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.

The Power of Imagination: How to Use Your Imagination to Get Through the Pandemic

The pandemic has forever changed the way that we live our lives.

Perhaps we should coin new abbreviations: B.P. (before pandemic) and A.P. (after pandemic).

Life B.P. seemed easier and more free-flowing. Obtaining goods and services happened relatively seamlessly, as did moving through dynamic processes involving multiple individuals and going places.

This is no longer the case.

When we can’t obtain what we desire in the expected but no longer extant B.P. modus operandi, what can we do?

In Freudian theory, there is something call the primary process. This process involves forming a mental image (imagining) an object that we desire (but cannot immediately obtain) in order to satisfy our desire for said object.

Beach Scenario

Let’s say that you’re dreaming of being on a favorite beach but that this isn’t possible right now in the A.P. world.

Close your eyes and imagine it. See the beach in your mind’s eye. Remember the time you were there. Feel the hot sand under your bare feet. Feel the soft, cool breeze that blows a slight ocean spray onto your body as you enter the water and slowly move deeper and deeper into the sea.

Can you hear the voice of the children playing on the beach? They suddenly scream for joy!

You’re in the water now, moving your arms rhythmically in order to stay afloat. You’re a ways off from the beach and can see the umbrellas lining the sand—blue and yellow blobs. The cicadas on the hanging vines that climb the surrounding cliff are loud and their ‘song’ reaches you intermittently, in cycles.

‘Ouch,’ you exclaim as you jerk your leg. A little fish bit you! But it’s alright. You’re here, at the beach, in the water, swimming and letting all your cares slip away.

This is an example of how you can imagine a favorite place and de-stress during these strange times.

The idea is that ideas, known in psychological terms as imagoes (idealized mental images of persons, the self or objects), can be willed in order to satisfy unmet needs.

Comparing Worlds

Lately, I’ve been wondering how children born A.P. will experience the world. For them, the B.P. world will be unknown. It was a world that was more carefree, less ecologically minded, less thoughtful, and perhaps more ‘real and physical.’

Perhaps A.P. kids will be more spiritual, less impulsive, more thoughtful, and prone to discover new inventions to help us adapt to the new, A.P. world. Perhaps these children will lead us into a new era.

No Regrets

Facebook came up with a new design. It’s sleek and elegant and we have until September to accept it. When September comes, we won’t have a choice; we’ll just have to accept it—or learn to live without Facebook.

It’s the same way now. Everything seems new. I deliberately use the word ‘seems’ because in many ways nothing has changed. Like Facebook, we can only repackage something so many ways—but it’s essentially still the same.

Spiritual Authenticity

Spiritual authenticity is what will enable us to move through the changes. In many ways, we can obtain this by replacing physical things with spiritual ones. It’s not as hard as you may think. With a little stretch of the imagination, even food can be obtained in this manner as the ancient Israelites were fed heavenly bread called manna.[1]

The pandemic is elevating us to higher thought and belief levels. We may feel as if we’re being pushed beyond our ability to cope, but this isn’t the case. There is a primary process that we can use to satisfy our needs.

Let’s Take it to the Next Level together. Book your appointment today.


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[1] Exodus 16:4.