A psychoanalytic hermeneutic investigation of destructive narcissism
- Authors: De Wit, Estelle
- Date: 2013-06-04 , 2004
- Subjects: Narcissism Narcissism -- Treatment Psychoanalysis Death instinct Ego (Psychology) Self psychology
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3180 , http://hdl.handle.net/10962/d1008055
- Description: The purpose of this research was to investigate the clinical phenomenon of destructive narcissism. Contemporary Kleinian and neo-Kleinian theoretical perspectives provided the interpretative perspective on the complexities of inaccessible personalities and subtle forms of internal destructiveness. Four research questions were formulated to interrogate the individual and collective experiences of three male patients whose internal worlds seem to be governed by rigid intrapychic structures organized around the dictatorship of a constellation of seemingly impenetrable defensive strategies. These questions were as follows: 1. What emotional states, actions and experiences of self and others characterize the clinical phenomenon designed as destructive narcissism and distinguish it from other forms of character pathology? 2. What early developmental experiences and relationships may have pre-disposed individuals to the development of this type of character pathology? 3. How are the psychodynamic processes of destructive narcissism structured and configured in the psychotherapeutic process and progress? 4. What are the transference/countertransference psychotherapeutic manifestations of the psychodynamics of destructive narcissism? The illustrative-didactic case study method was utilized to discuss pertinent aspects of each patient. This included their early developmental histories, inter- and intrapersonal relationships, their current mental state, defensive strategies and their stated reasons for commencing psychotherapy. In addition, the structure of the psychotherapeutic process with these patients was reviewed in depth. Various psychic and personality features, as unveiled through this process were discussed, as well as the implications of these for the therapeutic endeavor. The features chosen for discussion were: Firstly, the constellation of the internal object world, the capacity for symbolic thought and defensive organizations. Secondly, therapeutic ambivalence, which made psychotherapy untenable, was explored in conjunction with transference/countertransference issues. Thirdly, the shadow sides of psychotherapeutic change with these patients were considered and the issues of therapeutic failure and other treatment possibilities were examined. It was concluded that there need be an important shift with regard to the psychotherapeutic goals for those patients whose condition may be chronic, and for whom it appears that psychotherapy is of little benefit. In essence, the intent of psychotherapy with these patients is to reach the healthy sane patient of the patient within the pathological organization. Attempts to unravel the perverse gratification and protection derived from the domination of the narcissistic structure may not be enough, and the patient's collusion with the internal destructive gang should also be exposed. If this can be achieved, the patient may come to accept the existence of a part of himself as truly destructive. This, in turn, cannot be disowned, therefore the patient has to live with it. Thus, in destructive narcissism, the challenge for the therapist is the extremely difficult task of disentangling the patient's pain from the idealization of internal destructiveness. , KMBT_363 , Adobe Acrobat 9.54 Paper Capture Plug-in
- Full Text:
- Date Issued: 2004
- Authors: De Wit, Estelle
- Date: 2013-06-04 , 2004
- Subjects: Narcissism Narcissism -- Treatment Psychoanalysis Death instinct Ego (Psychology) Self psychology
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3180 , http://hdl.handle.net/10962/d1008055
- Description: The purpose of this research was to investigate the clinical phenomenon of destructive narcissism. Contemporary Kleinian and neo-Kleinian theoretical perspectives provided the interpretative perspective on the complexities of inaccessible personalities and subtle forms of internal destructiveness. Four research questions were formulated to interrogate the individual and collective experiences of three male patients whose internal worlds seem to be governed by rigid intrapychic structures organized around the dictatorship of a constellation of seemingly impenetrable defensive strategies. These questions were as follows: 1. What emotional states, actions and experiences of self and others characterize the clinical phenomenon designed as destructive narcissism and distinguish it from other forms of character pathology? 2. What early developmental experiences and relationships may have pre-disposed individuals to the development of this type of character pathology? 3. How are the psychodynamic processes of destructive narcissism structured and configured in the psychotherapeutic process and progress? 4. What are the transference/countertransference psychotherapeutic manifestations of the psychodynamics of destructive narcissism? The illustrative-didactic case study method was utilized to discuss pertinent aspects of each patient. This included their early developmental histories, inter- and intrapersonal relationships, their current mental state, defensive strategies and their stated reasons for commencing psychotherapy. In addition, the structure of the psychotherapeutic process with these patients was reviewed in depth. Various psychic and personality features, as unveiled through this process were discussed, as well as the implications of these for the therapeutic endeavor. The features chosen for discussion were: Firstly, the constellation of the internal object world, the capacity for symbolic thought and defensive organizations. Secondly, therapeutic ambivalence, which made psychotherapy untenable, was explored in conjunction with transference/countertransference issues. Thirdly, the shadow sides of psychotherapeutic change with these patients were considered and the issues of therapeutic failure and other treatment possibilities were examined. It was concluded that there need be an important shift with regard to the psychotherapeutic goals for those patients whose condition may be chronic, and for whom it appears that psychotherapy is of little benefit. In essence, the intent of psychotherapy with these patients is to reach the healthy sane patient of the patient within the pathological organization. Attempts to unravel the perverse gratification and protection derived from the domination of the narcissistic structure may not be enough, and the patient's collusion with the internal destructive gang should also be exposed. If this can be achieved, the patient may come to accept the existence of a part of himself as truly destructive. This, in turn, cannot be disowned, therefore the patient has to live with it. Thus, in destructive narcissism, the challenge for the therapist is the extremely difficult task of disentangling the patient's pain from the idealization of internal destructiveness. , KMBT_363 , Adobe Acrobat 9.54 Paper Capture Plug-in
- Full Text:
- Date Issued: 2004
Ethical decision-making in the therapeutic space : a psychoanalytic view
- Authors: Silove, Melanie
- Date: 2009
- Subjects: Decision making -- Moral and ethical aspects , Psychotherapy -- Moral and ethical aspects , Psychotherapists -- Professional ethics
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3273 , http://hdl.handle.net/10962/d1020873
- Description: This study examined the ethical decision-making process as it transpired in the everyday context of the therapeutic space. In-depth interviews explored the subjective experiences of six South African psychologists, practicing as psychoanalytic psychotherapists, and their efforts to resolve real-life ethical dilemmas. The theoretical framework used to interpret the data subsumed professional literature in psychology on principle-based ethical decision-making as well as contemporary psychoanalytic debates on the phenomenon of countertransference enactments. A review of ethics codes, survey research and seminal decision-making frameworks suggests that ethical dilemmas have traditionally been resolved by recourse to an objective and impartial “principle ethics” perspective. Empirical evidence shows, however, that logical thinking and the rational application of codes, principles and standards are often insufficient to secure ethical action. The establishment of reflective space and the core theoretical notion of “ethical decision-making enactments” were proposed in order to address the subjective, irrational and unconscious dimension of professional decision-making. This study used a broadly hermeneutic research method which transformed participants‟ descriptions of engagement with real-life dilemmas into a psychoanalytically informed interpretive account of ethical decision-making. Twelve aspirational ethical principles were found to guide participants‟ daily analytic work. Beneficence was the principle most strongly identified with and nonmaleficence was the most neglected ethical principle. Unprocessed countertransference responses were shown to drive earlier prereflective phases of the ethical decision-making process. Mature ethical judgment was predicated upon the retrospective analysis of enactment phenomena. Dissatisfaction was expressed by all participants with regard to the role of professional resources in aiding the resolution of stressful ethical dilemmas. Risk factors for compromised professional decision-making included the paucity and perceived irrelevance of postgraduate ethics training, supervisory failure to confront the ethical and countertransference dimensions of common dilemmas and professional isolation. Rather than eliciting the hope of emotional support and greater insight, professional resources on the contrary mostly appeared to induce anxiety, mistrust and fearfulness. Based on the data and the literature, a pragmatic psychoanalytically informed ethical decision-making model was finally generated. The model, which considers both principle ethics as well as countertransference phenomena, offers a preliminary contribution to professional dialogue on the development and evaluation of empirically based decision-making frameworks. Practical recommendations are made for both the revision of the current South African ethics code and for improving the postqualifying ethics education of psychoanalytic practitioners and supervisors. The limitations of the data are discussed and directions for future research initiatives are proposed.
- Full Text:
- Date Issued: 2009
- Authors: Silove, Melanie
- Date: 2009
- Subjects: Decision making -- Moral and ethical aspects , Psychotherapy -- Moral and ethical aspects , Psychotherapists -- Professional ethics
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3273 , http://hdl.handle.net/10962/d1020873
- Description: This study examined the ethical decision-making process as it transpired in the everyday context of the therapeutic space. In-depth interviews explored the subjective experiences of six South African psychologists, practicing as psychoanalytic psychotherapists, and their efforts to resolve real-life ethical dilemmas. The theoretical framework used to interpret the data subsumed professional literature in psychology on principle-based ethical decision-making as well as contemporary psychoanalytic debates on the phenomenon of countertransference enactments. A review of ethics codes, survey research and seminal decision-making frameworks suggests that ethical dilemmas have traditionally been resolved by recourse to an objective and impartial “principle ethics” perspective. Empirical evidence shows, however, that logical thinking and the rational application of codes, principles and standards are often insufficient to secure ethical action. The establishment of reflective space and the core theoretical notion of “ethical decision-making enactments” were proposed in order to address the subjective, irrational and unconscious dimension of professional decision-making. This study used a broadly hermeneutic research method which transformed participants‟ descriptions of engagement with real-life dilemmas into a psychoanalytically informed interpretive account of ethical decision-making. Twelve aspirational ethical principles were found to guide participants‟ daily analytic work. Beneficence was the principle most strongly identified with and nonmaleficence was the most neglected ethical principle. Unprocessed countertransference responses were shown to drive earlier prereflective phases of the ethical decision-making process. Mature ethical judgment was predicated upon the retrospective analysis of enactment phenomena. Dissatisfaction was expressed by all participants with regard to the role of professional resources in aiding the resolution of stressful ethical dilemmas. Risk factors for compromised professional decision-making included the paucity and perceived irrelevance of postgraduate ethics training, supervisory failure to confront the ethical and countertransference dimensions of common dilemmas and professional isolation. Rather than eliciting the hope of emotional support and greater insight, professional resources on the contrary mostly appeared to induce anxiety, mistrust and fearfulness. Based on the data and the literature, a pragmatic psychoanalytically informed ethical decision-making model was finally generated. The model, which considers both principle ethics as well as countertransference phenomena, offers a preliminary contribution to professional dialogue on the development and evaluation of empirically based decision-making frameworks. Practical recommendations are made for both the revision of the current South African ethics code and for improving the postqualifying ethics education of psychoanalytic practitioners and supervisors. The limitations of the data are discussed and directions for future research initiatives are proposed.
- Full Text:
- Date Issued: 2009
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