The treatment of a narcissistic disturbance in childhood

This paper surveys four years of psychotherapy, beginning at age eight and a half, of a boy whose psychopathology appears to be a precursor of the narcissitic charater disorder described by Kernberg (1975). The vicissitudes of the transference related chiefly to the patient's underlying narcissistic vulnerability. Interventions were generally aimed at demonstrating the relation of the patient's naricissistic (grandiose) defense to his underlying concern about devaluation by the therapist. The advantages of focuisng on such a patient's current needs and reactions are emphasized. The speed and success of the treatment of this child vis-a-vis adults with similar psychopathology is attributed to the relative ease with which his underlying needs (and related pathological envy, rage, and fear of retaliation) could be mobilized within the therapeutic relationship. This probably reflects the fact that his character defense was not yet fully entrenched. The contribution of normal development to the therapeutic process is also identified, as is the importance of both the real relationship and times of direct gratification of the patient by the therapist.