 participants, aged 21-61 years, randomly sampled from the Swedish general population. The participation rate was 62%. The applicability of a previously published seven-factor structure (Raskin & Terry) and a four-factor structure (Emmons) was investigated. The factor structure found in the present in the Swedish sample corresponded better with Emmons's version. Therefore the four-factor structure was chosen. Because the correspondence to Emmons's factor structure was not perfect, a revised NPI for Swedish use was constructed. The total scale score is usually used, although the Swedish NPI includes four subscales: Leadership/Power, Exhibitionism/Self-admiration. Superiority/Arrogance, and Uniqueness/Entitlement. For the total scale, the internal consistency (Cronbach's alpha) was 0.80 and the test-retest correlation was 0.93. The total scale score correlated with self-esteem as well as the interpersonal style and emotional aspects of psychopathy, supporting the validity of the scale.     

On the vicissitudes of early primary surrogate mothering II: loss of the surrogate mother and arrest of mourning

Among the catastrophic events experienced by infants and young children, one of the most frequent is the loss of an early primary surrogate mother (EPSM). Usually permanent, the loss is often followed by the advent of a new, "replacement" caregiver. One aspect of the emotional environment is unique to this kind of caregiving situation: that parents are often unable to validate the true nature of their child's relationship with the EPSM or, ultimately, the trauma experienced by the child when the EPSM leaves. The marked discrepancy between the parent's and the infant or child's experience of the surrogate mothering leads to an arrest of the child's mourning process, with the potential for serious developmental consequences. Issues related to EPSM loss and its aftermath are examined in the light of two examples. Further exploration of the environment of this kind of caregiving directs attention to the critical need to nurture and protect the attachments of both the infant or child and the parent to the ESPM.     

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 shattered mirror: Treatment of a group of narcissistic patients

Increasingly, group psychotherapy takes its place as a valid treatment model for patients with severe character pathology. This paper explores the impact of group treatment on a homogeneous group of patients with narcissistic character problems. The clinical example serves to illustrate the particular dynamics of this patient population; addresses the challenges inherent in treating these patients in a homogeneous, long-term therapy group; and, finally, underscores the countertransference pitfalls in such a clinical situation. Nonetheless, the successful working through of some of these patients' terrifying pathology supports the important of continuing experience and research into this arena.The author wishes to acknowledge with gratitude the invaluable assistance of J. Scott Rutan, Ph.D., in the planning and preparation of this clinical report.     

Accountability as a deterrent to self-enhancement: the search for mechanisms

Although self-enhancement is linked to psychological benefits, it is also associated with personal and interpersonal liabilities (e.g., excessive risk taking, social exclusion). Hence, structuring social situations that prompt people to keep their self-enhancing beliefs in check can confer personal and interpersonal advantages. The authors examined whether accountability can serve this purpose. Accountability was defined as the expectation to explain, justify, and defend one's self-evaluations (grades on an essay) to another person ("audience"). Experiment 1 showed that accountability curtails self-enhancement. Experiment 2 ruled out audience concreteness and status as explanations for this effect. Experiment 3 demonstrated that accountability-induced self-enhancement reduction is due to identifiability. Experiment 4 documented that identifiability decreases self-enhancement because of evaluation expectancy and an accompanying focus on one's weaknesses.     

Too proud to let go: narcissistic entitlement as a barrier to forgiveness

Narcissistic entitlement impedes forgiveness in ways not captured by other robust predictors (e.g., offense severity, apology, relationship closeness, religiosity, Big Five personality factors), as demonstrated in 6 studies. Narcissistic entitlement involves expectations of special treatment and preoccupation with defending one's rights. In Study 1, entitlement predicted less forgiveness and greater insistence on repayment for a past offense. Complementary results emerged from Study 2, which used hypothetical transgressions, and Study 3, which assessed broad forgiveness dispositions. Study 4 examined associations with the Big Five, and Study 5 extended the findings to a laboratory context. Study 6 demonstrated that entitlement predicted diminished increases in forgiveness over time. Taken together, these results suggest that narcissistic entitlement is a robust, distinct predictor of unforgiveness.     

The goal as process: music and the search for the Self

This paper explores and compares the processes of music and analysis from the author's experience as a musician, piano teacher and analyst. It explains how the use of music improvisation in analysis (with simple percussion instruments) can powerfully enhance the dialogue between the unconscious and conscious psyche, as well as deepen the relationship between analyst and analysand. This is connected theoretically to Jung's active imagination and Winnicott's concept of play within the analytic encounter. Finally, the question is raised whether analytic trainings could do more to expose trainees to the possibility of using music within the analytic encounter. This touches on the more basic and controversial issue (which often separates analytical psychology and psychoanalysis) of whether expressive therapy should be used in analysis at all.