An ego psychology object relations theory of the structure and treatment of pathologic narcissism. An overview.

This article summarizes the author's contributions to the psychoanalytic understanding of narcissistic personality disorders and their application to a theory of psychoanalytic and psychotherapeutic techniques for the treatment of these patients. The treatment is described as primarily focused on the analysis of the pathologic grandiose self in the transference. The early stages of this transference analysis are differentiated from later stages in the treatment, when the gradual dissolution of the pathologic grandiose self brings to the surface the underlying, dissociated, primitive object relations reflecting unconscious conflicts. The final stage of the treatment is described as approaching the characteristics of the treatment of neurotic patients. Finally, expressive or exploratory psychotherapy and supportive psychotherapy for narcissistic patients are described as psychoanalytically derived alternative treatment methods, and their respective indications and techniques are briefly summarized.