Otto F. Kernberg and Heinz Kohut regard the analytic process as well as the role of the analyst in quite different terms.
The analytical situation concerning pathological narcissism according to Otto F. Kernberg
Kernberg requests a methodological and persistent interpretation of the defensive function of grandiosity and idealization as they emerge in transference. The role of the analyst should be neutral rather than supportive, especially during the confrontation process, in order to modify the narcissist’s pathological structure. “The analyst must be continuously focusing on the particular quality of the transference in these cases and consistently counteract the patient’s efforts toward omnipotent control and devaluation”. This traditional emphasis on aggressive interpretation of narcissistic phenomena derives from and is wholly consistent with Freud’s early view of narcissistic neuroses as unanalysable and narcissistic defenses as generating the most recalcitrant resistances to the analytic process.
The analytical situation concerning pathological narcissism according to Heinz Kohut
In contrast to seeing primitive grandiosity or idealization as a representation of a defensive retreat from reality, Heinz Kohut regards narcissistic illusions within the analytic situation as representations of the patient’s attempt to establish crucial developmental opportunities. These narcissistic illusions thus give an opportunity for revitalization of the self. Therefore, Heinz Kohut advocates that the analyst’s position within treatment should be one where a full narcissistic transference should be encouraged instead of being challenged. To establish this, the analyst should be able to show empathic comprehension, which entails a receptivity to the narcissistic illusions and an avoidance at all costs of anything which would challenge them or suggest they are unrealistic. Heinz Kohut used the concepts of narcissistic transference and self-object needs. He also stressed the significance of infantilism and what appear to be excessive demands on the analyst and everyone else. Rather than instinctual wishes to be renounced, they are missed developmental needs to be warmly received and understood. The patient is groping toward self-cure, by trying to extract from others what was missing early in his development. Heinz Kohut feels the patient knows what he needs, regardless of what the analyst may think he knows. He stresses the importance of hopes in maturity and throughout development. There is an enduring need for ideals and idealization that vitalizes self experience. In his work with narcissistic patients, the defining feature of Heinz Kohut’s psychoanalytic methodology became therefore empathic immersion (or vicarious inspection), whereby he tried to put himself in his patient’s shoes. This view is certainly in contrast with Freud’s early view of the analyzability of narcissistic defenses as discussed above.
Approaches as regarded by Heinz Kohut and Otto F. Kernberg
Both Kohut and Kernberg regarded each other’s approaches as counterproductive. From Kohut’s point of view, the methodical interpretive approach recommended by Kernberg is interpreted by the narcissistically vulnerable patient as an assault and generates intense narcissistic rage. As Kernberg instead recommends this methodology for treating these patients, self-psychology regards Kernberg as creating narcissism instead of treating it. On the other hand, Kernberg (from the more traditional point of view) sees the approach of Kohut as leading to nothing. An unquestioning acceptance of the patient’s illusions with the assumption that they will eventually diminish of their own accord represents a collusion with the patient’s defenses. The analytic process is thereby subverted and the analyst never emerges as a figure who can meaningfully help the patient.
An integrative relational approach
However, Stephen A. Mitchell offers an integrative relational approach in which the perspectives of both Kernberg and Kohut are connected. In his opinion, “the more traditional approach to narcissism highlights the important ways in which the narcissistic illusions are used defensively, but misses their role in health and creativity and in consolidating certain kinds of developmentally crucial relationships with others. The developmental-arrest approach (Kohut) had generated a perspective on narcissism which stresses the growth-enhancing function of narcissistic illusions, but overlooks the extent to which they often constrict and interfere in real engagements between the analysand and other people, including the analyst”. Mitchell recommends a “subtle dialectic between articulating and embracing the analysand’s illusions on the one hand, and the provision of larger context in which they can be experienced, on the other”.