CORRESPONDENCE

Differing Narcissisms

Dear SirIn the continuing debate around narcissism I would like to add my observations

regarding the writings of the two principal contributors in this field, Kernberg andKohut. Following on from David Smith's article (British Journal of Psychotherapy, Vol4(3)) attempting to throw some welcome light on the very confused area that exists inthe literature I would like to support his view that most of the writing on this subject canbe divided into two camps. However I have found it helpful to think about the positionfrom which these two authorities come.

I recently had occasion to consider the writings of Kernberg and Kohut for thepurposes of presenting them to peers for discussion: I came to the subject as a relativeingenue and spent a considerable period wondering why I felt completely confused bywhat they appeared to be saying, particularly in relation to one another. A number ofarticles I read drew parallels and highlighted the differences between the two. Clearlythere was a large measure of agreement around the concept of the grandiose self, anddifferences around the areas of development, meaning of the core features, andconsequent treatment approaches. Despite this I could not grasp the essentialcomparisons between them. It was only when I realised that the two authors were notwriting within similar frames of reference that I suddenly understood why I had notbeen able to get my head around the comparisons and the differences.

Kernberg is writing from a firm theoretical base rooted in object relations theory in adirect line of descent. From the theory emerges practice, neatly consequent upon theassumptions underpinning it. Kohut was writing from a position familiar to many, thatof the therapist faced with (at first) difficult patient reactions and painful intensecountertransference; in other words, the clinical material. From this time-honouredposition he attempted to construct an explanatory base for what he intuitively felt wasthe right approach. As a result his young and inevitably tender theory is vulnerable toattack by intellectual predators, and his writings can sometimes appear difficult tounderstand in a purely theoretical way. In particular, within the framework of a medicaland peri-medical literature he comes over poorly as he is writing within a model that isexplicitly at odds with his stated intention of not identifying patients by clusters ofrecurring symptoms. Kernberg does much better in this setting, of course, and iseloquent in his plea that positive and negative aspects of the transference must beinterpreted. Since to neglect this is to condemn the narcissistic patient to increasing fearof the underlying rage and intensify the need for the very defences that cause theproblems. Kohut, of course, was trying to stress the phase appropriateness of thesepatients' demands and insisting that confrontation was just what the doctor didn't order.In order words Kohut and Kernberg are not writing within similar frames of referencebut it is often purported that they are. It is therefore difficult and perhaps unwise to seethem as in simple opposition to one another. Consequently there may be a synthesispossible between them in terms, perhaps, of a `process grandiose self

Another point is that the two may well have drawn their clients from differentpatient populations, and perhaps the two different views have arisen in part from

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seeing two different sorts of narcissistic patients in the public and private sectors.I hope these observations might contribute something to attempts to sort out the

confusion that continues to exist around this undoubtedly important but strangelydifficult and sometimes arid subject.

Richard Fry