Problems in the psychoanalysis of certain narcissistic disorders.

This paper considers the psychopathology and treatment of a particular group of narcissistic disorders which can be characterized by their use of 'simulation' in their attempt to resolve the conflicts of the Core Complex. The invasive, narcissistic mother's demand for success is responded to with an evident compliance but with a covert rebellion manifested in failure, accompanied by intense feelings of shame and low self-esteem. This is seen in the analysis in the patient's apparently positive response being followed by a Negative Therapeutic Reaction. The structure is seen to be as much concerned with protecting the mother from the infant's destructiveness as it is with protecting the infant from the colonizing mother (cf. Winnicott's 'False Self'). What is regarded as the hallmark of narcissistic disorders, namely shame, is found to be part of a defensive structure concerned with the exclusion of extreme violence and intolerable guilt. The significance of the father is discussed. Difficulties that arise in the analysis of such patients are considered.