www.nmgpsy.com内蒙古心理网DEBATE BETWEEN KOHUT (HK) AND KERNBERG (OK)
I'd enjoy getting any of your ideas about how to improve on or further elaborate this dialogue.
OK:Heinz, are you not indulging the patient's grandiose fantasy that he is the superior one, patronizing the therapist?
HK:Of course. The patient must be indulged in this fantasy if he is to experience this developmental stage. His grandiosity must be permitted. This is difficult because for the patient to act out such fantasies alienates the therapist. It is a test of the therapist's capacity for .
OK:No, that is not the countertransference problem. The countertransference problem is therapist's fear of the patient's anger. The therapist hesitates to confront the patient's fantasy for fear of provoking his rage. It is a test of whether the therapist can withstand the patient's rage. Indulging the patient's grandiosity only supports a defense against this rage. The rage is generated by the feelings of inferiority that the patient's grandiosity also defends against.
HK:Yes, well certainly that is a persuasive concept, and many eminent clinicians find it so. I formerly accepted it myself. However, I have since come to the conclusion that the patient's rage is reactive. He is angry because in interpreting his grandiosity you have, in reality, attacked his narcissism.
OK:Oh, but he can't enjoy his narcissism since he really feels inferior to the therapist.
HK:No, I think that is a later capacity. He really does not have the psychic structures necessary to support competitive feelings. To interpret as if he does, only becomes a demand from the therapist to be included in the patient's consciousness.
OK:There is no need for interpretations to be experienced as a demand by the therapist as long as the therapist is neutral.
HK:The word is empathic, not neutral. I don't think there is any way to be neutral from your position. Aren't you at risk for feeling like you have failed if you allow the patient to exclude you? Even if feeling excluded did not provoke you, is it not still up to you, for the patient's sake, to prevent him from ignoring and depreciating you?
If I may say so, my model gives the therapist a way to accept what the patient is doing and so provides him with a way to cope with the countertransference.
OK:Wait a minute. What you say about empathy, after all, goes without saying. I have to say that what you are really doing here is advocating complicity with the patient's withdrawal into grandiosity that you are obviously not all that happy with yourself.
HK:[Falls silent at this point, permitting Kernberg's grandiosity.]
OK:[continuing] I cannot see that your complicity--call it what you will--your endless patience, is any more than a manipulation, a corrective experience. And one that is not likely to be very corrective since we are talking about severely regressed patients who will interpret your behavior in magical, omnipotent ways.
HK:Otto, Otto. You really cannot take empathy for granted. To sustain it is a demanding task that can never be completely successful. It does not simply mean being a good diagnostician. You seem to be overlooking the fact that these patients are constantly testing the therapist over a long period, both with their grandiosity and with their tantrums.
I'd enjoy getting any of your ideas about how to improve on or further elaborate this dialogue.
OK:Heinz, are you not indulging the patient's grandiose fantasy that he is the superior one, patronizing the therapist?
HK:Of course. The patient must be indulged in this fantasy if he is to experience this developmental stage. His grandiosity must be permitted. This is difficult because for the patient to act out such fantasies alienates the therapist. It is a test of the therapist's capacity for .
OK:No, that is not the countertransference problem. The countertransference problem is therapist's fear of the patient's anger. The therapist hesitates to confront the patient's fantasy for fear of provoking his rage. It is a test of whether the therapist can withstand the patient's rage. Indulging the patient's grandiosity only supports a defense against this rage. The rage is generated by the feelings of inferiority that the patient's grandiosity also defends against.
HK:Yes, well certainly that is a persuasive concept, and many eminent clinicians find it so. I formerly accepted it myself. However, I have since come to the conclusion that the patient's rage is reactive. He is angry because in interpreting his grandiosity you have, in reality, attacked his narcissism.
OK:Oh, but he can't enjoy his narcissism since he really feels inferior to the therapist.
HK:No, I think that is a later capacity. He really does not have the psychic structures necessary to support competitive feelings. To interpret as if he does, only becomes a demand from the therapist to be included in the patient's consciousness.
OK:There is no need for interpretations to be experienced as a demand by the therapist as long as the therapist is neutral.
HK:The word is empathic, not neutral. I don't think there is any way to be neutral from your position. Aren't you at risk for feeling like you have failed if you allow the patient to exclude you? Even if feeling excluded did not provoke you, is it not still up to you, for the patient's sake, to prevent him from ignoring and depreciating you?
If I may say so, my model gives the therapist a way to accept what the patient is doing and so provides him with a way to cope with the countertransference.
OK:Wait a minute. What you say about empathy, after all, goes without saying. I have to say that what you are really doing here is advocating complicity with the patient's withdrawal into grandiosity that you are obviously not all that happy with yourself.
HK:[Falls silent at this point, permitting Kernberg's grandiosity.]
OK:[continuing] I cannot see that your complicity--call it what you will--your endless patience, is any more than a manipulation, a corrective experience. And one that is not likely to be very corrective since we are talking about severely regressed patients who will interpret your behavior in magical, omnipotent ways.
HK:Otto, Otto. You really cannot take empathy for granted. To sustain it is a demanding task that can never be completely successful. It does not simply mean being a good diagnostician. You seem to be overlooking the fact that these patients are constantly testing the therapist over a long period, both with their grandiosity and with their tantrums.
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