Transferences as differential diagnostic tools in psychoanalysis

A discussion of "Clinical Application of the Concept of a Cohesive Sense of Self," by Joseph Lichtenberg, M.D. Clinical phenomena, symptoms and specific "events" such as fragmentation are not reliable differential diagnostic tools in psychoanalysis and psychoanalytic psychotherapy. Rather it is suggested that this purpose can be better served by the proper diagnosis of the developing cohesive transferences in the course of the psychoanalytic treatment process. The discovery of the selfobject transferences (the various forms of mirror and the idealizing transference) has broadened the scope of analyzable conditions. The recognition of these transferences which arise in relation to the reactivation of infantile narcissistic structures (the grandiose-exhibitionistic self and the idealized parent imago), are helpful in delineating patients with primary self-pathology from the neuroses on the one end and the borderline and psychotic conditions on the other end of the broad spectrum of psychological disorders. It is important to recognize the presence of cohesive transference in order to make a clinically meaningful diagnosis. This is demonstrated with the help of the clinical vignette presented by Lichtenberg. Mr. T is described as suffering from a narcissistic personality disorder--or what we would prefer to call primary self-pathology.