Immersion in the surface1

In order to treat patients with a narcissistic structure showing a rigid shell of defence together with a lack of inner differentiation – insufficient subject/object constitution – one has to deal with a split kind of transference. Their compelling need for distance corresponds to their fragile self‐esteem. They feel threatened by the analysis and the analytic relationship. Because the seeming normality of these patients’ thinking and language is deceptive, a variation of psychoanalytic technique to facilitate the work with them is described and explained in detail. To transform their two‐dimensional ‘inner’ world, which functions in a PS modus, it is helpful to show them, with changing viewpoints step by step, their own manoeuvres, misconceptions and manipulative use of language within the analytic relationship. The gratifying extension of their self‐awareness leads to the introjection of the analyst’s alpha‐function. This makes possible a more distinct separation of subject and object representations and a transformation to a three‐dimensional, oedipally structured world with a strengthened capacity to symbolize. This method of working is grounded in Bion’s theory of thinking. A case vignette illustrates a development of this kind.