What is Narcissistic Neurosis?

Introduction

Narcissistic neurosis is a term introduced by Sigmund Freud to distinguish the class of neuroses characterised by their lack of object relations and their fixation upon the early stage of libidinal narcissism.

The term is less current in contemporary psychoanalysis, but still a focus for analytic controversy.

Freud considered such neurosis as impervious to psychoanalytic treatment, as opposed to the transference neurosis where an emotional connection to the analyst was by contrast possible.

Freud’s Changing Ideas

Freud originally applied the term “narcissistic neurosis” to a range of disorders, including perversion, depression, and psychosis. In the 1920s, however, he came to single out “illnesses which are based on a conflict between the ego and the super-ego‚Ķ we would set aside the name of ‘narcissistic psycho-neuroses’ for disorders of that kind” – melancholia being the outstanding example.

About the same time, in the wake of the work of Karl Abraham, he began to modify to a degree his view on the inaccessibility of narcissistic neurosis to analytic treatment. However his late lectures from the thirties confirmed his opinion of the unsuitability of narcissistic and psychotic conditions for treatment “to a greater or less extent”; as did his posthumous ‘Outline of Psychoanalysis’.

Later Developments

From the twenties onwards, Freud’s views of the inaccessibility of the narcissistic neuroses to analytic influence had been challenged, first by Melanie Klein, and then by object relations theorists more broadly.

While classical analysts like Robert Waelder would maintain Freud’s delimiting standpoint into the sixties, eventually even within ego psychology challenges to the ‘off-limits’ view of what were increasingly seen as borderline disorders emerged.

Relational psychoanalysis, like Heinz Kohut, would also take a more positive approach to narcissistic neurosis, emphasising the need for a partial or initial participation in the narcissistic illusions.

In retrospect, Freud’s caution may be seen as a result of his unwillingness to work with the negative transference, unlike the post-Kleinians.

What is Transference Neurosis?

Introduction

Transference neurosis is a term that Sigmund Freud introduced in 1914 to describe a new form of the analysand’s infantile neurosis that develops during the psychoanalytic process.

Based on Dora’s case history, Freud suggested that during therapy the creation of new symptoms stops, but new versions of the patient’s fantasies and impulses are generated. He called these newer versions “transferences” and characterised them as the substitution of the analyst for a person from the patient’s past. According to Freud’s description: “a whole series of psychological experiences are revived not as belonging to the past, but as applying to the person of the analyst at the present moment”. When transference neurosis develops, the relationship with the therapist becomes the most important one for the patient, who directs strong infantile feelings and conflicts towards the therapist, e.g. the patient may react as if the analyst is his/her father.

Refer to Narcissistic Neurosis and Negative Transference.

Basic Characteristics

Transference neurosis can be distinguished from other kinds of transference because:

  1. It is very vivid and it rekindles the infantile neurosis.
  2. It is generated by the feelings of frustration that the analysand inevitably experiences during sessions, since the analyst does not fulfil the analysand’s longings.
  3. In transference neurosis the symptoms are not stable, but they are transformed.
  4. Regression and repetition play a key role in the creation of transference neurosis.
  5. Transference neurosis reveals the particular meanings that the analysand has given to current infantile relationships and events, which generate internal conflicts between wishes and particular defences formed to strive against them. These meanings are united and create several transference patterns.

Resolution

Once transference neurosis has developed, it leads to a form of resistance, called “transference resistance”. At this point, the analysis of the transference becomes difficult since new obstacles arise in therapy, e.g. the analysand may insist on fulfilling the infantile wishes that emerged in transference, or may refuse to acknowledge that the current experience is, in fact, a reproduction of a past experience. However, the successful resolution of transference neurosis through interpretation will lead to the lifting of repression and will enable the Ego to solve the infantile conflicts in new ways. Furthermore, it will allow the analysand to recognize that the current relationship with the analyst is based on repetition of childhood experiences, leading to the detachment of the patient from the analyst.

The replacement of the infantile neurosis by transference neurosis and its resolution through interpretation remains the main focus of the classical psychoanalytic therapy. In other types of therapy, either the transference neurosis does not develop at all, or it does not play a central role in the therapy process. Although it is more likely for transference neurosis to develop in psychoanalysis, where the sessions are more frequent, it may also appear during psychotherapy.