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]

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


Follow Take it to the Next Level on Facebook here.

Photo by Halacious on Unsplash

[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.

Everything is Going According to Plan

I become inspired—infilled with creativity—when I sit on my balcony.

I become lost in the ‘hum’ of construction, the occasional chirping of birds and the steady oasis of lush, green trees that permeate the urban landscape and selflessly absorb carbon monoxide from a depleted environment and transform it into O2.

Earlier I listened to a vulnerable and powerful conversation on race between Dean Helen Easterling Williams, EdD and Greg McKeown of the ‘Essentialism with Greg McKeown’ podcast here.

One of the points brought up among many is that out of the chaos and violence that the world is currently experiencing, something new and better will emerge.

Righteous anger is bursting at society’s seams. The stitches are becoming loose.

What I liked most about Dr. William’s expressive style is the calm and clarity with which she speaks about an explosive topic. Her life experience including having worked in a sharecropper family as a child in South Carolina—a reality that her Baltimore, Maryland school teacher whom she admired denied—gives Williams the authority to navigate between two worlds—black and white—and activate changes that will, perhaps sooner than we think, bring inequity to an end.

In Kohutian psychological terms, the disappointment Williams experienced from an idealized other (her teacher) contributed to lessening her grandiose exhibitionistic (expansive) self’s sense of worth and diminishing the integrity of her nuclear self. Fortunately, Williams overcame this via the compensatory path of becoming the first African American, female dean of Pepperdine University. If, however, we imagine this kind of soul-damaging trauma happening to—being replicated on—countless other black children, we get a glimpse into how this denigration of one’s personal story, one’s intimate, lived life experience devalues all of us (blacks, whites, and those of other races) in the societal matrix of our shared human experience.

As I observe the sky from my  balcony, dark clouds are interrupted by bursts of sunlight. It is a cycle in which the sun makes strides, but clouds appear once more. This metaphor applies to how the fight against racism and racial injustice has progressed over the years.

As painful as dismantling old, inequitable, and iniquitous structures and building new, better, and righteous ones is, the time for this to happen has finally arrived. And I believe that this is happening on more than one level of society.

Our Creator is doing a new thing.[i] The tables are turning and sooner than we had ever imagined.

When all of these thoughts occurred to me on my  balcony, so did the title for this piece, ‘Everything Is Going According to Plan.’

Let’s ‘Take it to the Next Level,’ book your appointment today,


Follow Take it to the Next Level on Facebook here.

Photo by Ian Parker on Unsplash

[i] Isaiah 43:19.