Borderline Conditions and Pathological

A basic text for the understanding of patients with pathological narcissism.

Preface

ix

Acknowledgments

xiii

Part I Borderline Personality Organization

The Syndrome

3

(46)

Review of the Literature

Descriptive Analysis: The Presumptive Diagnostic Elements: anxiety; polysymptomatic neurosis; polymorphous perverse sexual trends; the ``classical'' prepsychotic personality structures; impulse neurosis and addictions; ``lower level'' character disorders

Structural Analysis: nonspecific manifestations of ego weakness; shift toward primary-process thinking; specific defensive operations at the level of borderline personality organization; pathology of internalized object relationships

Genetic-Dynamic Analysis

Summary

Countertransference

49

(20)

The Concept of Countertransference

Regression and Identification in the Countertransference

Some Chronic Countertransference Fixations

The Importance of Concern as a General Trait of the Analyst

Summary

Three General Principles of Treatment

69

(42)

Introduction

Review of the Pertinent Literature Transference and Countertransference Characteristics

Psychotherapeutic Approaches to the Specific Defensive Operations: splitting; primitive idealization; early forms of projection, and especially projective identification; denial; omnipotence and devaluation

Instinctual Vicissitudes and Psychotherapeutic Strategy

Further Comments on the Modality of Treatment

Prognosis

111

(42)

The Descriptive Characterologic Diagnosis: predominant type of character constellation; ego and superego distortions reflected in individual character traits; self-destructiveness as a character formation and negative therapeutic reaction

The Degree and Quality of Ego Weakness

The Degree and Quality of Superego Pathology

The Quality of Object Relationships

The Skill and the Personality of the Therapist

Summary

Differential Diagnosis and Treatment

153

(32)

A Critical Review of Recent Literature: diagnosis; treatment

Summary of Previous Work: the clinical manifestations of borderline personality; hypotheses regarding the origin of ego weakness; complications in analyzing patients with borderline personality organization, and technical implications for their treatment; some conditions under which analyzability improves or worsens

Further Considerations About Treatment: transference interpretation, regression and reconstruction; transference psychosis

Differential Diagnosis of Schizophrenia and Borderline Conditions

Overall Structuring and Beginning Phase of Treatment

185

(28)

The Overall Treatment Arrangements

The Basic Therapeutic Setting

Special Problems in the Early Stages: conscious withholding of material; consistent devaluation of all human help received; chronic development of ``meaninglessness'' in the therapeutic interaction; paranoid control and withholding; early, severe acting out; misuse of previous information regarding treatment, and of ``psychotherapeutic language''; the predominant quality of separation reactions; the psychotherapist's relationship with the hospital team

The Subjective Experience of Emptiness

213

(14)

Part II Narcissistic Personality

The Treatment of the Narcissistic Personality

227

(36)

Etiological and Dynamic Features

Differential Diagnosis

Considerations in Regard to Technique

Prognostic Considerations: tolerance of depression and mourning; secondary gain of analytic treatment; transference potential for guilt versus transference potential for paranoid rage; the quality of the sublimatory potential; the degree and quality of superego integration; presence of life circumstances granting unusual narcissistic gratifications; impulse control and anxiety tolerance; regression toward primary-process thinking; the motivation for treatment

A Crucial Period in the Treatment

Summary

Clinical Problems of the Narcissistic Personality

263

(52)

Clinical Characteristics of the Narcissistic Personality as a Specific Type of Character Pathology

The Relationship of Narcissistic Personality to Borderline Conditions and the Psychoses

The Relationship of Normal to Pathological Narcissism: developmental arrest or pathological development?; differential qualities of infantile and pathological narcissism; manifestations of pathological narcissism in the analytic situation; genetic considerations; types of idealization and the relationship of narcissistic idealization to the grandiose self; structural characteristics and origins of the grandiose self

Psychoanalytic Technique and Narcissistic Transference: vignette 1; vignette 2; vignette 3; vignette 4

Countertransference and Therapeutic Modification of the Narcissistic Resistances

Prognosis of Narcissism, Treated and Untreated

Normal and Pathological Narcissism

315

(32)

Definition of Normal Narcissism: the ideal self and ego goals; object representations; superego factors; instinctual and organic factors; external factors

Pathological Narcissism

Some diagnostic Applications of This Conceptualization of Narcissistic Pathology

The Treatment of Narcissistic Personalities

Some Problems Regarding Terminology and the Metapsychological Implications of Narcissism

General Bibliography

347

(8)

Index

355

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Borderline Conditions and Pathological Narcissism

Summary

Table of Contents

Supplemental Materials