Working with shame in psychoanalytic treatment

Shame is a central human affect, reflecting feelings of defect, inferiority, and failure of the self. It is, therefore, a proper focus for psychoanalytic treatment. Beginning with Freud's seminal attention to narcissism and the ego ideal, the possibility for studying shame and its relation to the ego ideal (i.e. the loving function of the superego) was inherent in psychoanalytic theory, but Freud's pursuit of intrapsychic conflict and the punitive superego postponed further elaboration of shame. Interest in the relation of the ego ideal to the superego (Hartmann, 1950; Reich, 1954), and in the ideal self (Sandler et al., 1963; Schafer, 1960, 1967) opened the way to further study of shame. Kohut's contributions, with their focus on narcissism and self-pathology, have given a language and perspective on self-deficits allowing elaboration of shame's place in psychoanalytic treatment. In this paper, I have focused on the treatment of shame in two patients. I suggest that shame lies at the very center of the narcissistic patient's pathology, with primary internal shaming (directed at the self's failures and inadequacies) permeating all aspects of the treatment. For the neurotic patient, shame is more circumscribed, reflecting partial failures of the self; it tends to be reactive, relating to passive withdrawal from internal conflict and castration fears, and is intermixed with oedipal manifestations. I have described clinical sequences that demonstrate my approach to working with shame in each of these patients. In both cases, the task is to recognize, acknowledge, accept, and investigate the patient's shame. Only after such empathic investigation can underlying conflictual and genetic derivatives be productively pursued. This sequence is often intuitively followed in analysis, but in this paper I have attempted to articulate more systematically shame's role in psychoanalytic treatment.     

The superego, narcissism and Great Expectations

The author notes that the concepts of the superego and narcissism were linked at conception and that superego pathology may be seen as a determining factor in the formation of a narcissistic disorder; thus an examination of the superego can function as a 'biopsy', indicating the condition of the personality as a whole. Charles Dickens's novel Great Expectations is presented as a penetrating exploration of these themes and it is argued that in Pip, the central character, Dickens provides a perceptive study of the history of a narcissistic condition. Other key figures in the book are understood as superego representations and, as such, integral to the vicissitudes of Pip's development. In particular, the lawyer Jaggers is considered as an illustration of Bion's notion of the 'ego-destructive superego'. In the course of the paper, the author suggests that Great Expectations affirms the psychoanalytic understanding that emotional growth and some recovery from narcissistic difficulties necessarily take place alongside modification of the superego, allowing for responsible knowledge of the state of the object and the possibility of realistic reparation.     

Narcissism as motive

This essay proposes replacing the traditional concept of narcissism as derived from the theory of drives with a concept of narcissism that is concerned with motives and their correlative meanings-specifically, motives connected to self-organization, self-preservation, self-cohesion, self-valuation, and self-esteem. The reasons for and the metapsychological underpinnings of a motivationally based theory are discussed. This revised motivational view proposes that narcissistic dynamics can be preserved and articulated in exclusively motivational terms. Developmental aspects are explored, including formation and functioning of the ego ideal and self-esteem regulation. Implications for psychoanalytic technique are suggested in discussions of case material.     

The Silence of the Body

As a practice meant to release the subject from the narcissism that informs the concerns and preoccupations of her or his ego, psychoanalysis aims at a transformation of the subject comparable to the Buddha's quest for enlightenment. In order to clarify this subtle and difficult dimension of psychoanalytic work, this essay draws upon a clinical example and discusses it in the context of both Freud's and Lacan's ideas about the role of narcissism in the formation of the ego, and the Buddha's doctrine of Anatta, which insists that the concept of the Atman, or self, is based upon an illusory thought.     

Thin Images Reflected in the Water: Narcissism and Girls’ Vulnerability to the Thin‐Ideal

The purpose of this research is to test how adolescent girls’ narcissistic traits—characterized by a need to impress others and avoid ego‐threat—influence acute adverse effects of thin‐ideal exposure. Participants (11–15 years; total N = 366; all female) reported their narcissistic traits. Next, in two experiments, they viewed images of either very thin or average‐sized models, reported their wishful identification with the models (Experiment 2), and tasted high‐calorie foods in an alleged taste test (both experiments). Narcissism kept girls from wishfully identifying with thin models, which is consistent with the view that narcissistic girls are prone to disengage from thin‐ideal exposure. Moreover, narcissism protected vulnerable girls (those who experience low weight‐esteem) from inhibiting their food intake, and led other girls (those who consider their appearance relatively unimportant) to increase their food intake. These effects did not generalize to conceptually related traits of self‐esteem and perfectionism, and were not found for a low‐calorie foods outcome, attesting to the specificity of findings. These experiments demonstrate the importance of narcissism at reducing girls’ thin‐ideal vulnerability. Girls high in narcissism disengage self‐protectively from threats to their self‐image, a strategy that renders at least subsets of them less vulnerable to the thin‐ideal.     

Superego formation, adolescent transformation, and the adult neurosis

The superego is heir to the Oedipus complex but has a much larger developmental legacy which includes preoedipal precursors and the influence of latency and adolescence. The superego continues to change in function and content throughout life, and radical transformation in adolescence may result in developmental discontinuity as well as core developmental continuity. A case is discussed in which adolescence was overlooked in previous analysis and in which adolescent superego modification had a major impact on the patient's character and his adult neurosis. The developmental significance of adolescence experienced under conditions of social isolation and rejection with forebodings of the Holocaust was unrecognized in sanctioned silence and shared analytic denial. These repeated earlier experiences of silent submission and stifled protest, and the silent suffering of the patient and his family, were an integral part of his humiliating and emasculating adolescent experiences. The intimidated adolescent, threatened from within and without, identified with the aggressor as well as with the victim. Identification with the aggressor and glorified victor contributed to a final adolescent structuralization of a punitive, sadistic superego and a rigidly perfectionistic ego ideal. As an adult, he tended to passive masochistic compliance with diminished self-esteem and unconscious self-denigration. He was prone to shame and guilt, self-criticism, and hidden hypercritical attitudes toward others. The adolescent internalization of aggression, intense castration anxiety, and pervasive narcissistic mortification led to retreat from resolution of revived oedipal conflict and to concomitant detrimental superego alteration. These issues were of major importance for analytic understanding and therapeutic progress.     

The ego according to Klein: return to Freud and beyond

This paper explores fundamental dimensions of Melanie Klein's concept of the ego through a detailed study of the writings of Klein and her early colleagues (Paula Heimann, Susan Isaacs and Joan Riviere). The study examines three central issues: (a) the basic theoretical framework for Klein's conceptualization of the ego, and specifically how her conceptualization builds on Freud's structural and dual instinct models; (b) the processes involved in the development of the ego and its capacities (including the development from id to ego and from ego to superego); and (c) the view of the ego as an object of phantasy. Through this examination, the study demonstrates that Klein's conceptualization of the ego is firmly grounded both in Freud's formulations about the ego and in his theoretical and metapsychological approach to thinking about the ego. This counters the prevalent view that Klein was only focused on clinical understandings, unconcerned with theory and fuzzy in her abstract thinking. More specifically, it counters the view that Klein did not really have a concept of the ego in any well-structured sense of the term (Britton, 2003; Hinshelwood, 1994; Segal, 2001). The study considers the sources of these misconceived views. Finally, it argues that discarding such views allows us to appreciate better the richness of Klein's thinking, her theoretical affinities to Freud, and the role of theory in the development and justification of psychoanalysis.     

Do narcissists make better decisions? An investigation of narcissism and dynamic decision-making performance

We investigated whether narcissism affected dynamic decision-making performance in the presence and absence of misleading information. Performance was examined in a two-choice dynamic decision-making task where the optimal strategy was to forego an option providing larger immediate rewards in favor of an option that led to larger delayed rewards. Information regarding foregone rewards from the alternate option was presented or withheld to bias participants toward the sub-optimal choice. The results demonstrated that individuals high in narcissistic traits performed comparably to low narcissism individuals when foregone reward information was absent, but high narcissism individuals outperformed individuals low in narcissistic traits when misleading information was presented. The advantage for participants high in narcissistic traits was strongest within males, and, overall, males outperformed females when foregone rewards were present. While prior research emphasizes narcissists’ decision-making deficits, our findings provide evidence that individuals high in narcissistic traits excel at decision-making tasks that involve disregarding ambiguous information and focusing on the long-term utility of each option. Their superior ability at filtering out misleading information may reflect an effort to maintain their self-view or avoid ego threat.     

Ego and narcissism theory between 1914 and 1922 as it appears in the International Journal of Medical Psychoanalysis

The publication of Freud's essay on narcissism in 1914 set off a discussion about the psychoanalytic concepts of the ego and of narcissism. The author reviews this discussion by reference to articles appearing in the Int. Z. ?rztl. Psa. between 1914 and 1922. She highlights the theoretical and technical modifications corresponding to this discussion and demonstrates that apparently modern theories of the ego and of narcissism have their roots largely in that period.     

The Bright Side of Threatened Narcissism: Improved Performance Following Ego Threat

Narcissistic individuals have highly positive self‐views and overestimate their abilities. Consequently, they tend to react aggressively whenever they receive information that does not match their high self‐views (ego threat). We argue that focusing on aggression merely portrays a one‐sided view of narcissistic individuals and the manner in which they counter ego threats. We propose that following ego threat, narcissism can also fuel performance. In four studies, we measured nonclinical narcissism and allocated Dutch undergraduate university students (N₁ = 175, N₂ = 142, N₃ = 159, N₄ = 174) to either an ego threat or a no ego threat condition. Ego threat involved negative feedback (Studies 1–2) or threat to uniqueness (Studies 3–4). We measured participants’ intentions to complete a challenging task (Study 1), their creative performance (Studies 2–3), and their performance on an anagram task (Study 4). Across Studies 1–3, we consistently found that following ego threat, higher nonclinical narcissism was associated with greater willingness to perform tasks that enabled demonstration of abilities and enhanced creative performance. These results were confirmed using a meta‐analysis. However, anagram performance was not enhanced following ego threat. We provide additional analyses that might help explain this. Our findings thus reveal a more positive side to the way narcissistic individuals manage threats to their self‐image.     

Die analytische Monade als Wiege der Realitätsprüfung

The relocation of my practice caused a lot of irritation and trouble, but triggered also psychic improvements in the analytic process with my patients, which is interpreted by referring to the theories of M. Balint and B. Grunberger. It is helpful to focus here on a narcissism concept which is not under instinctual control and to distinguish it from the transference rooted in drive theory. Especially useful proves to be the statement of both M. Balint and B. Grunberger that it is necessary to acknowledge and to affirm the wish of the analysand to establish and experience a pre-objectal “primary love” resp. an analytic monad. In case studies I try to show that the acceptance and affirmation of the projection of not drive-controlled narcissistic omnipotence feelings to the analyst are apt to secure and to preserve the narcissism of the analysand. Only this way can idealization and a stabilizing ego ideal initiate the integration of narcissistic exigencies and instinctual drives and organize the establishment of the reality principle.     

Narcissism and Other‐Derogation in the Absence of Ego Threat

The relation between narcissism and other‐derogation has been examined primarily in the context of ego threat. In three studies, we investigated whether narcissistic individuals derogate others in the absence of ego threat. In Study 1, 79 judges watched four videotaped dyadic interactions and rated the personality of the same four people. In Study 2, 66 judges rated the personality of a friend. In Study 3, 72 judges considered the average Northeastern University student and rated the personality of this hypothetical person. Across the three studies, targets' personality characteristics were described on the 100‐item California Adult Q‐Sort (CAQ; Block, 2008). Judges' ratings of targets were compared to a CAQ prototype of the optimally adjusted person to assess target‐derogation. Judges' narcissism and other‐derogation were positively related in Studies 1 and 2. Narcissism positively predicted and self‐esteem negatively predicted target‐derogation after controlling for each other in Study 3. Narcissistic individuals derogate others more than non‐narcissistic individuals regardless of whether ego threat is present or absent.     

Social conditions that foster narcissistic adaptational patterns

The purpose of this paper is to examine the parameters of our current social structure that encourage the narcissistic solution as an adaptive pattern of our times. One parameter is the decline of personal authority, resulting not in an absence of superego processes, but in ones based on early reaction formations which are archaic and punitive. A second parameter is the disruption in the national idealized self. As our identity as Americans has become tarnished, the formation of the ego ideal is disrupted. A third parameter is the modern urban life style, whose characteristics of mobility and interchangeability, advertising of a materialistic life style, credit cards, and modern appliances all encourage immediate gratification and do not encourage hard work and delay of gratification. The paper concludes with a prediction of a self-correcting mechanism in society that will soon make the old verities adaptive again.     

Opening the mind to reality

The author shows, through the use of clinical material, how an early failure in love can give rise to a severely crippling superego. The experience of a hateful relation with the mother is not simply internalized as a persecuting internal object, but is grafted onto the very roots of superego formation. As a result, the development of other parts of the psyche are affected – specifically the relation between the ego and self and the development of sexuality. The alienation between ego and self impairs thinking and the perception of external reality, which is modified and denied in the service of maintaining a pathological superego. By allowing the patient's hateful feelings to come out in the transference, without making him feel guilty, he is then able to risk expressing his loving feelings without the fear of rejection or abandonment. Through this process, the pathological superego can be dismantled and a more benign superego constructed.     

On a type of heterosexuality, and the fluidity of object relations

This paper delineates a form of heterosexuality whose underlying psychological structure resembles that of perversions. It is characterized by: idealization of instinctual processes, whereby the ego subordinates the object to the actualization of the instinctual event itself; heightened narcissism in an otherwise neurotic ego organization; multiple intrapsychic uses of the object; a special kind of defensive organization; an experienced victory over the superego and associated elevation of certain aspects of the ego ideal; and a resultant alteration in the nature of close interpersonal relationships. I use clinical vignettes from both male and female patients in psychoanalysis to focus on the phenomena in question. The thinking of Chassequet-Smirgel, Freud, Khan, Rangell, Socarides, and others is used in an attempt to gain an encompassing perspective. It is emphasized that patients demonstrating this form of heterosexuality do not possess a perversion per se, but demonstrate a character neurosis which integrates certain perverse mechanisms into its defensive organization. These mechanisms can be isolated and studied in psychoanalytic treatment, with the potential for illuminating their defensive and mood-regulating functions, and eventual working through and resolution of the intrapsychic conflicts underlying them. Some comments on the implications of this form of sexuality for our contemporary culture are included.     

Self,other and individuation: resolving narcissism through the lunar and solar paths of the Rosarium

This paper describes narcissism as our natural, infant-like behaviour, and specifies three characteristics relating to the evacuation and avoidance of distress, to control, and to distancing from relationship. It suggests that the processes of incarnation and individuation represent the development of the early ego and the ‘resolution’ of these narcissistic ways of being, including escape from the ‘mirror trap’. The development of the early, controlling ‘homunculus-ego’ entails the loosening and broadening of ego-identifications and the ego becoming subject to the Self. This is an embodied-relational-social-spiritual process outlined in detail by the full 20 woodcuts of the Rosarium Philosophorum, and specifically the lunar (relational) and solar (self-expressive) paths, which are explored herein. These processes are illustrated with respect to the interaction between infant and caregiver, clinical vignettes and examples from the political sphere.     

Notes on the Superego

The idea of the superego emerged late in Freud's conception of countercathexis or counterwill. It was preceded by censorship and the ego ideal, the latter of which later became associated with the newfound superego. Freud believed that the superego emerged as the resolution of the Oedipus complex. Klein, though agreeing with Freud, also uncovered the origin of the archaic superego in the early oral stage owing to projective identification of aspects of the infant into its image of the mother, which is then introjected and installed within the infant's internal world. The epigenesis of the superego, from the Kleinian point of view, enters into a transformation from a harsh, punitive, and retaliatory superego in the paranoid-schizoid position to a more forgiving and helpful one in the depressive position. The author suggests that there is such a thing as a “triune superego,” much like the Christian trinity, in which there are representations of the infant, the mother, and the father. Pathologic retreats constitute a default superego that vies with a normal superego.