On speaking of oneself by name

Speaking of oneself by name is studied. Such behavior occurred with unusual frequency in the case of a patient with predominantly narcissistic character pathology who underwent brief psychotherapy for a stress response syndrome following his wife's suicide. A content and context analysis of this phenomenon showed that the patient would refer to himself by name as a characteristic defense in response to severe threats to his self-esteem. An object-relations perspective proved useful in clarifying dynamic aspects of this defensive maneuver, which depended for its effectiveness on the evocation of self-images negating guilt and shame. In addition to the patient's character style and the nature of the stress event, the framework of the therapy and the therapist's countertransference responses to the patient were other factors influencing the appearance of this behavior. It is concluded that referring to oneself by name reflects at least momentary disturbance in the sense of self and may be unusually prominent and frequent in narcissistic pathology. A study of the phenomenon appears to elucidate an important step in the building of self-representation from the self-object representations of the symbiotic phase: the concept of "I" becomes possible through the reconciling of a sense of physical and psychic separateness with the need for emotional relatedness to others. Where problems of this early developmental phase are reactivated in the treatment situation, the patient's relationship with the therapist is the vital bridge toward a more coherent sense of self.