The following is a contrast between the approach to the treatment of narcissism of Otto Kernberg and Heinz Kohut, largely an exposition of this essay on the subject.
Otto Kernberg and Heinz Kohut are some of the most important clinicians in the history of psychoanalysis, particularly when it comes to the psychotherapeutic treatment of narcissism; a condition widely believed to be untreatable by psychoanalysts. Kohut and Kernberg differ with one another as to how to treat narcissism, however, because they differ in the manner in which it is theoretically articulated. There is a great deal of agreement between them, however, when it comes to descriptive accounts of how narcissists behave. Such patients can to be self centered and in constant need of recognition and praise in order to feel good.
In order to feel good about themselves, they need a steady source of supply from the outside. They are insensitive to others and use humans as mere objects from whom to obtain supply. Real or imagined slights throw them into fits of explosive rage. They engage in developmentally stunted defense mechanisms such as splitting and oscillating between idealization and devaluation of individuals. In these respects, they agreed concerning the more mainstream DSM model of narcissistic personality disorder.
First Kernberg’s theoretical understanding of narcissism will be described. Kernberg believes that both those with narcissistic personality disorder and borderline personality disorder have borderline personality organizations. He takes his schema from Jacobson, who distinguishes between psychotic and borderline personality organizations. On the one hand, psychotic individuals struggle with keeping self and object images separate from one another, and they are on the verge of having their sense of separateness dissolve altogether. Individuals with a borderline personality organization do not struggle with this, except for brief quasi-psychotic regressions.
The borderline individuals strenuously avoid the experience of ambivalence. They engage in the defense mechanism of “splitting,” according to which they cannot synthesize self and object images with a positive affect with self and object images which have a negative one. They experience both positive and negative feelings for an individual at the same time. They instead oscillate between idealizing and devaluing the one and the same individual, incapable of seeing individuals who are complex and nuanced, possessing both good and bad traits.
While these characteristics are typical of individuals with a borderline personality organization, there are nonetheless differences between individuals with NPD and BPD, despite both having the same personality organization. For the narcissistic patient, for example, Kernberg believes that the narcissist tends to fuse parts of his ideal self and real self. In other words, the individual combines what he wants from an ideal person and combines these qualities, which he sees as existing in his ideal self, with his real self. He attributes, in other words, his aspirations with his real self, and has a hard time telling the difference between the two. He exists in a fantasy world in which he is totally satisfied by the merging of his ideal self and ideal object with his real self.
For Kernberg, the narcissist needs self-sufficiency. He sees this need as one of the most fundamental components of the narcissistic personality. He no longer has to acknowledge, according to this tendency, to acknowledge that other individuals are separate, distinct subjects or people in their own right, and so he does not have to worry about his feelings of envy and rage towards sch a person. Kernberg emphasizes that the narcissist is incapable of tolerating his rage and envy towards other individuals. Realizing that the other person is independent and not in his control causes intense rage and helplessness in the narcissist. It is by means of his devaluing tendencies towards others, and idealizing of himself, that he is able to protect himself from his extreme hunger for validation from others.
“Of course, he pays a huge price for such a defensive structure. His inner emptiness, boredom, restlessness, intermittent social withdrawal, and lack of “empathy” for others, coupled with his simultaneous need for admiration from theo outside and only transient satisfactions from relationships and work, are well-known aspects'(Adler).
Kernberg thinks that it is important to acknowledge the grandiosity of the self in the narcissist, which is constituted by the ideal object, the ideal self and the real self. He projects such grandiosity onto other individuals, giving him the ability to idealize them and see them as omnipotent. This protects the narcissist, Kernberg believes, against the self-devaluation and helplessness of his own self, as well as from acknowledging the separateness of the other individual.
So much for Kernberg’s understanding of pathological narcissism. Heinz Kohut’s approach is different. Kohut articulates his understanding narcissism in terms of his theoretical construct of the “self-object.” The self-object is someone or something who performs the important function of validating individuals. The self-object helps the individual hold himself together by providing the function of empathically responding to the individual’s need for validation. Humans need to be made to feel adequate by means of response from these self-objects. Experiences of others either validating or invalidating humans plays a crucial role in the self-cohesion of humans.
The self-object projects humans from breaking down due to harsh criticism, which is associated with rage and depression. Adults need a self-object applauding them no less than children, although their self-object responses are hopefully developed in more mature forms. Instead of being coddled from bruised knees, adults need as their self-object applause in response to an impressive academic presentation. Indeed, individuals require “mirroring” for their successes in order to feel adequate.
Individuals who have lacked such mirroring may require excessive mirroring during adulthood, in which case they suffer from narcissistic pathology due to extreme vulnerability. They present a grandiose self in order to compensate for their feelings of worthlessness. They need to feel continually idealized by others. Healthy individuals do not require such excessive displays of admiration from others. They feel like they belong and they feel loved.
Being made to felt normal and accepted is known in self psychology as the “alter ego” response. Having experienced the required alter ego responses when young means that we do not need excessive reassurance that we belong as adults. Weaker or nonexistent alter ego responses when young may result in an excessive need to be continually made to feel like we fit in.
For Kohut, the therapist plays the role of the self-object in the transference relationship. The therapist becomes the person, in other words, who provides the kind of validation the narcissist requires. The narcissist feels safe and complete. This helps the therapist to understand what is going on in the individual’s head. Although all individuals require a self-object, the narcissist is one who has received inadequate self-object validations and thus requite excessive plays, as noted before, in order to validate it. Individuals are capable of “merging” with the pleasant and comforting qualities of the self-object who provides mirroring to them. In other words, the child is able to internalize the comforting functions of the self-object, in order to grow out of the need to receive continual validation from the outside. Instead, they possess within themselves that which can provide reassurance and protection from lack of self-cohesion.
Since Kohut focuses on functions, he does not need to define the inner life in temrs of objects, images, representations, etc. He has no need to go into such elaborate detail as Kernberg tends to. Kernberg and Kohut both tend to differ a great deal when it comes to “merging.” For Kernberg, merging involves the fusion of self objects and other objects, which results in psychosis. This does not happen in Kohut’s model. Instead, the merging of the self and object simply refers to the validation which the self-object provides to the self. Kohut emphasized the importance of the therapist playing this role, empathetically listening to, and vicariously experiencing by means of empathy, the pain and lived experience o the narcissist.
It is at this point that the differences between Kohut and Kernberg will be discussed. Kernberg emphasized the idea that the patient idealizes the therapist as a defensive measure, projecting his own grandiosity onto that of the patient. This is a recapitulation, for the narcissist, of unsuccessful childhood transferences. He idealizes the therapist because he is unable to bear the fact that he cannot control the therapist. He feels envious of the power of the analyst because he cannot control him. Kohut, however, thinks that it is important for these transferences to take place in order for the therapist to understand what is going on in the narcissist’s head.
The two clinicians also differ in their understanding of the role of aggression in narcissists. Kernberg sees aggression as a primary drive. Individuals with borderline personality organizations in general struggle with oral aggression. Kernberg believes that narcissists are afraid o their own envy and hatred, and are afraid to destroy the relationship with the therapist through this rage and envy. Kohut, however, saw aggression as secondary. One of the more fundamental concerns is the disappointment the narcissist has when it comes to the therapist as a failing self-object. Indeed, Kernberg criticizes Kohut’s lack of attention to oral rage and his emphasis on disappointment.
Another crucial difference between the two is that both have distinct views of the relationship between NPD, BPD and psychosis. Kerberg believes that the individual with NPD has a distinct inner psychic organization, differentiating him from other individuals with borderline personality organizations. Kohut emphasized the continuity in narcissists with psychotic individuals in that both experienc epainful self fragmentation and failures of self-cohesion.
It must be remembered that Kernberg because that the narcissist suffers from a grandiose combination of the ideal self, real self and ideal object whereas Kohut believes that the grandiose self is developmentally stunted because the parent provided inadequate self-object mirroring in the individual’s childhood. Kernberg ephasizes the need for the narcissist to feel self-sufficient as a defense against his anger and envy.