Clinical Social Work Journal, Vol. 33, No.

2, Summer 2005 ( 2005)

DOI: 10.1007/s10615-005-3528-x

KEY CONCEPTS IN THE THEORY AND TREATMENT

OF NARCISSISTIC PHENOMENA

Sandy Hotchkiss, M.S.W., L.C.S.W.

ABSTRACT: In the 90 years since Sigmund Freud opened the dialogue on

narcissism, successive theorists have taken turns at defining what it is, where it
comes from, whether or not it is healthy, and what to do about it when it is not.
This paper summarizes the history of narcissism theory and offers thumbnail
sketches of what narcissism looks like from the perspective of several major
theorists. From these conceptualizations are derived six key concepts that recur
in narcissism theory: (1) differentiation; (2) internal objects; (3) primitive
defenses; (4) envy; (5) superego development; and (6) affect regulation. A
vignette shows how these phenomena manifest, and strategies for intervention
are discussed for each concept.

KEY WORDS: differentiation; internal objects; primitive defenses; envy;

superego development; affect regulation.

A BRIEF HISTORY OF NARCISSISM THEORY

Classical Theory: Freuds Narcissist

Early in the 20th century, Sigmund Freud faced challenges to his
libido theory from Carl Jung, who had defected from his inner circle in
1913. Freud insisted that libido was sexual energy, while Jung be-
lieved that it was a more qualitatively neutral psychic force (Jacoby,
1990, p. 6). To defend his point of view, in 1914 Freud wrote the essay
On Narcissism: An Introduction (Freud, 1957), and in it he grappled
with the concept of narcissism as both a healthy phenomenon in very

Correspondence should be directed to Sandy Hotchkiss, M.S.W., L.C.S.W., 595 E.

Colorado Blvd., Suite 432, Pasadena, CA 91101, USA.

127 2005 Springer Science+Business Media, Inc.

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young children and later a perversion in which ones own body is taken
as the sexual object. He described a normal course of infant develop-
ment which includes a phase of primary narcissism, when the childs
first object choice is his own body. Optimally, this autoerotism
evolves into alloerotism, or love for others who represent the original
caretakers, which Freud called anaclitic (attachment) object choice.
In contrast, those whose love objects represent some aspect of them-
selves were said to exhibit narcissistic object choice. Freud also ex-
plained how frustrations, disappointments, and losses might lead to
secondary narcissism, a withdrawal from object love to self love after
the ability to love others has been established. In describing how pri-
mary narcissism develops into healthy object relations, Freud also
introduced the concept of the ego ideal. The investment of libido in
this ideal, he wrote, diminishes primary narcissism and becomes the
basis of moral development.
Key to Freuds theory is the assumption that the psyche originates
in a closed, or objectless, system (Sandler, Person, & Fonagy, 1991, p.
xvi). He believed that the newborn infant has no sense of others as dis-
tinct from itself, and that separateness and differentiation become pos-
sible only when enough libido has been retained through primary
narcissism to strengthen the rudimentary ego. Although Freud essen-
tially abandoned theorizing about narcissism after his 1914 essay, his
controversial ideas of how a self develops from objectlessness to object
relatedness would influence the unfolding of narcissism theory for dec-
ades after him.
While Freuds narcissist was most likely homosexual or female (in
his mind, those most likely to choose a mirror-image as a love object),
later interpreters of his theories have emphasized the existential
aloneness of the narcissistic character from the Freudian perspective
(Treurniet, 1991, p. 83). Withdrawn, noncommunicative, perhaps nega-
tivistic, this is someone who becomes overstimulated and loses bound-
aries when in the company of others too long. This person cannot
reconcile intense and overwhelming feelings of dependency with a nec-
essary belief in omnipotent self-sufficiency, and the conflict is ex-
pressed as a craving for admiration.

Object Relations Theory: Kleins Narcissist

One of the first to dispute Freuds concept of differentiation was
Melanie Klein. Writing in the mid-20th century, she said there is no
mental state, however regressed, that is without objects (Klein, 1952).
To her, differentiation is not a matter of objectlessness and object love
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but rather a process of forming ever more complex and realistic mental
representations of both self and others. She rejected Freuds notion of
psychosexual stages of development and offered in its place her own
theory of two states, or positions, of the ego and their associated af-
fects and defenses. The paranoid/schizoid position represents the
more primitive state and features an internal world of warring good
and bad objects which the immature self maintains in split fashion,
so that good and bad are always kept separate and never appear
simultaneously when projected externally.
There is a need to protect the self and its idealized objects from
the murderous objects that contain the split-off and projected aggres-
sion that originates in the infants self (Segal & Bell, 1991, p. 160).
Somewhere between three and six months of age, Klein postulated, the
child begins to recognize that good and bad can coexist in the same ob-
ject and feels gratitude, regret for attacking those who have provided
care, and a desire to offer reparation. Evolving into this depressive po-
sition, the child enters the ethical world. Klein wrote of narcissistic
withdrawal to an idealized internal object, but she thought that pri-
mary narcissism was no more than oral sadism. Like Freud after the
1914 essay, she was not specifically concerned with addressing narcis-
sism. Her contributions to narcissism theory are nevertheless signifi-
cant and include the elaboration of a concept of internal objects, the
description of primitive defense mechanisms associated with the less
differentiated paranoid/schizoid position, and explanations of the phe-
nomenon of envy.
Kleins narcissist is a deeply envious and paranoid individual who
has a JekyllandHyde drama playing out inside her head. She has
withdrawn from reality and teeters on the verge of psychosis. In her
internal world, she is all good, and all badness resides in others, who
want to attack her. Insecure about her own goodness, however, she
flies into a rage when she perceives others to be better than herself.
She cannot accept anything good from them, because to do so would
mean acknowledging their worth and separateness. So she hates their
goodness and devalues them, then fears retaliation.

Pathologies of the Self: The Narcissists of Kernberg, Kohut, and

Masterson
When Freud wrote about the ego in his 1914 essay, he was talking
about what we now call the self, but his subsequent theory of the tri-
partite mindid, ego, and superegogave a more specific meaning to
ego as the executive apparatus of the mind. His definition of narcis-
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sism as a cathexis of the ego thus lost its original meaning until 1950,
when Heinz Hartmann made the correction, calling narcissism a ca-
thexis of the self-representation within the ego (Hartmann, 1950).
With this refinement was born the concept of a self, as opposed to an
ego, psychology, and Hartmann is credited with paving the way to the-
ories of a distinct clinical pathology of the self that launched deeper
exploration into the etiology of narcissism.
For the next two decades, three major theorists approached the
concept of narcissism from different perspectives, each struggling with
the fragmented legacy left by Freud. Otto Kernberg (1975) emphasized
the aggressive aspects of pathological forms of narcissism related to
flaws in superego development. Margaret Mahler, a pediatrician whose
observations of young children at play became the basis of an elabora-
tion of Freuds controversial ideas on the development of object rela-
tions, described the evolution of early narcissism in the practicing
subphase of separation-individuation (Mahler, 1972). Her model would
inspire James Masterson (1981) to develop his theory of pathological
narcissism as a developmental arrest in this subphase.
Heinz Kohut (1971), from his roots in traditional drive/structural
and object relations theory, veered off on his own to create a whole
new paradigm that had more in common with Jung than Freud. Like
Jung, who had shown little interest in narcissism other than as the
shadow side of the process of individuation (Jacoby, 1990), Kohut
emphasized what Freud had originally hinted at: the essential nor-
malcy of something which becomes pathological only when normal
development is thwarted. Whereas Kernbergs theories are linked to
clinical interventions which urge the patient to give up infantile nar-
cissism in favor of object love, Kohut encouraged therapists to under-
stand and accept primitive forms of narcissism, allowing the patent to
use the therapist as an object of idealization and a source of mirroring
support for growth. Throughout the late 1970s and early 1980s, there
ensued a lively debate among proponents of Kernbergs more tradi-
tional thinking, those who espoused Kohuts innovative ideas, and the
followers of Mastersons Mahler-based developmental approach. Narcis-
sism and its treatment had become a central issue in psychoanalytic
circles, with clarity and unity more elusive than ever.
Kernbergs narcissist is an aggressive charactergrandiose, self-
absorbed, and exploitive, full of chronic envy and rage, and lacking in
values and empathybut superficially less fragmented than the near-
psychotic character described by Klein. This individual basically hates
and fears his parents but manages to keep his aggression in check by
putting on a show of competence. He has very little in the way of a
conscience and uses and discards people when he is not denying that
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he needs them at all. His inflated sense of himself protects him from
any awareness of his own shortcomings, but if his omnipotence falls,
he is awash with inferiority and insecurity.
If Kernbergs narcissist is someone in need of a moral tuneup,
Kohuts is a more pitiful character, a needy, depressed person with low
self-esteem, a deep sense of uncared-for worthlessness and rejection,
and a hunger for response and reassurance. She needs to idealize oth-
ers so that she can siphon off some of their wonderfulness to replenish
her depleted self. She collapses at the slightest hint of criticism and
has a temper tantrum if her expectations are not met. She needs ten-
der loving care to grow into the person she is meant to be.
Mastersons narcissist is a brash, exhibitionistic, selfassured indi-
vidual with a strong need for control and perfection, an emotional
two-year-old without the two-year-olds essential lovability. Her inter-
personal relationships are cold and exploitive, as her main interest in
others is in how they can be used to keep her feeling good about her-
self. When this is working, she does not feel good, she feels better
than. Her inflated self-image is impervious to depression, and she will
never admit to weakness.

An Interpersonal Perspective: Fiscalinis Narcissist

In stark contrast to 70 years of imaginative theory on the internal
life of young children, a body of research featuring direct observations
of infants using scientific methodology emerged in the mid1980s to
challenge some of the most cherished tenets of psychoanalytic thought.
Daniel Stern (1985) was among the first to use this research to refute
Freuds ideas about differentiation openly, and he proposed his own
Interpersonal theory of the development of the self.
Notably absent from his thinking is any reference to narcissism,
either normal or pathological. Yet his theory resonated with the follow-
ers of Kohut, the growing body of literature on attachment, and a new
school of psychoanalytic theory emphasizing the intersubjective or
relational aspects of human behavior.
From this perspective, all pathology can be explained as an arti-
fact of relational disturbance, and there is an avoidance of labels,
including those pertaining to narcissism.
John Fiscalini (1993), whose writing represents the relational
school of theory, describes a narcissist as someone who exhibits a con-
stellation of grandiosity, selfcenteredness, contempt and idealization
of the self and others, vulnerable selfesteem, psychological inaccessi-
bility, entitlement, need for admiration, and coerciveness. These are
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attributed to faulty parenting in which the child has been either

shamed, spoiled, or treated as special to the extent that he or she
meets a parents needs.

The Neurobiological Revolution: Schores Narcissist

By the late 20th century, psychoanalytic theory was in danger of
losing what little clarity it was beginning to have on narcissism, until
a new development occurred which has been called the Neurobiologi-
cal Revolution. Spearheaded by Allan Schore in his seminal work on
affect regulation (1994), it bridged the gap between the science and
the art of psychotherapy to explain how right-brain-to-right-brain
communications between infants and their caretakersand by extrap-
olation between patients and their therapistsmediate brain develop-
ment and the capacity for selfsoothing. We can now document
through sophisticated imaging techniques how the brain processes
emotion. Technology has given new life to Freuds ideas of superego
development, as we learn more about the role of shame, the under-
side of narcissism (Morrison, 1989), in socialization and the forma-
tion of character pathology. Today, 90 years after Freud penned his
first thoughts on the subject, we have the opportunity to understand
narcissism with the wisdom of hindsight as well as the benefits of
modern science.
With emphasis on deficits in affect regulation, Schores narcissist
is someone whose envy, contempt, and arrogance are a cover for the
inability to neutralize shame states. Faulty parenting has left this per-
son with a distorted sense of self that is both easily deflated and des-
perately needy of inflation from outside sources. Reality is also
distorted in a more general sense in order to prop up a fragile ego.
Brain circuitry having been shorted in a crucial developmental stage,
this person uses and abuses others without conscious awareness of or
concern for the damage being inflicted. Personal boundaries are rou-
tinely violated without compunction and with a strong sense of entitle-
ment. Frustration tolerance is poor, and rage erupts when the persons
efforts at control are thwarted.
Clearly, how one approaches narcissism in ones patientswhether
one focuses on primitiveness, envy, aggression, self-centeredness, defi-
cits in achieving an adequate sense of self, flaws in moral development,
depression and emptiness, shame sensitivity, or poor parenting
depends on ones theoretical orientation. Helping the narcissistic pa-
tient means being able to attune and respond to all of these factors.
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SIX KEY CONCEPTS IN THE THEORYAND TREATMENT OF

NARCISSISM

From 90 years of theoretical evolution can be culled six key con-

cepts that lead to helpful goals and interventions with patients who ex-
hibit narcissistic symptomatology.
The first of these is the concept of differentiation. When Freud
wrote of autoerotism in the earliest days of life, he meant that all of
the infants libido is directed toward the self while the psyche is with-
out external objects. At first, he believed, the infants perceptions of the
soothing and pleasure-inducing aspects of its caretakers are perceived
as part of the self, the state of primary narcissism. Mahler (1968)
would expand on Freuds ideas, referring to autoerotism as normal in-
fant autism and primary narcissism as symbiosis with the caretak-
ing object. Freud had theorized that enough libido needs to be retained
by the infant to create an ego that is capable of differentiating self
from other. Only when the ego is strong enough is the infant capable of
alloerotism, or object love.
Mahler used the concept of differentiation to describe the first of
three stages in the separationindividuation process, in which the
child gradually emerges from symbiosis and begins to form a cohesive
sense of self and others as separate from one another. The transition
from symbiosis to differentiation is marked by a hatching phenome-
non, in which the infant seems to become more open to the world out-
side the caretaking relationship. Others are compared to the caretaker,
and it begins to dawn on the child that the caretaker belongs to the
world of others. By subtracting the caretaker from the symbiotic dual
unity within one common boundary (Mahler, 1968), the child is left
with the first rudimentary notion of a separate self. The next stage is
marked by a sense of grandiosity and omnipotence derived from a still-
fused relationship with the caretaker (the practicing subphase), fol-
lowed by a stage of moodiness and clinging when reality begins to sink
in (the rapprochement subphase). Masterson (1981) would later de-
scribe narcissism as a developmental arrest in the practicing subphase,
caused by parenting that failed to deflate infantile grandiosity. His the-
ory offers much to explain why narcissists seem to treat others as
extensions of themselves, why they become either disinterested or en-
raged when others assert their separateness, and why they often do
not even understand why boundaries exist or when they are being vio-
lated. Narcissism is a state of undifferentiation.
Despite the controversy over objectlessness, many of Freuds harsh-
est critics on the issue of differentiation acknowledge that there is a
developmental progression from the primitive to the mature, with the
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former being characterized by a lack of clear boundaries between self

and other, the state of undifferentiation which Klein described as the
paranoidschizoid position.
This brings us to the second important concept in narcissism, that
of internal objects, or those mental representations of self and other
that live within us. To ignore the internal world of the narcissistic
patient is to risk poor treatment outcome or premature termination.
All of the major theorists of the mid20th century wrote of internal ob-
jects, giving rise to the body of theory known as object relations. Klein
(1946) gave us a particularly vivid description of this internal world,
envisioning a clear demarcation between the former, earlier state of
warring good and bad part objects and the latter, more mature one,
in which the infant develops a relation to whole objects which con-
tain both good and bad qualities. Mahler, too, would write of whole
object constancy as the end product of separationindividuation, when
the childs infantile fantasies of grandiosity, omnipotence, and control
over its objects yield to reality, the recognition of separateness, and
psychological autonomy. In developing their theories of pathological
narcissism, both Kernberg and Masterson give detailed descriptions of
the internal world of objects, and Kohut explains how narcissism
evolves from the primitive to the mature through the process of trans-
muting internalization of the therapist as good object.
The outward manifestation of primitive internal objects is in the
defense mechanisms associated with them. Others are not seen realis-
tically but rather through a kind of prism of partial truths. They are
good if they resonate with my expectations and make me feel good, bad
if they disappoint me. The narcissist does not hold an image of another
person as simultaneously both good and bad. This is apparent in the
rapid idealization and devaluation of significant others in response to
narcissistic gratification and injury.
This process, known as splitting, is one of the primitive defense
mechanisms, the third key concept in narcissism. We recognize narcis-
sists both by the way they behave and by the way they make us and
others feel. Their arrogant inability to see their own flaws, to accept
blame, or to atone for their transgressions may make us angry and
resentful. We observe how they avoid owning any imperfection by pro-
jecting it onto others, often creating confusion and shame in the recipi-
ents of these distortions. Sometimes, they engage in a most pernicious
defense, which Klein called projective identification, whereby the per-
son on whom they project the imperfection becomes identified with the
disowned quality. A mother whose unacceptable lust is projected onto
her daughter, for example, may consider her a whore, and the daugh-
ter may come to believe she is one. Conversely, narcissists may idealize
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SANDY HOTCHKISS

another person in order to bask in the glow of the others wonderful-

ness. In either instance, reality fades to the background, and the nar-
cissist lives in a world of his or her own creation. We may feel
alienated and shut out from that imaginary place, or we may find our-
selves enchanted and eager to be drawn in.
A fourth key concept in narcissism is that of envy. Klein tells us
that envy is the hatred of good objects. The narcissist hates goodness
because it threatens to outshine him. He must sully or disparage it, de-
stroy it with his contempt, in order to restore his superiority. He en-
acts in real life the internal battle between good and evil, all the while
fearing punishment for his aggressive intentions. That is why the nar-
cissist is often obsequious in his relationships with those whom he per-
ceives as more powerful. This is not genuine humility but rather a
need to disguise his hatred and avoid retaliation.
Klein believed that in time the child begins to recognize the sepa-
rateness of his caretakers and to feel remorse for his infantile aggres-
sion and fear of abandonment by needed others. For the first time, he
feels gratitude and a desire to make reparation. She called this the
depressive position, and the onset marks the childs entry into the ethi-
cal world.
The fifth concept is that of superego development. Nearly every
major theorist who has had something to say about narcissism has
highlighted the defect in this area. Freud wrote of the ego ideal, the
seat of conscience and precursor of his later concept of the superego,
and how it is formed in response to the shaming of socialization. With
shaming and the awakening of critical judgment, the growing child can
no longer retain the infantile image of himself as perfect. But in the
ego ideal, he can recover some of his lost perfection, and healthy ma-
ture narcissism can be achieved by living up to the dictates of his own
conscience.
Later, Kernberg would write of the superego defect in pathological
narcissism which forms the pathological grandiose self, which he defined
as a fusion of real self, ideal self, and ideal object representations.
Kernberg emphasized the unrestrained aggression of the narcissistic
character, the lack of empathy and detachment that allow for ruthless or
thoughtless exploitation of others to achieve narcissistic goals.
The narcissists problems with aggression and shame lead to the
sixth concept, that of affect regulation. Schores compilation of the
research in this area documents that faulty parenting leads to deficits
in brain development at both ends of the practicing period (age
1012 months and age 1618 months), leaving the individual unable to
selfsoothe the out of low arousal states such as shame. Schore
describes how the narcissistic person compensates by bypassing
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shame, which appears to others as shamelessness, coldness, or haugh-

ty disdain. The narcissists fundamental inability to regulate her own
affect through healthy channels also explains why others are so needed
to provide admiration and to serve as receptacles of off-loaded, or pro-
jected, shame.

STRANGE ENCOUNTERS OF THE NARCISSISTIC KIND:

MARGARET

There was a sense of urgency in the voicemail Margaret left for

me, asking for help with the daughter to whom she had not spoken for
five years. At the age of 20, this kitten had become a cougar, leav-
ing Margaret dumbfounded and searching for answers. She had found
my book on narcissism, and it seemed to explain her daughters behav-
ior, which she described as rageful and hypersensitive to criticism. She
left her phone number and asked if we might speak, then said she
would call me back so that I would not have to pay for a long distance
call.
Since writing this book, I have received many such calls from peo-
ple who want more personalized attention to their concerns about nar-
cissism, and for those who live a great distance from me, as Margaret
did, I offer a 50-minute phone consultation for which I charge my
usual hourly fee. I do not solicit this sort of business, but when people
seek me out, I try to help.
Although I am reluctant to incur long distance charges with
strangers and aware that this might communicate an unrealistic
expectation of availability, I knew that Margaret would have difficulty
reaching me, so I called her back. Since she had seemed respectful en-
ough in her initial message, I thought I could make a quick call, see if
there was a fit between what she wanted and what I could offer, and
set up a phone consultation if there was. However, our first conversa-
tion lasted nearly 15 minutes, and there was little dialogue. After
thanking me for returning her call (but not, tellingly, offering to pay
for it), she immediately launched into the details of her estrangement
from her daughter. Two, perhaps three, times, I was able to get a word
in edgewise, and I used those moments to describe to her the terms
and the limits of my ability to help. She declined to set up an appoint-
ment, saying that she was ill, but she asked for my e-mail address so
that she could get her thoughts across in a more organized way.
Thinking that this would be the best way to facilitate any future con-
tact between us, I gave it to her. I then had to cut her off in the middle
of yet another outpouring in order to end the conversation.
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Later that day, I received the first of three lengthy e-mails from
Margaret in which she told me how depleted she was feeling both
physically and emotionally. She asked me to allow her to wallow in
her pain and promised that she would be more coherent when it lif-
ted. She told me she had lost both her children to disorders, but
that she was not a victim, just wounded. She praised my book,
thanked me for contacting her, and told me she was looking forward
to learning something more from me. She proposed the idea that I
might learn something as well from her experiences with her daugh-
ter, so that the bad would be turned into something good, worth-
while, and useful. Using dramatic language, she wrote of her
suffering, her survival, and her desire to summon a tow truck to haul
her and her daughter out of the depths of their shared pain. I was to
be that tow truck.
To this first e-mail, she attached what seemed to be the beginnings
of a story she was writing about the pivotal conflict with her daughter,
in which the mother character is leveled by a tornado called Envy and
the daughter speaks to the mother in cruel and haughty ways. Marga-
ret ended her first message by saying that she would be in contact la-
ter when things were more stable for her both physically and
emotionally. I wrote back simply that I would be there when she was
ready to proceed.
The following morning, I received a second e-mail from Margaret.
She asked me to bear with her, as she had a plan. Her plan included
soliciting the help of unnamed others by giving them my book and
somehow getting them to cooperate with getting treatment for her
daughter. Although still ill and miserable, she was feverishly organiz-
ing and delivering these letters and books. She joked that half of my
book sales might come from her city, as she planned to send a copy to
everyone she knew for Christmas.
There was another attachment, this a letter to her estranged
daughter. Intermittently referring to herself in the third person, she
used the concepts in my book to interpret her daughters behavior to
her, attributing the rageful outbursts to envy and stating that she
couldnt allow herself to be in a relationship with a daughter who tried
to obliterate her autonomy. She asked her daughter to acknowledge
that her behavior had become violent and controlling and warned her
that if they did not accept some help, she was in danger of the serious
and irreversible condition of narcissism. She told her about contacting
me, and how I would be the tow truck that would pull them from their
suffering. She wrote at some length of the progression of her own feel-
ings, of her daughters lost love for her, and of her intention to come
and get her. She vowed that they would find what they had lost, be-
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cause mothers and daughters belong together. She pleaded with her
daughter to work with her, and with me.
By this time, my uneasiness with Margarets initial boundariless-
ness toward me had grown to alarm. Without any input from me, she
had concocted a fantasy of how I would rescue her and her daughter
from the clutches of what she was convinced was her daughters nar-
cissism. And in the process of revealing this plan to me, she had ex-
posed an even more egregious lack of boundaries with her daughter.
Most distressing was her utter lack of awareness of her own dynamics.
I wrote back immediately, carefully choosing my words to firmly
set the boundaries she had so far ignored and create a test of whether
she could benefit from a single phone consultation, which I had begun
to doubt deeply. I had offered my help, but now I was faced with
retracting it. I knew that I had to protect her from the shame that
would come if I popped her bubble too abruptly and the rage that she
might feel toward me for abandoning her after she had idealized my
book and invested me with her hope.
I began by telling her that we could not proceed until I had clari-
fied that, for both legal and ethical reasons, I could not provide phone
therapy to either her or her daughter. I expanded on what I had told
her on the phone about the nature of consultation, which I defined as
an opportunity for some personalized feedback in regard to issues that
my book had raised for her. I told her that if she lived near me, I
would be happy to work with her in more depth, but that given the
great distance between us, it would be in her best interests to seek
competent professional help in her own community.
Then, the test. I told her that if she wanted to proceed with a
phone consultation, I would recommend that she focus on herself ra-
ther than her daughter, so that we could use our limited time together
more productively. I reiterated for what seemed like the tenth time
that, if she would like to proceed, we could make an appointment when
she was feeling better. I acknowledged her despair and offered her the
hope of a better way of managing her relationship with her daughter,
and I finished strongly, saying that while I could not be her tow
truck, I could provide roadside assistance.
Another day passed, and I received what would be the final, and
longest, e-mail message yet. Margaret began by telling me that a book
consultation was not exactly what she had in mind. That should have
been the end of it, but Margaret was not finished. For four long pages,
she continued to describe the details of her conflict with her daughter,
interspersed with rhetorical questions that left me wondering if she ex-
pected to continue our e-mail correspondence despite having refused
the phone consultation. A new fantasy had captured her imagination
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that seemingly justified her outpouring: if I could not help her, maybe
she could help me, and through me, others. She invited me to pick her
brain. Her situation was special, she felt, and she could think of noth-
ing she had done that would create narcissism in her daughter. Then
she segued sharply from what was clearly her own humiliation to a
discussion of her daughters shame from childhood, which had always
been an enigma to her.
Finally, Margaret began to talk about herself and the abuse she
had suffered at the hands of her violent, character disordered, men-
tally ill mother. She wrote of being beaten and shamed, tormented at
school and at home, friendless, parentified, the family protector. She
alluded to having been indulged in some way. Yet she had triumphed
over her trauma, had grown up compassionate and loving. She had no
guilt or regrets about her parenting. So why had her daughter turned
into a hateful, raging narcissist at age 20?
My heart went out to her, but there was no common ground on
which we could meet to process all that she had shared. If I would
not be her tow truck, then there was nothing left for us but that she
should be of some service to me. She thanked me for everything I
had given her in writing my book, and in a postscript, referenced my
husband. It was then that I realized that she must have been the
person who, a few days previously, had contacted an art organization
he belongs to, trying to locate me. Most people track me down
through the professional channels listed in my authors bio, but Mar-
garet had zeroed in on something in the acknowledgments section of
my book that mentioned my husband is an artist. She told me, in
parting, that she and her husband were artists and that they had
admired my husbands work. She asked me to pass that along to
him. A little shiver ran down my spine as I felt she had invaded my
home.
Margaret had stirred many conflicting feelings in me. On the posi-
tive side, I felt compassion for her suffering and a desire to help her
sort through what had gone so terribly wrong with her daughter. But
at the same time, I also felt used, overwhelmed, apprehensive, and
strangely invisible, no more real than a character in a drama of her
invention. Despite my understanding of characterological issues, I had
been drawn into her web. With considerable effort, I resisted the bait
she had left me and wrote her back a short note thanking her for her
offer but declining to engage with her further in the way she had pro-
posed. I suggested again that she work with a competent professional
in her own community, and I expressed regret that I could not have
been more useful to her.
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DISCUSSION

As clinicians, our first awareness of being in the presence of char-

acter pathology is often our own countertransference reactions. With
narcissists, we feel the slippage of boundaries, our own and the pa-
tients, while at the same time whatever is stewing in our own primor-
dial stockpot floats a little closer to the surface. We have entered the
interpersonal world of undifferentiation, primitive internal objects, and
their associated defenses of denial, idealization, splitting, projection,
and projective identification.
Margaret showed no awareness of her many violations of either
my personal boundaries or those of her daughter. She treated us both
like extensions of herself, me representing the good, powerful object
under her control and her daughter the frustrating bad object. Having
engaged me, her grandiosity and omnipotence seemed to kick in, pro-
viding glue to the fragmented self she had initially shown me. It was
not hard for me to imagine what had made her daughter so angry with
her when my own attempts to communicate the terms on which I
would interact with her were met with an impenetrable brick wall. My
needs and wishes for reciprocity in our relationship were entirely irrel-
evant to her. Is this how her daughter had felt? Margaret told me that
neither her daughter nor her son ever really went through the terrible
twos, and her daughter had been a model teen. At some point, clearly,
both of her children had exploded out of the symbiotic fusion. These
wrenching separations left Margaret feeling she had been hit by a tor-
nado, yet Margaret referred to her daughter, now 25, as a little girl
and herself as her daughters love object, images that even five years of
estrangement had not altered.
There was other evidence in her messages to me of her lack of dif-
ferentiation, her boundarilessness. At one point, she complained about
how resistant therapists had been to investigating her suspicions.
Since she had not spoken to her daughter in five years, I was left to
wonder whether she was disappointed in therapists who had treated
her or those she may have contacted after discovering they were work-
ing with her daughter. In either case, she apparently expected them to
act as her agents and was bewildered when they would not. She won-
dered if this was because of professional arrogance, a clear projection.
Boundaries seemed incomprehensible to her.
The revelations about her own childhood offer insight into Marga-
rets primitive defenses of denial, idealization, projection, projective
identification, and splitting. Both as a child and as a parent, she por-
trayed herself to me as the noble victim, her mother/daughter as the
mentally ill abuser whom she loved despite the abuse. Good and evil
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battling it out, with love the longed-for but elusive winnerher love
constant, the Others withheld. Her descriptions of her daughters
childhood showed that for years Margaret had been projecting the
shame and wounding of her own past onto her daughter and rewriting
the drama with herself as the loving, patient mother she herself never
had. Her daughter was split, too, into a gentle kitten and a menacing
cougar. The incident that had triggered the estrangement involved
Margaret patronizingly scolding her daughter and asking for more
love, which had triggered a rageful response in her daughter. Margaret
could not perceive this as a daughter trying desperately to separate
and individuate but instead seemed to experience it as a re-enactment
of the abuse she had suffered at the hands of her violent mother. Now,
her daughter had become the abuser and had resonated with the pro-
jection. Having lost her mother to mental illness, Margaret was now
convinced she was on the same slippery slope with her daughter, and
once again, she must fight for the happy ending she had been deprived
of with her own mother.
Margaret had come to the conclusion that her daughters contempt
and hatred toward her were manifestations of envy, yet she was totally
unaware of her own aggressive impulses toward her daughter, as ex-
pressed in her condescending attitude. Klein believed that primitive
envy is often hidden, split off, and silent. In Margarets request for
more love can be seen her envy of a child who had gotten what she had
not and therefore owed her something in return.
Margaret mused about how her daughter had become a narcissist
at age 20. Was it because she was so kind, considerate, and loving that
her daughter admired and loved her so much that she wanted to be
her? Or did her daughter come to hate her because she was so good? In
a rare moment of insight, Margaret told me that she had devoted her
life to parenting because her own chaotic childhood had made her
crave well-adjusted children. She wanted for them what had been
missing for her, and what she had missed most was a loving, caring,
calm, nurturing mother.
Masked in smothering love and superficial gratitude, Margarets
attitude toward both her daughter and me is essentially aggressive and
exploitive, revealing flaws in her superego development. Kernberg
describes how this defect occurs as the result of a fusion of real self ima-
ges, the ideal self, and the ideal object which prevents the development
of a more realistic self image and a genuine appreciation for others in
their separateness. The fusion is formed, Kernberg says, as a defense
against expressing rage over early deprivation. The resulting pathologi-
cal grandiose self of the narcissist presents as an inflated
selfconcept. In Margarets case, this self-concept is represented by her
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portrayal of herself as a perfect mother with unique suffering. Her spe-

cial place in her family as a parentified child (real self image) is fused
with idealized fantasies of herself as powerful and loving (ideal self, com-
pensating for her trauma) and the evergiving, everloving and accept-
ing parent (ideal object, replacing her devalued real experiences as a
child). Kernberg explains that identification with ideal images elimi-
nates the need for depending on frustrating others. Margaret did not
express a need for her daughter so much as an ideal image of
fusionthey belonged together, and it was not right that they should be
estranged. The intense rage over her early trauma was also denied and
well concealed, and her superficial adaptation (marriage, creative pur-
suits, politeness toward me) belied her essentially exploitive orientation.
Margaret told me that she could honestly say that she had no
guilt, no regrets, only confusion about the way things had turned out.
This is an example of what Schore calls bypassed shame. Unable to
neutralize shame states because of defects in brain functioning caused
by faulty parenting, narcissistic individuals have only their defenses of
projection and denial to protect them from intolerable emotions. These
supremely shame-sensitive individuals never appear ashamed because
they are so adept at sidestepping or transferring it onto others. In
Margarets case, her daughter is presented as the shame-filled one,
with Margaret left wondering why.
Margaret repeatedly thanked me for writing my book, but she was
unable to acknowledge the gift that she had surreptitiously stolen from
me with her long e-mails, the time she had taken from my usual activ-
ities, and the space she had taken up in my own psyche. As she did not
exist for herself in any real way, it could hardly be expected that I
would either.
Challenging as she had been, I felt some regret at not being able
to work with Margaret as a patient. Bright, questioning, and passion-
ate, she would have brought much of value to the therapeutic relation-
ship. Our work would have been focused on helping her differentiate
self from other by bringing to her attention the differences between
peopleparticularly herself and her daughterand the fundamental
healthiness of that fact. I expect this would have taken a long time,
with many gentle confrontations on my part and avoidances on hers. I
would have encouraged her to live in reality and soothed her feelings
when she did.
Work with Margaret would have meant constantly monitoring the
state of her internal objects and how those interacted with my own. It
would have been challenging to sort through how our deepest fantasies
of self and other met on the playing field of our relationship, trying to
figure out what belonged to whom. I would have been looking for signs
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of movement from the paranoidschizoid to the depressive position:

genuine regret, real abandonment depression, true gratitude, and rec-
ognition of separateness.
Progress for Margaret would have meant movement from primitive
to more mature defenses, containing projections, resolving splitting,
facing rather than denying. I would have listened for and acknowl-
edged her expressions of wisdom, humor, empathy, creativity, and
acceptance of the impermanence of lifewhat Kohut calls mature
(healthy) narcissism.
Margaret would need to come to terms with her own envy, to re-
claim her projections, and to make peace between the warring good
and evil objects of her internal world. In her case, I imagine that there
would have been much slow and painful work calling up and putting to
rest the real traumas of her childhood, acknowledging and comforting
the real wounded child still operating within her, sorting through her
reactions to present triggers that activate her primitive defenses,
encouraging her to see and test differences between what could be true
now as opposed to what she expects based on her past experiences.
I would have privately chronicled, then gradually and gently con-
fronted, Margarets lack of empathy or real regard for others, knowing
that tolerable doses of shame are how we build a conscience. To know
what a person can tolerate involves understanding her, knowing what
can and cannot be said, and how. This takes time. I would have looked
for awareness in Margaret and built on that, recognizing and soothing
her shame when it arose. I would have taken special care to reflect
back her progress in this regard and introduce her to the rewards of
being able to appreciate and love others in their separateness.
Throughout the process of therapy, I would have offered myself as
a regulator of Margarets affective states, knowing that the brain is
capable of growing what it needs in the presence of attuned and com-
passionate others. (Kohut called this mirroring, and the growth trans-
muting internalization.) Like the goodenough mother she did not
have, I would have tried to help lift her out of low arousal states such
as shame and depression, calmed her when she was angry, agitated, or
anxious, and injected reality when she was dangerously inflated, then
helped her to recover from the deflation.

CONCLUSION

Ninety years of theory have elucidated the significance of narcis-

sism as a psychic construct but have given us no consensus, no unified
strategy for intervening clinically. However, with attention to key con-
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cepts addressed by major theoristsdifferentiation, internal objects,

primitive defenses, envy, superego development, and affect regula-
tiontreatment goals can be set, interventions can be linked to theory,
and the prognosis can improve for the difficult narcissistic patient and
those with deep narcissistic wounds.

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Sandy Hotchkiss, M.S.W., L.C.S.W.

595 E. Colorado Blvd., Suite 432
Pasadena, CA 91101
USA