Borderline Conditions and Pathological Narcissism

Part I: Borderline Personality Organization One: The Syndrome 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 Structured Analysis: nonspecific manifestations of ego weakness; shift toward primary-process thinking; specific defensive operations at the level of borderline personality organization; pathology of internalized office relationships Genetic-Dynamic Analysis Summary Two: Countertransference 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 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 Four: Prognosis The Descriptive Characterological 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 Five: Differential Diagnosis and Treatment 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 Six: Overall Structuring and Beginning Phase of Treatment 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 Seven: The Subjective Experince of Emptiness Part II: Narcissistic Personality Eight: The Treatment of the Narcissistic Personality 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 Nine: Clinical Problems of the Narcissistic Personality 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 Resistance Prognosis of Narcissism, Treated and Untreated Ten: Normal and Pathological Narcissism 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.