The case-study method of psychological research was applied to the brief psychodynamic therapy of a narcissistically disordered female patient. The aim of this research was to explore, clarify and explain certain diagnostic and psychodynamic anomalies to emerge in the course of treatment, using a conceptual framework derived from select psychoanalytic object relations theorists in the area of narcissistic pathology. The author, discovering that there was no diagnostic or explanatory object relations model adequate to the therapeutic data, formulated his own diagnostic category narcissistic neurosis and an eclectic object relations model in order to explain the anomolous research findings. Narcissistic neurosis was defined as a form of psychopathology in which a primarily neurotic character structure presents with a distinctly narcissistic profile. The narcissistic false self-structure serves the functional purpose of protecting the psyche from a repressed negative self-representation derived from a destructive bipolar self-object introject. The primary etiological factor to emerge was that of a narcissistic mother conditional affection and self-object target child necessitated adaptive whose insensitivity, relationship with the premature self-sufficiency and the defensive emergence of a narcissistic surface self-representation. It was proposed that narcissistic neurosis and narcissistic personality disorder are two discrete forms of pathology differing in terms of severity, psychodynamics, defensive structure, mode of object relating, therapeutic accessibility and prognosis. Assessment criteria were proposed in order to differentiate the two areas of narcissistic pathology and assess suitability for psychotherapeutic treatment. Positive treatment results in this case-study suggest that narcissistic neuroses may receive long-term benefit from short-term psychodynamic therapy.

The purpose of this research was to investigate the clinical phenomenon of destructive narcissism. Contemporary Kleinian and neo-Kleinian theoretical perspectives provided the interpretative perspective on the complexities of inaccessible personalities and subtle forms of internal destructiveness. Four research questions were formulated to interrogate the individual and collective experiences of three male patients whose internal worlds seem to be governed by rigid intrapychic structures organized around the dictatorship of a constellation of seemingly impenetrable defensive strategies. These questions were as follows: 1. What emotional states, actions and experiences of self and others characterize the clinical phenomenon designed as destructive narcissism and distinguish it from other forms of character pathology? 2. What early developmental experiences and relationships may have pre-disposed individuals to the development of this type of character pathology? 3. How are the psychodynamic processes of destructive narcissism structured and configured in the psychotherapeutic process and progress? 4. What are the transference/countertransference psychotherapeutic manifestations of the psychodynamics of destructive narcissism? The illustrative-didactic case study method was utilized to discuss pertinent aspects of each patient. This included their early developmental histories, inter- and intrapersonal relationships, their current mental state, defensive strategies and their stated reasons for commencing psychotherapy. In addition, the structure of the psychotherapeutic process with these patients was reviewed in depth. Various psychic and personality features, as unveiled through this process were discussed, as well as the implications of these for the therapeutic endeavor. The features chosen for discussion were: Firstly, the constellation of the internal object world, the capacity for symbolic thought and defensive organizations. Secondly, therapeutic ambivalence, which made psychotherapy untenable, was explored in conjunction with transference/countertransference issues. Thirdly, the shadow sides of psychotherapeutic change with these patients were considered and the issues of therapeutic failure and other treatment possibilities were examined. It was concluded that there need be an important shift with regard to the psychotherapeutic goals for those patients whose condition may be chronic, and for whom it appears that psychotherapy is of little benefit. In essence, the intent of psychotherapy with these patients is to reach the healthy sane patient of the patient within the pathological organization. Attempts to unravel the perverse gratification and protection derived from the domination of the narcissistic structure may not be enough, and the patient's collusion with the internal destructive gang should also be exposed. If this can be achieved, the patient may come to accept the existence of a part of himself as truly destructive. This, in turn, cannot be disowned, therefore the patient has to live with it. Thus, in destructive narcissism, the challenge for the therapist is the extremely difficult task of disentangling the patient's pain from the idealization of internal destructiveness. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in