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Narcissism, Entitlement & Kohut

November 5, 2010

Concept of the Self

According to Kohut and Wolf (1978), the self, a psychic structure, is at the core of our personality. Kohut (1971) asserts that the development of self is a process that begins at birth and depends on the environment. Grosch (1994) writes, “As long as the self is imbedded in a social matrix that provides a field of the needed mirroring responses and the needed availability of idealizable values, the self will feel comfortably affirmed in his or her total self with its ambitions and goals” (p. 55). An individual’s “self will emerge as either a firm and healthy structure or as a more or less seriously damaged one” (Kohut & Wolf, p. 20). This emergence is dependent on the quality of the interactions between the self and its self-objects in childhood. Kohut (1984) writes that selfobject relationships form the essence of psychological life from birth to death.

Features of Narcissistic Personality Disorder

The essential features of NPD are a pervasive pattern of grandiosity, need for admiration, and lack of empathy that can be present in a variety of contexts. Individuals with this disorder have a grandiose sense of self-importance and are often preoccupied with fantasies of unlimited success, power, and beauty. Often they believe they are superior, special, or unique, and expect others to recognize them as such. Individuals with NPD generally require excessive admiration that often takes on the form of a need for constant attention. A sense of entitlement is apparent in these individuals, which, combined with a lack of sensitivity to the needs of others, may result in the exploitation of others. Individuals with NPD generally have a lack of empathy, are often envious of others or believe that others are envious of them. Arrogant, haughty behaviors characterize these individuals, as they often display snobbish or patronizing attitudes toward other (American Psychiatric Association, 1994).

Source: Perspectives in Psychiatric Care, Jan-Mar 2004 by Romano, Donna M Czuchta

In the three years i spent researching my book, It Has A Name! on the subject of unhealthy narcissism (unhealthy sense of self), I came to understand and sympathize with the theories of Heinz Kohut, father of self-psychology. I found another posting on Psychiatry MMC.com today that supports my conclusions and summarizes Kohut’s theory.

There are many theories about the causes of NPD. Often certain childhood developmental and parental factors have been implicated. An example of a developmental factor includes a postulated innate oversensitive temperament in the child; parental factors include excessive admiration by parents, lack of realistic feedback from parents during development, unreliable parental caregiving, and/or emotional abuse during childhood.[3]
Heinz Kohut proposes that in order to understand the narcissistic patient, the therapist must assume an empathic-introspective observational stance. By doing so, the therapist can understand the complex, inner world of the patient and the patient’s inner subjective experience. The patient can then communicate freely, and the analyst becomes privy to what is being repressed or warded off by the patient. Self psychology, like object-relations theory, emerged out of an effort to treat patients who were not responding to ego psychology therapies constructed around the analysis of psychological defenses.[4]

Heinz Kohut asserts that adult narcissistic psychopathology is a result of parental lack of empathy during development. By failing to provide appropriate empathic feedback during critical times in a child’s development, the child does not develop the ability to regulate self esteem, and so the adult vacillates between an irrational overestimation of the self and feelings of inferiority.

Furthermore, the adult relies on others to regulate his self esteem and give him a sense of value, essentially looking for empathic feedback not received during development. Kohut believes that under normal circumstances, the developing infant has two important psychological constructs: the grandiose-exhibitionistic self (normally evolving into self-assertive ambitions) and the idealized parental imago (normally evolving into internalized values and ideals). Pathology in the first area results in fixation on grandiosity, and pathology in the latter area results in deficits, where the psychopathology is rooted in fixations on archaic idealizations (Figures 1 and 2).[4]

In Kohut’s self psychology model, the dyad occurring between a child and his parents is a continually evolving process (via the formation of self objects). In Kohut’s theory, a self object consists of the developing child plus each of those people who give the child the abilities to maintain self structure and firmness and a sense of cohesion and steadiness.[5] They are self objects because, according to Kohut, the infant is unaware that they are not part of his- or herself and that they are providing functions the infant will later learn to do on his or her own as these functions are incorporated into his or her psychic structure. In Kohut’s model, when certain self object needs are not met empathically, a developmental arrest occurs and pathologic narcissism can occur. Kohut describes three reasons for this relative lack of parental empathy to occur: 1) A poor fit between the child and parents in regards to the disposition of both; 2) the parent(s) is unable to react to and nurture the child, which can often be secondary to physical or mental limitations; and/or 3) the child has unusually great self object needs.[6] Whatever the reason, the earlier and more pervasive the failures occur, the more severe the developmental arrest and the degree of narcissistic pathology in the adult.

Psychotherapy with a Narcissistic Patient Using Kohut’s Self Psychology Model

October 2007 by Jamie McLean, MD
Series Editor: Paulette M. Gillig, MD, PhD
Drs. McLean and Gillig are from the Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.

http://www.psychiatrymmc.com/psychotherapy-with-a-narcissistic-patient-using-kohut%E2%80%99s-self-psychology-model/

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