Can the Treatment of Narcissistic Personality Disorders Produce Positive, Life-Transforming Effects?

Can individuals diagnosed with narcissistic personality disorders (NPD) be treated psychoanalytically and move toward positive, life transforming treatment outcomes?

According to Austrian-born, American psychoanalyst Heinz Kohut, the answer is yes.[1]

In spite of the ravages that narcissism causes, I suggest that an alternative to abandoning the narcissist is possible. This alternative involves the person with NPD being treated by a Kohutian analyst and changing.

Contrary to Sigmund Freud (19th century), the father of psychoanalysis, Heinz Kohut (20th century) believed that certain forms of narcissism could be healthy and formed on an independent line of development. Whereas Freud thought that you could either love others (object love) or love yourself (narcissistic love) and placed them at opposing ends of one developmental pole, Kohut placed them on two.

Trouble Starts Early

According to Kohut’s theory of Self Psychology, healthy development happens when a child gradually—and phase appropriately—transmutes psychological structures (i.e., cathected narcissistic energies) from idealized objects such as the grand exhibitionistic self or the idealized parent imago to the central part of her budding psychological self.

When, however, trauma happens and the child experiences either disappointment in, or the absence of, for example, an idealized parent imago, then that child will ‘wall off’ certain parts of her self at the exact point when the trauma took place—the so-called pathogenic fixation point.[2]

This means that the child continues growing with an entire section of her psyche ‘stuck’ at this traumatic fixation point. The walled off segment of the child’s psychological structure remains ‘fixed in time’ and is unable to grow normally alongside the rest of her primary nuclear self—because of the trauma she experienced.

This separation in the psychological structure caused by what Kohut terms the vertical split,[3] is at the root of adaptation problems in later life when the child—now an adult—acts out inappropriately demonstrating narcissistic behaviors.

An example of socially inappropriate behavior

According to Christina Oxenberg, Ghislaine Maxwell allegedly hosted a tea party in her underwear.[4] This behavior is considered to be socially inappropriate. That is to say, people normally don’t host tea parties in their underwear.

One explanation for why a person (not necessarily Ghislaine Maxwell) might not be able to discern between that which is considered socially acceptable behavior, and that which is not, could be untransmuted childhood trauma. A part of such a person’s archaic grandiosity and exhibitionism, therefore, never became fully integrated into their developing, adult personality—and remained separated from their nuclear self[5] by a vertical split—thus causing such a person to act out in ways that are socially inappropriate.

Therapy Activates Fixated Psychic Structures

During analysis, patients with NPD are able to, via what Kohut calls mirroring and idealizing transferences, access archaic psychic content and—provided that the therapist is patient, tolerant, sensitive to nuances, perceptive and allows the transferences to develop spontaneously—understand themselves better, transmute narcissistic energies to their primary psychological structure, and move toward healing in the form of ‘a gradual increase of realistic self esteem, of realistic enjoyment of success … and the establishment of such complex developments within the realistic sector of the personality as humor, empathy, wisdom, and creativeness.’[6]

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[1] Heinz Kohut, The Analysis of the Self.

[2] Ibid., 85.

[3] Luba Rascheff, Self Psychology in Brief,, 18, accessed online on September 4, 2020.

[4] Disclaimer: Ghislaine Maxwell is presumed innocent until proven guilty and this example, if true, in no way contributes toward a psychological diagnosis.

[5] Luba Rascheff, Self Psychology in Brief,, 80, accessed online on September 4, 2020.

[6] Heinz Kohut, The Analysis of the Self, 199.