In this paper, Dr. Masterson gives an understanding of the intrapsychic structure of Narcissistic Personality Disorder and how it finds clinical expression through the disorders of the self triad. Clinical cases are presented to illustrate how the therapeutic intervention of mirroring interpretation of narcissistic vulnerability helps the patient to convert transference acting-out to therapeutic alliance and transference, thereby creating the condition for psychoanalytic psychotherapy.
This address is a review of the significant theoretical and practical changes in the practice of psychoanalytically-oriented psychotherapy in the experience of the author's personal practice over the past 62 years.
This workshop comprises three elements: A one-hour videotape demonstrating the use of mirroring interpretation of narcissistic vulnerability to establish a therapeutic alliance, discussion of the tape, and supervision of cases presented by the audience.
The major emphasis in contemporary psychoanalytic psychotherapy is on the early and consistent interpretation of the transference. A growing attention to countertransference analysis, to the risk of "indoctrinating" patients, to character analysis, to the analysis of unconscious meanings in the "here and now" also are dominant trends. Significant controversies continue regarding the importance of the "real" relationship, the therapeutic versus the resistant aspects of regression, the role of empathy, and the relation of historical to narrative truth.
In the early decades of the 20th century Freud's mastery of the craft of presenting a case enthroned a belief that anxiety disorders were caused by repressed emotional complexes and that recovery required the restitution of repressed ideas. This belief dominated psychotherapeutic practice, and even though little was to be seen in the way of success, any alternative was treated with scorn. Mid-century studies of experimental neuroses showed that these disturbances were the consequence of the learning of maladaptive anxiety and could be overcome by systematic counteraction by other emotions.