Narcissism and narcissism disorder
Article Abstract: From the perspective of the history of psychoanalysis, the research of psychoanalysis on the important phenomenon of human mental structure is included here.
After more than 100 years of experience in psychoanalysis, the study of narcissism has formed a complete set of phenomenology, genesis, pathology and therapy.
This article highlights the context of the development of narcissism research, and Xi Yi can be of benefit to studying our cultural personality.
First, the question is raised and the Freudian understanding: the word narcissism (narcissism) is commonly used in literary works, which is literally translated into Chinese as narcissus. This comes from a beautiful ancient Silas myth: the beautiful young man NasisWhen I saw my reflection in the water, I fell in love with myself. Every day, I did n’t think about it, and I died. It turned into a flower. Later generations called it daffodil.
Psychiatrists and clinical psychologists borrow the term to replace the phenomenon of a person falling in love with themselves.
Narcissism was first introduced into the clinical description from literary concepts. The credit was attributed to psychiatrists, sexologists, Richards and Nack, respectively, who described the pathological phenomena of narcissism in their respective papers in 1898 and 1899, respectively.It shows an attitude that an individual treats himself like a sexual object.
Narcissists appreciate, touch, and play with themselves until they are completely satisfied.
Then, in 1914, Freud, the master of psychiatry and the ancestor of psychoanalysis, first systematically implanted narcissism.
In his famous dissertation “On Narcissism”, the origin, nature, expression and role of narcissism in human development were explained respectively, and constituted an important part of the theory of sexuality.
In this paper, Freud believes that narcissism is an undifferentiated spiritual energy that transforms Libido, originally for the self and the woman who nurtured himself, which he called primitive narcissism.
Freud also believes that this first love is a kind of self-sexual sexual satisfaction, which is experienced as a living function. Its purpose is to protect itself. Primitive narcissism is regarded by him as seen in every individual.
In the original narcissism, the child loves and raises the woman who loves and cares for her as one. He does not have the ability to separate the woman who raises himself, but also for the future, to love an independent oneIndividuals laid the foundation.
According to Freud, people first put the power of love on themselves, then developed healthily, and invested it on the object. The mother, as the first caregiver of the child, was always regarded as the first assaulter.
The mother or mother’s substitute, therefore the object of initial love, but here the mother is loved as an object different from herself.
If the love to the object is frustrated, this outward-facing love will return to itself. This phenomenon is called secondary narcissism, which is clinical pathological narcissism.
In the choice of love in the future, these people are not modeled on mothers-that is, they are not modeled on the other, but on themselves. They obviously use self or ideal as the object of love. The extreme example isgay.
Narcissistic love manifests itself in loving one’s past, present, and future.
Love others because they are part of themselves and subordinate to themselves.
The love that narcissists demand is selfless giving, support, and unconditional praise to prove their omnipotence and speciality.
Freud believes that a mature person will not maintain this childhood, perfect, narcissistic illusion. He will replace narcissistic love with an idealized self.
For a narcissist, he needs a deep attachment to others as well as a healthy person, but at the same time, attachment to an object of love leads to low self-esteem, so he or she often flees from such attachment.
Narcissism is always related to self-esteem. Morbid self-esteem is the infinite expansion of narcissism.
Healthy self-esteem shrinks into three parts. One is the remnant of narcissism in infants, the other comes from the gradual realization of the ideal self, and the third comes from the satisfaction of object love.
”On Narcissism” is an epoch-making essay, which has been included in the annals of psychoanalysis in advance, but the problem is also obvious.
It can be roughly summarized as follows: 1. The concept is confusing: the structure and the drive are indistinguishable, and the reference to the term narcissism is ambiguous.
2. Sexual instinct is supreme: The strongest resistance to Freud in later generations lies in that his narcissism theory is part of the theory of internal drive. The self has many complex sources and many defenses and adaptive abilities. These cannot be driven by internal drive alone.Theoretical explanation.
3. Incomplete explanation of psychotic disorders: I believe that narcissism is the basis of psychotic disorders. Later generations believe that the etiology of psychotic disorders is a complex mixture. It involves genetics, social and cultural environment, self-function and other factors.Explain with narcissism.
4. Limitations on empathy: Because narcissists are oriented towards themselves, they cannot establish relationships with others, and they cannot produce empathy in analysis situations, so they cannot be analyzed.
The development of later generations comprehensively described the special empathy of persons with narcissistic personality disorder, and at the same time the in-depth study of narcissism, an independent psychology of psychoanalysis.
It must be mentioned that AlfredAdler, another master of the same age as Freud, highlighted the influence of sociocultural factors on the formation of narcissism in his “male protest” theory.
He believes that “the purpose of neurosis is to increase self-esteem.”
And self-esteem is inseparable from superiority, safety, perfection, and success.
So narcissism is the loss of narcissism’s interest in society. It is always the patient’s drive to himself, and all the patient’s relationships are towards themselves.
This voice was hit hard at the time-Freud was severely hit, but later facts proved that Adler was right.
In summary, it is precisely because of Freud’s contribution and regret that psychoanalysis has developed vigorously more than 100 years after its birth. Narcissism, as part of its theoretical framework, can also continue to be full and full.Along this growing vein, try to draw a rough outline of it.
Second, the development of modernity from Freud to the 1960s?
In the 1970s, the field of narcissism was almost dominated by Freud. Among them, although many analysts mentioned it, no one could match him.
The gradual activity in this field has been happening for nearly three decades.
In 1967, Joffe and Sandler took the lead in clearly stating the research direction of narcissism and narcissism disorder. They believed that “the clinical understanding of narcissism and narcissism disorder must take into account the impact of social culture, emotions, attitudes, values and ideals.Postmodern psychology is an important part, so research on narcissism must take into account the above factors, not just the issue of internal drive or hypothesis.
Pulve (1968) considers narcissism as “a broad, non-special concept that describes many phenomena, all of which are attributed to the evaluation of the self.
In 1968, the American Association for Psychoanalysis defined narcissism as “a psychological interest focused on one’s own attention.”
In the past three decades, articles about narcissism and narcissism have been used, among which the potential influence is Melanie, the representative of the object relationship theory.
Klein’s follower Herbert.
Rosenfeld, Heinz of Psychology.
The relationship between kohut and self-psychological object Otto.
kenberg, and especially Heinz.
kohut has contributed most.
(1) Kleinist perspective: Kleinists convert Freud’s narcissism is the difference between narcissism or object power into the difference between internal or external object relations.
Herbert, a faithful follower of Klein’s theory.
Rosenfeld’s description of narcissistic sexuality in empathy in Abraham (1919), Joan.
A description of the negative treatment response by Riviere (1936) and Melanie.
Based on Klein’s (1957) research full of jealousy and satisfaction, a paper published between 1964 and 1978 detailed the structural characteristics of narcissistic personality and the development of empathy during the analysis.
He developed the first modern theory of pathological narcissism.
The core of the theory can be summarized as follows: (1) The narcissist completely projects himself to the object he is concerned about, denies that he is any different from the object, or does not separate himself from the object at all, as a person.
Such indistinguishment between self and object causes the patient to deny that he has any need for external object dependence, because relying on the other person also depends on himself. For them, it means love, but he who has hurt himself is very “The need of the “hateful” object.
(2) The narcissist has a very high idealized self-image and completely denies any person or thing that hinders this perfect self-image.
Such a personality structure comes from the patient’s subconscious idealization of the part of his or her uncertain identity. In these next steps, the patient subconsciously hates everything that is good. It can be entirely an external object, but also includes the inner normal part.The need for self-dependence on objects.
(3) Such a distinction between themselves and the object may indicate that the patients subconsciously merge the male and femininity of their internal and external objects, so that they can become immune to dependence.
In fact, in the treatment, when these explained explanations are overcome, the patient can show a deep, true dependence, enter a state of depression and experience the Russian-low conflict.
(4) Narcissism is the expression of the original inner spirit of death instinct.
This formulation is based on Freud’s original argument about the relationship between narcissism and offensiveness.
Narcissistic object relationships can evade frustrating offensive emotions and any jealous awakening.
Can assimilate the value of others very quickly, assertive, and turn these into what they see as their own, or may subconsciously reduce the value of others and devalue what they get from others.
Followers of Klein’s theory have described the structural characteristics of narcissistic personality for the first time since Freud, and first proposed that narcissism is related to aggressiveness, but the most obvious mistake is: denial of narcissistic personality and objectseparate.
Subsequent development holds that narcissistic personality does not deny that they are separated from the object, but denies that they are different from the object. This is obviously different from the schizophrenia that cannot distinguish between them and the body.
(2) The viewpoint of Kohut and his psychology: At that time, the needle moved to the 1970s?
In the 1980s, the development of psychoanalysis will be another great figure, American psychiatrist Heinz.
kohut pushed to the front desk.
In a series of dissertations and two major books-“Self-analysis” and “Self-repair”, he designed a completely different clinical postmodern psychology for narcissistic personality disorder based on his clinical findings.Explanations, and treatment models.
He considers himself a concept relative to the object.
He found such a group of patients; they had, their psychopathology was between neurosis and marginal state, and on the other hand, their psychopathology was between mild personality disorder and neurosis.
In kohut’s conception, whether or not this type of personality disorder can be analyzed depends on their empathy rather than other clinical descriptions.
(1) Special empathy presentation: He finds that a certain patient and object show a special interpersonal relationship.
Called its own object relationship.
Self object is a special type of object that cannot be separated from itself. The most important thing is that self object is used to serve the function of narcissism in order to maintain contraction, damage or invasion.Unbalance of love.
In such patients, they treat others subconsciously as a self-object to maintain the purpose of narcissism. There is no separate reality, motivation or boundary for their own object.
The self-object is experienced as controlling itself, just as it is controlling its own body or part of the body.
In fact, such a group of people enters the treatment, and also brings such object relationship into the treatment place.
That is, idealized empathy and mirror-image empathy.
Idealized empathy is the idealization of the therapist, reflecting the activation of the idealized parental image.
Kohut first had two separate development lines in the early stages of mental development: the line of narcissism and the line of object relations.
The development of the narcissistic thread-dependent early adopter’s response to the two basic needs of the child-can be used as a mirror to show omnipotent self and allow idealization.
Normal self-esteem, ambition and ego ideals are the products of this stage of development.
If the traumatic damage fostered at this stage would lead to retardation of development.
The lack of omnipotence itself and idealized parental impressions necessary for normal development.
Kohut, unlike traditional analysts, views empathy as a transformation. He sees idealization or mirror-image empathy as a manifestation of the pathological self-object relationship established earlier.
This relationship is activated in the context of analysis.
Activated a period of development retardation, a primitive omnipotent self.
This fragile primitive itself needs empathy and the normal mirror function of the mother as an “self-object”. The mother’s love and care first allow omnipotence to strengthen herself.
Later, as the self-esteem and self-confidence gradually developed, the original mirror image became less and less.
According to Kohut, this strong reliance on idealized objects is due to the patient’s desire to replace the missing part of his mental structure.
The patient defends the balance of narcissism with interest and praise for the current replica of the traumatic loss of his own object in the past.
The ideal relationship with the mirror-like object also helps the normal idealization of its own object.
This self-object comes from the original omnipotent self.
At this moment, it appears in the relationship with an idealized self object. The apex of this relationship is the “deformation and internalization” of the idealized object into the inner spiritual structure. These will be the source of the ideal self and provide the superego.Ideal content.
All of this will be preserved in the new internalized self-esteem rules.
(2) Pathology of narcissism: Morbid narcissism comes from the traumatic failure of empathic mother function and the failure of normal idealization process development.
The developmental hindrance brought by these traumatic failures is anchored in the omnipotence of the primitive infants themselves.
Then, as an unmet original need, it remains in the adult’s true self, consuming the energy of the self, as a kind of compensation, to prove his omnipotence by the infinite need to praise.
The clinical manifestations are patient dissatisfaction, low self-esteem, loss of face, seriousness of praise addiction and depression, or more obvious aggression.
Aggressiveness is predicted to be a weakened self response to various injuries.
If the caregiver stumbles the child into his morbid narcissistic world, that is, the caregiver is a narcissistic personality, and uses the child to satisfy his narcissism, this will cause the child and the caregiver to be omnipotent, and correspondingClinical manifestations of narcissism.
The pathology of narcissism begins with the original omnipotent self, and ends with the internalization of the ego’s ideal change.
This self-ideal needs to be tested in the ups and downs of the two-way inherent (omnipotence and self-ideal).
These two contradictory self can be presented in the mother’s mirror-like acceptance, which confirms the core omnipotence and the accommodation and care from the mother. This kind of love allows the experience of merging with the idealized all-around self-objectAnd is internalized in this experience to replace pathological omnipotence.
(3) Normal narcissism and pathological narcissism: An objective fact is that in all normal love relationships, there is a factor of narcissism.
How to distinguish between normal and abnormal is unlikely to have a quantitative scale.
In these normal relationships of love, especially the love of young people, always contains an over-evaluation of the object of love, and even includes the projection of the old self-impression on the object of love, but this love relationship is differentThe pathological narcissism lies in the fact that in the relationship of normal love, although the ideal of the self is also projected on the other party, it can correspond to the other party as an independent individual and has a desire and need to change himself.
For example: If you give a gift to the other person, the original purpose is to make the other person happy as a person who changes you, and get good reviews many times.
Another example: If a person in a normal object love relationship is connected to a new environment, he or she will experience a period of loneliness for the loss of the person he or she loves and everything he or she can.
He or she cannot quickly establish an intimate relationship with the new object that completely transforms the old object while maintaining the old object.
But pathological narcissism is different. In the new environment, he or she can ignore the new changes.
He or she quickly replaced the impression of the old object with the new object. In his or her eyes, the new and old objects are no different.
Ask it all according to his or her own desires.
Extremely little by little, the sick narcissist regards the people around him as unbearable.
He or she sees only himself, and the surrounding objects are only used as a tool to relieve loneliness, or only as a mirror, which can prove the omnipotent self.
Another important difference is that from a clinical perspective, in normal object love, both sides have extremely difficult personalities to understand, and they have the ability to empathize.
This ability manifests itself in an interest in the needs of the object of love to help the other person maintain self-esteem.
For example, when the other party needs to listen, he has the ability to listen, and when he needs it, the other party can respond accordingly.
Pathological narcissism is the opposite, they have no ability to empathize.
Empathy comes from the original narcissistic relationship, like the relationship between mother and baby, and they are aware of the same thing at the same time.
Then developed to feel the feelings of others, allowing the other party to be different from himself, allowing the other party to have his own desires and interests.
Morbid narcissism has no subsequent period of development.
(4) A special term in self-psychology: idealized empathy: the idealization of the healer in the treatment, which reflects the activation of the idealized parental image.
Mirror reflection empathy: Immediately treat the healer as a mirror, and be equal to himself with the therapist’s ring.
Mirror reflection empathy has three different levels of performance, and reflects three different levels of regression, sorted from the most primitive: a.
Merger: Imagine the therapist and himself as one person.
Alter ego or twinship: Conclusion The analyst may like himself or be similar to him, just like twins.
Mirror: The patient experiences that the analyst is separated from himself, but as an omnipotent self that satisfies his own activation, he is a spiritual one.
Selfobject: An individual subconsciously uses the natural power of another individual to maintain his own psychological balance.
From the beginning of life, infants and young children subconsciously use the caregiver to comfort themselves instead of the integrated and divided emotions and guide behavior.
Empathy: An introspection that can experience the suffering and joy of others.
We observe ourselves and discover a state of experience and emotion that allows us to appreciate the experience of our patients and the individual meaning of this experience.
The center of this ability is to understand the complex behaviors of our patients, and most importantly, to understand the meaning of their behaviors, which is considered the starting point for engaging in psychotherapy.
This healing art is a gesture to communicate the ability to understand the patient, which leads to the rehabilitation of the injured mental state.
Omnipotent self (grandiose self): the original defensive organization, usually defensively used to compensate for weak self, is a common feature of narcissistic personality.
Transmuting internalization: At the beginning of life, individuals need a sympathetic mother to survive better.
Psychotherapy requires a special therapeutic situation — presenting an object that can sympathize with the person seeking treatment, and thus, in the interaction between the person treating the treatment and the therapist (self object), the damage or lack of structure can be repairedThe process of establishment and formation is called deformation internalization.
Kohut is one of the greatest contributions to the research of narcissistic pathology in modern times.
It is because of his contribution that the scope of psychoanalysis has been expanded, and a large group of patients outside the door of psychoanalysis have been treated. Moreover, due to the deepening of his treatment and research, he has proposed the importance of environment and culture to human growthSex.
He believes that “the environment must provide the necessary experience for a child to grow up not only as a person, but also to feel personal” and put forward a number of challenging points that the study of empathic neurosis is “guiltful””Guilt man”, narcissistic personality disorder studies “tragic man.”
The emergence of this idea pushed the perspective of narcissism research to a broader social and cultural background.
The author believes that this is the extremely rich spiritual heritage left by Kohut to mankind and an important weapon for our study of Chinese culture.
Among the innumerable terms of psychoanalysis, only his “empathy”, “self-object” and Freud’s immortal terms should coexist with subconscious, empathy, depression and so on.
In his later period, he betrayed the theory of internal drive and moved closer to the object relationship. His biggest attack was that he accepted this empathy, surpassed this empathy, and was considered too radical.
(3) Viewpoint of self-psychological object relationship (self-psychological object relationship) This school is based on Otto.
Kernberg is the representative.
He believes that the driving force for narcissism is still more powerful.
He inherited Freud’s theory of narcissistic libido and objective libido, and Kohut narcissistic libido and objective libido began to be together, separated in subsequent development, and narcissistic personalityAggressiveness is secondary to their view of damage from narcissism.
He believes that the development of normal and pathological narcissism is always involved in the relationship between self-impression and object-impression, and that external objects are regarded as an offensive instinct conflict.
Therefore, the study of narcissism cannot be separated from the study of the internalized object relations of Lipituo and aggressiveness.
The essence of self is the fully integrated expansion of self-impression in all development periods, as a purely psychological essence.
The normal self integrates good and bad self-images into a true self-concept.
The pathology of narcissistic personality is related to the pathological self. The omnipotent self of pathology includes: true self, ideal self, and ideal object impression.
Depreciated or offensive self and object impressions are separated or separated, suppressed or projected.
He believes that the pathological narcissistic personality cannot be regarded as the fixation of normal development or some kind of internal spiritual failure. It is the result of pathological self and superego development. It comes from the pathological development of itself.
The central issue of narcissistic personality is related to vague identification and loss of deep empathy for others, closing the door to understanding others.
They don’t seem to love anyone except themselves, but in fact they love themselves as incompetent as they love others.
They also lack the ability to integrate love and hate.
Third, about narcissistic personality and its obstacles In DSM-IV, the diagnosis of personality disorders is mainly based on psychoanalysis.
But personality is a fairly broad concept.
It includes multiple scales and is predicted to be a pattern formed in early life experiences and continued over time.
In DSM-III-R, many symptoms are described as personality replacement or morbid personality. These become habitual patterns and become a trait memory. They are repeatedly started and ended when encountering a certain situation (such as the onset of depression).).
Personality includes personality and habitual behavior. It is the result of the interaction between genes and the environment. It includes both emotional and cognitive components.
The same is true for the diagnosis of narcissistic personality and its disorders. A brief introduction to several related issues is as follows: 1. Narcissistic disorders can be found in some personality disorders: narcissism is a fairly broad basic pathology, narcissistic, marginalNarcotic disorders can be found in personality disorders and diseases such as schizophrenia, hysteria, obsessive-compulsive, bidirectional, depression, mental illness and other personality disorders and diseases.
2. Pseudo-narcissism (neurophilic narcissism): Obvious narcissistic disorders are also seen in some neurotic people, which is called pseudo-narcissism.
Akhtar (1989) believes that pseudonarcissists have no severe traumatic experiences in childhood, leading to narcissistic personality. They show a successful process of individual separation, heavier internalized conflicts, and betterSuperego integration, a unified sense of identity, depression as the main defense, has the ability to deep object relations.
3. Characteristics of narcissistic personality: a.
Addiction to praise c.
Better work abilities and social adaptation, even better personality evaluations in public places.
Difficulties of intimacy e.
Highly intelligent or beautiful appearance4, DSM-IV diagnostic criteria for narcissistic personality disorder: an omnipotent pattern that requires praise, including the spread of fantasy and behavior.
Lack of empathy.
It started in early adulthood and continues to the present.
And meet the following five or more criteria: ① have a sense of omnipotence.
For example: exaggerating achievements and talents, expecting to be considered the best without corresponding achievements.
② Bewildered by the illusion of unlimited success, power, talent, beauty or ideal love.
③ Believe that you are special and unique, and believe that you can only be understood by other equally special or high-level people, or should be associated with the above-mentioned people.
④ Ask for excessive praise.
⑤ There is a feeling of privileged person, some kind of unreasonable expectation of special good treatment or others’ obedience to his or her expectation automatically.
⑥ is an interpersonal adventurer, some kind, to capture the interests of others in order to achieve their own goals.
Lack of empathy, no desire to recognize or agree with the emotions and needs of others.
I often slander others or believe that others are jealous.
⑨ Express a arrogant behavior or attitude.
4. Therapeutics of narcissistic personality disorder (psychodynamic psychotherapy): (1) Systematic analysis of pathological omnipotence: Analytical psychotherapy for narcissistic personality is most importantly a systematic analysis of the patient’s morbidityomnipotent.
It is diffused in the empathy of the analysis process.
Analysts should cope with this diffuse omnipotence combined with therapeutic use.
The emergent condition of dissociated, repressed, or projected emerges in the initial treatment occasion. This condition will be detrimental to the manifestation of morbid omnipotence and the most primitive object relationship.
The morbid state being activated at the analysis site gives a sense of distance and emotional blankness.
In this difficult to capture but as a “normal” malignant presentation, or in “real” interpersonal relationships between patients and analysts.
On the patient’s side, the activated pathological idealized self is projected on the analyst.
Convey is an impression that in this room there is only one ideal omnipotent person and a shadowy, complimentary supplement.
The often reversed role between patient and analyst is the basic mode of expression of this narcissistic empathy.
It is worth mentioning that the analyst must be clear that the omnipotent mechanism of the patient is that the patient tries to redesign the analyst to suit his needs. At this time, the analyst must give the patient a smart and knowledgeable impression, so thatFeeling like you are with the best therapist.
In the subsequent treatment, the analyst must not be too clever, so as not to cause the patient’s terrible jealousy and resentment, must behave as smart as the patient, that is, not better than you, avoid causing jealousy, and not worse than the patient.
Avoid situations in which patients feel devalued, leading to complete collapse.
An analyst’s systematic analysis of the nature of this empathy must also satisfy the needs of some patients for compliments and once again confirm their omnipotence.
This omnipotent characteristic causes anger, anger, or a sudden devaluation of the analyst and the analyst’s evaluation.
But the analysis of empathy attributes is more important than the shell.
When patient awareness comes from the true understanding and help of the analyst, an important feature emerges in the analysis arena.
This understanding and help from the analyst painfully shifts the patient’s awakening to the analyst’s autonomy and independence.
The analyst must endure and tolerate the anger and depreciation that occurred during this period. The analyst’s explanation of this reason should be carried out gradually. The patient should be allowed to integrate positive and negative empathy, integrate ideals, trust and anger, and despiseParanoid mistrust.
(B) Secondary characteristic defense a.
If the feature alignment here does not mean personality, but some narcissistic personality patients sometimes act like acting, sometimes they may imitate the “perfect analyst” and carry some appreciated thoughts and dramatic discoveries from the past.
They learn to “perfectly associate”, including appreciation from emotion to thought, from now to the past, and from fantasy to reality.
But in the treatment, there is the fact that their emotional relationship with the analyst has failed.
This is a typical “as if” characteristic.
This paranoid fear is that when not acting, there will be a critical conflict that must be faced by the analyst’s explanations, and activation worries and pain may lead to the beginning of this behavioral functional expedition.
Paranoid micropsychiatric serials: This situation is seen when narcissistic is called mastery, but also in other types of psychopathology.
When the projection mechanism used was analyzed, the patient tried to defend against the intolerable feelings of guilt he experienced.
The patient showed a sense of respect for the analyst’s attack.
It has been repeatedly stated that analysts are lying to him, cheating him, betraying him, and wanting them to suffer painfully from him or her.
Problems like this may be solved by a guarantee, and even this guarantee is more important than true repair.
The patient’s deep conclusions of uselessness to the analyst are suppressed or separated from other empathic developments. Eclectic methods can temporarily support the patient’s safety and self-esteem, but it basically leads to the resurgence of this paranoid drama.It’s bad reviews one by one that gradually accumulate.
It usually results in a huge “acting out”, sudden breakdown of treatment, or artificial termination of treatment.
The patient insisted that he never believed in the analyst and that termination of treatment was an escape from a dangerous enemy.
This is a painful scene of treatment failure.
Because analysis seems to be on the way to curing this serious personality disorder.
This characteristic interaction caused disruption and stalemate in the analysis process, and Kernberg believes that such patients may not be analyzed.
Secondary is sufficient This is difficult to distinguish from the symptomatic secondary of neurosis.
If the patient is in a narcissistic environment, the adaptation of many severe personality disorders improves the patient’s function and thus reduces his motivation for change.
The classic example is when the patient is in adolescence or early adulthood, and certain narcissistic habits can cause them to fall in, which will make the prognosis of treatment in this period poor.
However, the prognosis is better for patients like these in middle age, or when narcissistic admiration declines.
Characteristic Narcissism The morbid omnipotence of some narcissistic patients cannot be infiltrated by primitive aggression, and their sadism is a kind of self-coordination.
For these patients, the occasion for analysis is very satisfactory, it can eliminate the need for change, and it can lead to stagnation of treatment.
Analysts who have empathy for patients without ill-treatment and realize that there are severe restrictions on reality. Such restrictions do not carry a counter-transference attitude to action, which may have a decisive effect on the characteristics of these alternative treatments.Impact.
Characteristic defense (severe suppression: dull personality) Some narcissistic patients, after repeated analysis, give a feeling that they understand everything.
But contact with these patients always makes people feel lack of emotion.
There is no emotional communication with their communication.
Gives a dull, wooden feeling.
In the clinic, they did not even show obvious narcissistic characteristics.
Although carrying a pseudo-adaptation attitude towards treatment, these correspond to their external “stiff” lives.
Their experience analysis is only an opportunity to be educated once, but there is no deep motivational subconscious experience.
The best treatment is to expose these patients further. Such patients are often misdiagnosed.
(C) Further treatment: a.
Let the patient internalize and change the object relationship in the relationship with the analyst; b.
Rebuilding dependencies; c.
Allow the patient to reproduce their own (self) empathy, tolerance of attack, and guilt after the attack;
Analysis of positive and negative empathy, the integration of partial and complete object relations simultaneously leads to the integration of their own good and bad objects.
(D) Supportive Psychotherapy Supportive Psychotherapy is necessary throughout the treatment.
When patients experience traumatic experiences, or primitive aggression, guilt, and defense are analyzed, support is needed.
(5) General treatment attitude: empathy (empathy) a.
Personality near the patient; b.
Humble attitude; c.
Experience with the patient; d.
Psychologically sensitive to the patient’s emotions and clinically alert to the patient’s behavior; e.
Be keenly aware of your countertransference.