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Mauro Mancia
'Hate, as a relation to objects, is older than love. It derives from the narcissistic ego's primordial repudiation of the external world.’ (Freud, 1915, cited in Mancia, 1993:11)
Mancia, discussing the development of Freud's understanding of narcissism, describes how Freud gradually conceived of narcissism being 'dynamically linked' to the death instinct and to masochism.
'Narcissism (is inevitably linked) to masochism and to all the clinical manifestations resulting from the actions of the death instinct, especially whenever this instinct is not externalised in the form of aggressiveness but remains internalised and somehow attached to the libido.' (Mancia, 1993:15)
Narcissism is a kind of death choice, a turning away from the world and contact with others. The self-sufficient, enclosed world of the self gives pleasure and security, with the sense that nothing can be lost, nothing taken away. There is a knowledge that reaching out into the world will inevitably entail vulnerability, pain, and loss. The loss may consist of being left or rejected by others; there is also loss of omnipotence and self-control in allowing oneself to love another. The narcissist refuses to lose control, refuses to be vulnerable, refuses to risk loss and pain.
'Pleasure is identified with the narcissistic situation, whereas pain is identified with the object relation. Mental pain (is) taken as an experience primarily associated with the renouncing of narcissistic pleasure and auto- erotic satisfaction. ' (Ibid p.16)
Gestalt psychotherapy does not postulate a death instinct, a 'primordial repudiation of the external world' in the sense of a biologically determined, inevitable and original way of relating to the world. Rather, the Gestaltist assumes that we, as human beings, have inherent needs to be in satisfying, fulfilling, mutually loving relationships with others as well as having needs for privacy.
'The human heart yearns for contact - above all it yearns for genuine dialogue. Dialogue is at the heart of being human. Without it, we are not fully formed - there is a yawning abyss inside. With it, we have the possibility of our uniqueness, and our most human qualities emerging. Each of us secretly and desperately yearns to be 'met' - to be recognised in our uniqueness, our fullness, and our vulnerability. We yearn to be genuinely valued by others as who we are, even that we are. The being of each of us needs to be revered - by ourselves, but also by others. Without that, we are not fulfilled - we are not fully ourselves.' (Hycner and Jacobs, 1995: ix)
The turning away from life, which is the way of being for the narcissist, would be understood by a Gestaltist not as an expression of the death instinct but as a response to the environment. This response might be the most creative and satisfying which could be found under the circumstances, for instance if the adults who care for the child are cold, hostile, mystifying or cruel.
If this way of relating to the world becomes fixed and inflexible, then the person is cutting himself off from his true, buried and most profound needs - to be met and recognised in authentic relationship with other people. It is the task of therapy to begin to make possible this longed for experience of being met and understood.
There is a commonality in Gestalt understanding and Mancia's description of narcissism as a turning away from contact with others because the risk of pain, frustration and loss which this entails will not be borne by the narcissistic person. Where Gestaltists will disagree with Mancia is in his attributing the cause of this response to a death instinct; Gestaltists will rather think of this choice as an initially creative response to the environment, which has, in adulthood, become fixed and unproductive and which can, within therapy, be re-evaluated and changed.
Neville Svmington
'A person's inner life is not a given, it is a construction. My life is ultimately my own creation; narcissism smothers that creation, does not allow it, prevents energy from being available to make it possible.' (Symington, 1993:124)
Symington finds this concept of the death instinct muddled and unnecessary; for him, narcissism arises because people make a choice. In his book Narcissism - A New Theory, Symington postulates the existence of a mental object which he calls the lifegiver - 'that the mind can opt for or refuse at a very deep level'. (Symington, 1993:3) He writes that for many years he believed that his patients' narcissism was caused by psychic trauma; however, his current understanding, which he has found very helpful in his therapeutic practice, is that whilst it is true that most or all narcissistic patients have been psychically traumatised, it is their response to the trauma which constitutes narcissism, not the trauma itself. In his description, narcissistically disordered people have turned away intentionally, at a very early age, from the lifegiver as represented by the mother, the breast.
As narcissists live their lives they continue, on a moment to moment basis, to choose to reject the lifegiver which presents itself in their life in the form of the other - the partner, the friend, the colleague, the therapist. They are emotionally dishonest, they hide their feelings from themselves and others, they refuse to feel the pain which real contact involves. They project unwanted aspects of themselves (their jealousy, spite, sadism, etc) into others; in particular, narcissistic therapists do this to their patients. They do not know themselves; self-knowledge is too painful and they refuse it.
'As with all realities, the self is inherently relational. It is always in relation to other selves in the human community - from birth, even from conception, this is so. If when the baby was born there was no tendency in it to find its way to the mother, the breast, it would die. This relational nature permeates all the parts of the self in the way that gravity permeates all matter. We shall come to see, as we go on, that the core of narcissism is a hatred of the relational - a hatred of something that is inherent in our being.' (Ibid p.18)
Symington observes that we all have narcissistic currents within us and that, as therapists, it is essential that we subject ourselves to the most rigorous self- examination in order to address and confront these currents. The methods he advocates are familiar to any Gestalt therapist. It is necessary, he writes, for us to own our projections and integrate them into the self, in other words we really need to know and experience and confess our own hate, sadism, spite and so on. It is also necessary to be emotionally open to others with whom we are in relationship, being honest about our dirty feelings, bad feelings, shame, pain, anger and so on.
He emphasises that being truly alive (not only in the biological sense) involves a choice and describes the narcissist as psychically dead: 'the origin of narcissism is self-murder, a psychological suicide' (ibid p.48). This choice is not just a one-off decision arrived at in infancy; it is a moment to moment choice:
'This turning away from the lifegiver is a turning against the self. Life is potential for growth. Mystics and spiritual writers say that you either advance or regress - you cannot stand still. You can never say 'Well, now I have arrived at my goal, and I can stay here for the rest of my life.' The psychoanalyst Wilfred Bion said that it is a fateful day when someone 'settles into middle age'. Choice is always confronting the individual.' (Ibid p.41)
Symington seems to allude to a moral choice facing us at every moment: whether to live authentically and courageously, with all the pain that this involves or whether to be false and live a kind of death-in-life. Authentic living, if we have the courage to undertake it, brings relief, intimacy and the ability to work creatively from the wealth and goodness, which we find within ourselves.
Symington's terminology of the lifegiver is unfamiliar in Gestalt; however, the concepts of choice, self-responsibility and authenticity are not only familiar but central to the philosophy underpinning Gestalt Psychotherapy.
Gestalt, as an Existential Therapy, holds the belief that we are responsible for our actions, and feelings:
'Knowing about oneself and not owning that it is chosen is a form of self-deceit'. (Yontef, 1993:27)
'Alienated from his own impulses, yet unable to obliterate the feelings and acts to which they give rise, man makes 'things' out of his own behaviour. Since he does not then experience it as himself-in-action, he can disclaim responsibility for it, try to forget or hide it, or project it and suffer it as coming from the outside.' (Perls, Hefferline and Goodman, 1951: 215)
Also central in Gestalt philosophy is the belief that man is 'inherently relational' (see Section Two) and that narcissism involves a turning away from what is most profoundly needed: contact with the other .
Symington stresses the necessity for therapists to confront the painful truth of their own narcissism and to heal this through owning projected aspects of themselves. The importance of personal therapy in the training of Gestalt psychotherapists is widely recognised; for instance, at the Gestalt Centre, London, weekly psychotherapy with an experienced and qualified Gestalt therapist is mandatory throughout the five year training. Through this rigorous process of personal therapy, it is hoped that trainee therapists will be able to own their projections and integrate their disowned aspects into themselves.
Heinz Kohut and the 'self-obiect'.
As well as the behaviours and attitudes described above, Kohut (1971) describes other indications of Narcissistic Personality Disorder, namely hypochondriacal concerns about mental and physical health, lack of interest in sex, perverse fantasies, a sense of emptiness, depression and lack of meaning, a tendency to search for a perfect other to complete one's self. Narcissists, according to Kohut, often dream they can fly: this symbolically represents their sense of not being bound by ordinary human, physical constraints. They also often dream in technicolour .
In Kohut's view when in analysis, the patient will invariably form or defend against an idealised transference. This will involve seeing the analyst as a perfect, god-like figure, whose empathy, approval and praise are needed for the patient to be able to conduct his life in a satisfactory way. When the supplies of approval, empathy and so on are disrupted - by weekends, holidays, illnesses or failures of complete empathic understanding, the patient will feel devastated and this may well have serious effects on his day to day life: he may feel unable to function. He does not wish for the analyst's empathy, as does a neurotic patient in a positive transference; he requires it, in the same way as a small child requires the love and approval of his mother. The patient who has formed an idealised transference is hungry for - or, rather, demands to see - the 'gleam in his mother's eye', that sign of joy and pride that a mother shows when she sees her small child's efforts and achievements. When this 'gleam' is absent, the patient may feel humiliated, devastated and either rageful or depressed.
As well as the idealised transference, the patient will also form a mirror transference, demanding to be perfectly understood and mirrored by the therapist and not wishing to hear interpretations which indicate that the therapist knows more than the patient but wishing only to hear his own words and feelings reflected back to him (like the reflecting pool!) and a twinship transference, where the patient wishes to believe that the therapist is just like himself (another 'reflection').
The narcissist's demands for empathy, mirroring and twinship are different from the usual human wish to be understood and cared for and to experience commonality with the other. The demands are altogether more insistent and failure is altogether more outrageous for the narcissist than with the neurotic. It is as if (in Kohut's understanding) his arm or leg did not obey him, when the therapist fails to give the desired response.
The therapist's emotional response to the patient - the counter-transference - may be characterised by boredom or sleepiness and also a sense of annoyance or outrage at being used as a thing by the patient.
Kohut writes of the correct (analytic) approach to narcissists and has developed a theory of causation of narcissism, a description of the psychology of narcissism and a detailed exposition of methods of treatment, sometimes, rather disparagingly, called a 'cookbook' approach.
In Kohut's view, the narcissist has missed the opportunity, in his childhood, to transmute the archaic idealised parent imago into a real person. Ideally, this happens gradually, through optimal frustration, i.e. repeated manageable disappointments, held and supported and made tolerable through the love, empathy and responsiveness of the 'good enough parent'.
How does the narcissist miss this opportunity? Probably through the personality of his parents (rather than their death or illness, for example, or other accidental factors, although these naturally do not help). Especially, the parents' own narcissistic disturbances, their own inabilities to regard the infant and child as a separate person, having feelings and responses of his own, their own inabilities to love and empathise with another, will deprive the infant and child of the opportunity to grow up able to relate to others as real, separate people.
For Kohut, adult narcissism is an arrested development, caused by failures of parental (usually maternal) empathy. The narcissist, as a child, has suffered massive, unmanageable frustration. There has been repeated and unrepaired failure in empathy. He has been used as an object by his parents, rather than being responded to as a person. This will have begun before the Oedipal stage, although naturally may continue beyond it.
The narcissist has a depleted self; he is unable to feel whole and separate but holds on to what Kohut terms the archaic idealised parent imago, looking to the outside for love and approval, terribly sensitive to slights, being ignored, not being praised and successful, in other words, 'narcissistic wounding'. In this he is extraordinarily dependent on others for narcissistic supplies, yet people as such mean little to him. He cannot love or really receive love: others are perceived as instruments for him to use to get what he needs, primarily a sense of being superior to others. He may wish to feel more intelligent, more physically attractive, richer, more creative, harder working, better liked, thinner, fitter, more compassionate - any factor at all, provided it is better than other people.
Within the therapy, via optimal frustration (every empathic failure, holiday break and so on) -being held by the therapist's concern, empathy, reliability and genuineness, the patient can bit-by-bit relinquish the archaic idealised parent imago and form his own self (which has been lacking). The therapist is the necessary self-object (Kohut, 1971). Thus, genuine humour, wisdom, creativity and an idealised super ego, giving meaning, standards and values to life, can be formed.
The archaic, idealised, parent imago, through disappointment, becomes a real love object -a person, who the patient can love and hate and with whom he can be truly intimate (Winnicott). Therefore, in the patient's life, people are no longer objects (in the sense of being things or instruments), gratifying or frustrating his narcissistic needs, but can be separate people, with needs and responses of their own: there is the possibility of mutuality. Thus the patient is free to love and be loved.
Although the terminology which Kohut uses and that used by Gestalt therapists differs, there is much in common between the two approaches. Kohut sees that the narcissist can be helped by being in relationship with an attuned, empathic other, that this (therapeutic) relationship is, in and of itself, curative. This is very similar to the Gestalt concept of the healing power of inclusion and confirmation within a dialogical relationship.
Like Kohut, Gestaltists such as Yontef, Hycner and Jacobs allow idealised transference, advocate mirroring and empathy and expect the patient to gradually change his experience of the therapist, himself and the world. This change would broadly coincide with Kohut's expectations: the patient will hopefully become more realistic in his perception of the therapist as a fallible, though helpful, human being; he will feel less lonely, less rageful, less shame-prone; he will be more empathic, more creative and be capable of a sense of humour.
Kohut and the above mentioned Gestaltists believe that it is the therapeutic relationship that heals, through which psychological repair is made and new ways of being are experienced which transform the person.
Otto Kernberg
Otto Kernberg writes of pathological narcissism and believes that, whether for constitutional or environmental reasons, pathological narcissists suffer from intense oral aggression, a desolate internal world peopled by shadowy objects which are unsatisfying, envy and hatred of others and a fear of others because this hatred is projected onto them, leading to paranoid attitudes. His descriptions of these patients paints a chilling picture, they are manipulative, heartless, unprincipled, emotionally empty, full of rage and unacknowledged pain.
'The narcissistic character defences protect the patient not only against the intensity of his narcissistic rage, but also against his deep convictions of unworthiness, his frightening image of the world as being devoid of food and love, and his self-concept of the hungry wolf out to kill, eat and survive.' (Kernberg, 1975:276)
Kernberg differs from Kohut in some maior ways; firstly he states that pathological narcissism develops from early pathology and that patients who go on to develop this pathology are markedly aggressive and unempathic from an early age - crudely, it if as if they have 'always had something the matter with them.' The adult disorder is not a fixation to early or primary narcissism but different in nature: '...narcissistic idealisation is a pathological process rather than a normal develpmental stage.' (Ibid p.278)
He goes on to refer to
'a condensed, pathological self. This self stems from the fusion of some aspects of the real self 1 the ideal self 1 and the ideal object. This condensation is pathological and does not simply represent fixation at an early stage of development.' (Ibid p.279)
Kernberg agrees with Kohut that the nature of the transference is in itself a diagnostic indication, but describes the transference differently. Where Kohut stresses how dependent the patient will be and how deeply affected by breaks in empathy and also real breaks at weekends, holidays and so on, Kernberg describes patients who will not depend on anybody, including the analyst, and are notably indifferent to breaks in the treatment, as if they didn't care at all for the analyst.
Many commentators have noted that a counter-transferential indication of narcissism in the patient is that of persistent sleepiness and/or boredom on the part of the therapist (Mancia,1993). Kernberg (1975) indicates that work with such patients is frustrating at best; he recommends attempting treatment however (except where the pathology also includes anti-social features) noting that the emotional suffering of the narcissist is extreme. He also notes that, unlike borderline conditions, which tend to remit with age, narcissistic disorders tend to become worse with age. This is because the narcissistic compensations and satisfactions of beauty and success are often less available.
As old age approaches, agonising existential realities loom and cannot be denied. Death is certain. There is the likelihood that one will be helpless, will lose one's faculties, will become dependent on others and that one's death may be in pain and indignity .If a person has never learnt to give or receive love, has never built up an internal sense of goodness and health, this can be impossibly hard and suicide is a real possibility.
Kernberg understands of the cause of narcissism to possibly be constitutional factors such as an inherently high level of oral rage and aggression, or possibly to be caused by maternal empathic failure:
'It is an open question to what extent inborn intensity of aggressive drives participates in this picture, and that the predominance of chronically cold, narcissistic and at the same time over -protective mother figures appears to be the main etiological element in the psychogenesis of this pathology.' (Kernberg, 1975:276)
Gestaltists would tend to regard narcissistic behaviour and experience to be a response to unfavourable early experience, a process of creative adaptation to the environment, rather than being caused by ‘an inborn tendency of aggressive drives'.
Gestaltists would rather tend towards Kohut's view (which Kernberg also considers) that maternal empathic failure has something to do with a person becoming narcissistic. Gestaltists however would not view this in a rigidly deterministic sense: a person could have a cold, narcissistic, over-protective mother and yet not respond by becoming themselves narcissistic. Like Symington, Gestaltists view narcissism (or any fixed personality structure) as being a choiceful response to a set of circumstances. A famous quotation from John-Paul Sartre comes to mind: 'Freedom is choosing what to do with what's been done to you’.
Kernberg tends to stress the aggressive and sadistic aspects of the narcissist's personality, the 'narcissistic rage' and 'his self-concept of the hungry wolf out to kill, eat and survive.' His psychotherapeutic technique stresses the necessity of interpretation of these aggressive aspects:
'The analysis of all these components of this pathological structure reveals defensive functions against the emergence of direct oral rage and envy, against paranoid fears related to the projection of sadistic trends on the analyst (representing a primitive, hated, and sadistically perceived mother image), and against basic feelings of terrifying loneliness, hunger for love, and guilt over the aggression directed against frustrating parental images'. (Kernberg, 1975: 280-281)
This sounds as if it could be a confrontational therapy. If Yontef is right, this might present dangers: the patient could feel shamed and insufficiently understood and may leave the therapy.
However, there might be learning from Kernberg for Gestaltists. Certainly, people who are narcissistic are definitively rageful, envious and unempathic. To overlook these aspects and only to stress their suffering could lead to sentimentality and collusion. To offer only support and no challenge would be a poor therapy. Perhaps in the early stages of therapy, attunement and mirroring will need to be offered for most of the time; however, as the therapy progresses and the relationship deepens and trust is built it may be helpful to confront the patient.
Gestaltists do not, on the whole, interpret to their patients in the manner of psychoanalysts. Perls disapproved of interpretation as a psychotherapeutic technique:
'(The patient) has not learned to chew up and work through what is nourishing and necessary. He will drink down his analyst's words as something new with which to identify, rather than mulling them over and assimilating them. He expects his therapist to do the work of interpretation for him, and he will later spew out these very interpretations to his bored friends. Otherwise, 'intellectually accepting' the interpretation - without conflict, suffering and disgust - he merely imposes on himself a new burden, a further complication of his concept of himself.' (Perls, Hefferline and Goodman, 1951 :202)
The Gestalt psychotherapist may however confront the patient by disclosing his own emotional response to the patient ('when you said x I felt y') or by suggesting an experiment to raise awareness (Zinker, 1978). As the therapy progresses and the patient is able to relinquish some of his narcissistic behaviours and attitudes, this may become increasingly possible.
Gestaltists will have no argument will Kernberg's stress on the desirability of helping the narcissist face existential realities: the prospect of diminishing powers and the certainty of death. If a person has no capacity to give and receive love, this is a terrible future to face. Gestaltists will hope that through the dialogical relationship this incapacity can be redressed and .the person will have the internal resources to face the ultimate concerns of life.
Victoria Hamilton
Hamilton (1982) gives an overview of different psychoanalytic theories of human development. She herself disputes the classically Freudian view that the human infant is originally narcissistic and believes that research undertaken by Bowlby and others such as Ainsworth (not to speak of everyday observation and common sense) demonstrate to us that babies, from the beginning, seek enjoyable and playful relationship with their mothers and others. This enjoyment of reciprocal, mutual dialogue is not reducible to needs for relief from pain, discomfort, hunger or anxiety, but is enjoyable for its own sake and is as much part of the infant's instinctual responses to the world as the sucking reflex or the tendency to cry when hungry.
Hamilton, following Bowlby and others, believes that people are, from the very start of life, relational.
For Hamilton, childhood and adult narcissism is defensive rather than regressive, that is, it forms a protective 'shell' which is not a return to normal infancy nor a return to a womb-like state, but a new (and pathological) mechanism to protect the child against unbearable reality. Writing of autism, which she considers an extreme variant of narcissism :
'Reality is disappointing and harsh. Similarly, a child who has lost his autistic shell, needs a therapist who is able to withstand the child's volcanic eruptions and disappointments. The therapist must also endure repeated retreats into the painless fog or brittle shell of the autism The swings from elation to despair can be very exhausting and test the therapist's trust. Some patients may try to destroy the therapist or themselves rather then face the initial surrender or the enormous task of reparation which follows breakthrough.' (Hamilton, 1982: 133)
Hamilton's belief that human beings are inherently relational is identical to the Gestalt view. Yontef (1993:17) refers to 'the vital Gestalt notion that everything and everyone is inherently relational.' This also coincides with Symington's view (above).
For the Gestalt therapist, as for Hamilton, narcissistic pathology is a failure in relationship, a failure of dialogue. It is a process, rather than a thing. It is what someone does, rather than who they are. There is the implication and hope that the person can do things differently, that is, can relate to others and himself differently.
For the Gestalt therapist, as for Hamilton, one way to learn how to relate differently is here and now, in the consulting room with the therapist. The therapist is a person who can cope with distress, fear and anger, both in himself and another I can think constructively about what is going on between the two people who are meeting and who offers himself to be used by the other for the other's growth and health. He is empathic, thoughtful, honest and emotionally available. He maintains the boundaries of the therapeutic relationship so that the patient may be held and contained and the shared space is safe enough for anything to be said.
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