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.
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.