The present study examines the lack of strong correlations among existing self-report measures of narcissism. A principal-components analysis of 6 MMPI narcissism scales resulted in 2 orthogonal factors, 1 implying Vulnerability-Sensitivity and the other Grandiosity-Exhibitionism. Although unrelated to each other, these 2 factors were associated with such core features of narcissism as conceit, self-indulgence, and disregard of others. Despite this common core, however, Vulnerability-Sensitivity was associated with introversion, defensiveness, anxiety, and vulnerability to life's traumas, whereas Grandiosity-Exhibitionism was related to extraversion, self-assurance, exhibitionism, and aggression. Three alternative interpretations of these results are considered, and an argument for the distinction between covert and overt narcissism is made.

/pdf/two-faces-of-narcissism-1vmxg46az7.pdf

Two Faces of Narcissism

This article examines the validity of grandiose and vulnerable subtypes of narcissistic character styles through an analysis of personality disorder criteria, interpersonal problems, and adult attachment styles in a nonclinical population. The grandiose personalities in this sample were rated high in the dramatic traits associated with narcissistic, antisocial, and histrionic personality disorders based on a diagnostic interview, and they reported domineering and vindictive interpersonal problems. However, despite the observation of narcissistic personality pathology, they denied interpersonal distress related to their interpersonal problems and the majority reported adult attachment styles reflective of positive self-representations (Secure, Dismissive). Vulnerable narcissistic individuals were represented by high ratings on avoidant personality disorder based on a diagnostic interview. They reported high interpersonal distress and greater domineering, vindictive, cold, and socially avoidant interpersonal problems. The majority reported adult attachment styles reflective of negative self-representations (Fearful, Preoccupied). The validity of grandiose and vulnerable narcissism based upon the results of this study was discussed in terms of clinical theory and with reference to the implications of two subtypes of narcissism for diagnosis and treatment.

/pdf/interpersonal-analysis-of-grandiose-and-vulnerable-4wp6xqezxv.pdf

Interpersonal analysis of grandiose and vulnerable narcissism.

Helping Clients Forgive: An Empirical Guide for Resolving Anger and Restoring Hope

Psychoanalytic Techniques: A Handbook for the Practicing Psychoanalyst,edited by Benjamin B. Wolman, 596 pp, $15, New York and London: Basic Books, Inc., 1967. Psychotherapeutic techniques depend on the way the therapist understands the personality of each patient and what changes both patient and therapist strive for. The personality makeup of man may be simple in its broad essentials but is certainly complex in its details, and full of surprises. Freud opened up our understanding of it—he did not close it. Certainly no single school has all the answers, although this is the tone of much orthodox psychoanalytic writing as distinct from contributions that are free inquiries using all available knowledge. Dr. Greenson's book is based primarily on the theory of dammed-up libido, correct in itself but not expanded and enriched by the last 40 years of study which have seen such revolutionary progress in every other clinical and scientific

The Technique and Practice of Psychoanalysis

Objective: The purpose of this study was to determine the efficacy of panic-focused psychodynamic psychotherapy relative to applied relaxation training, a credible psychotherapy comparison condition. Des- pite the widespread clinical use of psychodynamic psychotherapies, randomized controlled clinical trials evaluating such psychotherapies for axis I disorders have lagged. To the authors’ knowledge, this is the first efficacy randomized controlled clinical trial of panic-focused psychodynamic psychotherapy, a manualized psychoanalytical psychotherapy for patients with DSM-IV panic disorder. Method: This was a randomized controlled clinical trial of subjects with primary DSM-IV panic disorder. Participants were recruited over 5 years in the New York City metropolitan area. Subjects were 49 adults ages 18–55 with primary DSM-IV panic disorder. All subjects received assigned treatment, panic-focused psychodynamic psychotherapy or applied relaxation training in twice-weekly sessions for 12 weeks. The Panic Di...

/pdf/a-randomized-controlled-clinical-trial-of-psychoanalytic-2z3cnex260.pdf

A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder.

The authors present a brief written psychodynamic formulation that focuses on central conflicts, anticipates transferences and resistances, and helps guide all psychiatric treatments. After placing the presenting problem in the context of the patient's life and identifying nondynamic determinants of the psychopathology, the formulation explains the development of central conflicts and their repetitive effect on the patient's behavior. It concludes by describing how these conflicts will be manifested in treatment. Three sample formulations and their application are presented to illustrate the value of this clinical tool.

https://focus.psychiatryonline.org/doi/pdf/10.1176/foc.4.2.297

The psychodynamic formulation: its purpose, structure, and clinical application.

Current psychiatric research on panic disorder and its treatment are heavily influenced by neurobiological and cognitive-behavioral models rather than psychodynamic propositions, and psychodynamic treatment is generally considered to be of little benefit in amelioration of symptoms. However, because neither of the current models fully explains the clinical psychopathology, etiology, or pathogenesis of panic disorder, there is a need for further model building. The authors suggest that a psychodynamic approach may add to the understanding of patients with panic disorder. They base their psychodynamic formulation on pilot interviews with nine patients with panic disorder, published reports of psychological characteristics of patients with panic disorder, and data from infant and animal research on temperament. Interview results included the following: 1) all of the patients described themselves as fearful, nervous, or shy as children, 2) they remembered their parents as angry, frightening, critical, or controlling, 3) they frequently indicated discomfort with aggression, 4) most described chronic feelings of low self-esteem, 5) their spouses were characterized as passive, kind, and nonaggressive, and 6) stressors associated with frustration and resentment preceded the onset of panic. The authors propose a model in which inborn neurophysiological irritability predisposes to early fearfulness. Exposure to parental behaviors that augment fearfulness results in disturbances in object relations and persistence of conflicts between dependence and independence, which predispose to fears of feeling trapped, suffocated, and unable to escape and/or feeling alone and unable to get help. Catastrophic fears of helplessness in the face of suffocation or abandonment are easily accessible.(ABSTRACT TRUNCATED AT 250 WORDS)

A Psychodynamic Model of Panic Disorder

A psychodynamic formulation for panic disorder. Overview of treatment. Initial evaluation and early sessions. Psychodynamic conflicts in panic disorder. Defense mechanisms in panic disorder. Transference, working though, and termination. Techniques of psychodynamic psychotherapy as they apply to panic disorder. Approaches to common problems in the treatment of panic patients. Combining panic-focused psychodynamic psychotherapy with other treatment approaches. Case example: Ms. P. References. Index.

Manual of panic-focused psychodynamic psychotherapy.

Interpretation of the transference is central to all psychoanalytic models. Definitions of transference and transference interpretation have changed greatly during the past half-century, influenced by major movements in philosophy, advances in psychoanalytic research and theory, and changes in our understanding of Freud. This paper suggests that historical, relatively simple, concepts of the transference as the reproduction in the present of significant relationships from the past do not adequately meet current clinical and theoretical demands. Modernist views of the transference emphasize as additional sources of transference responses, the role of the analytic background of safety, the constant modification of unconscious fantasy and internal representations, and the interactive nature of transference responses, with important interpersonal and intersubjective components. It is suggested that the evolving modernist views of transference and transference interpretation permit a fuller accounting for transference phenomena and open the way for better informed interventions. A brief discussion of the issue of psychological "truth" and "distortion" as applied to transference phenomena is presented. The themes are illustrated with clinical vignettes.

Changes in psychoanalytic ideas: transference interpretation.

The authors present a brief written psychodynamic formulation that focuses on central conflicts, anticipates transferences and resistances, and helps guide all psychiatric treatments. After placing the presenting problem in the context of the patient’s life and identifying nondynamic determinants of the psychopathology, the formulation explains the development of central conflicts and their repetitive effect on the patient’s behavior. It concludes by describing how these conflicts will be manifested in treatment. Three sample formulations and their application are presented to illustrate the value of this clinical tool.

Arnold M. Cooper

Papers

The psychodynamic formulation: its purpose, structure, and clinical application.

A Psychodynamic Model of Panic Disorder

Manual of panic-focused psychodynamic psychotherapy.

Changes in psychoanalytic ideas: transference interpretation.

The Psychodynamic Formulation: Its Purpose, Structure, and Clinical Application