Klein, R.

(1995) Closet narcissistic disorder

 2

Klein, 1995,s. 1
More often than not they defy the precise symptomatology of the DSM and
elude the clinician's best efforts at treatment.

a form of narcissistic disorder not yet codified In the DSM the Closet
Narcissistic Disorder

Klein, 1995,s.2
the Masterson Approach and describes in detail the specific form
of developmental arrest experienced by the closet narcissist.

Klein, 1995,s.3
Clinicians who viewed these disorders as mild forms of psychosis
emphasized supportive counseling. Those who saw these disorders as
severe psychoneurosis attempted interpretations within a classical analytical
framework. For the most part, these interventions failed because they did not
address the patient's developmental arrest.

The Masterson Approach does this by:

I) identifying the developmental arrest;

2) linking the particular developmental arrest to a specific category of

personality disorder and underlying intrapsychic structure; and

3) correlating specific personality disorders (or "disorders of the self as

Masterson refers to them) with specific therapeutic interventions.

The appeal of the DSM system is that it focuses on the most readily
identifiable and most easily replicated phenomena: symptoms. The
weakness of this system is that symptomatology is episodic and
transitory lforbigaendeJ. Another shortcoming of the DSM is that it
emphasizes lower-level borderline and narcissistic patients who
have difficulty functioning and tends to overlook higherlevel patients who
tend to function better.
 3

Klein, 1995,s.4
the DSM ..... does not include "closet narcissistic disorder"-the topic of
this video and manual-an obvious handicap for evaluating and treating this
type of personality disorder.

the intrapsychic structure-the patient's template [mal] for self-expression

the Masterson Approach reorganizes the many categories of personality

disorder identified in the DSM-IV into four basic divisions: borderline,
narcissistic, schizoid, and antisocial Each diagnostic category
of personality disorder within the Masterson Approach corresponds to a
unique intrapsychic structure which reflects a specific developmental arrest
that occurred during the patient's toddler years and impeded [hindre] normal
maturation from that point on.

The Masterson Approach: The Theoretical Framework

The theoretical framework of the Masterson Approach is founded on the

premise that the psychological development which occurs from birth
through three years of age is especiaUy critical to an understanding of
both normal development of the self, and the developmental arrest of
the self which produces a personality disorder.

Failures in the developmental process result in an impaired real self. To

deal with the painful affects associated with the impaired real self (what
Masterson has termed the "abandonment depression"), the patient
develops a "false self."

Klein, 1995,s.5
The "real selr is the sum total of the individual's intrapsychic images of
the self and of significant others, as weU as the feelings associated with
those images.

The self can be seen as the "operational arm" of the ego, though it is more
than that. The ego can be seen as the "executant arm" of the self (through
reality testing, impulse control, and other ego functions and "defenses").
 4

While the clinician is concerned with ego functions (reality testing,

frustration tolerance, impulse control) and object relations (the interpersonal
world of the patient), the focus is on the self as it must act in the world (self-
acknowledging, self-activating, committing, and creating).

The ingredients or building blocks of the real self consist of the biologic
and genetic endowment, evolving maturational processes... , and the
interactions of the developing self with a caring object (i.e., a mother or
other primary caregiver) who can acknowledge and respond
with support to the unique emerging self.

too each of us begins life with different genetic potentials that will direct our
psychological capacities.

Klein, 1995,s.6
Caracteristics of the real self.

Spontaneity-Aliveness of Affect
The capacity to experience affect deeply with liveliness, joy, vigor,
excitement, and spontaneity.

Self-Entitlement
From early experiences of mastery, coupled with
parental acknowledgment and support for the emerging self, the person
develops a sense that he/she is entitled to appropriate experiences of
mastery and pleasure, as well as to the environmental input necessary to
achieve these objectives. This sense is sorely deficient in patients with a
borderline disorder of the self, and pathologically inflated in those with
a narcissistic disorder.

Self-Activation and Assertion [hevdelse)

The capacity to identify one's unique wishes and to autonomously take
initiative and use assertive modes of behavior to express those wishes in
the external world, and to support and defend them when under attack.

Acknowledgment of Self-Activation and Maintenance of Self-Esteem

To identify and acknowledge to oneself that one has coped with an
affective state and/or an environmental demand in a positive, adaptive
 5

manner. This ability is a prerequisite for autonomously maintaining

self-esteem.

Soothing of Painful Affects

The capacity to autonomously limit, minimize, and soothe
(berolige) painful affects.

Continuity of Self
The recognition and acknowledgment that the "I" of one experience is
continuous over time and related to the "I" of another experience.

Commitment
To commit the self to an objective or a relationship and to persevere
despite obstacles.

Creativity
To use the self to change old, familiar patterns into new, unique, and
different patterns.

Intimacy
The capacity to express the self fully in a close relationship with
minimal fear of abandonment or engulfment [oppslukthet)

Klein, 1995,s.7
(1) The separation of internalized self representations from internalized
object representations.

The child must learn that his or her needs, feelings, and thoughts are distinct
and separate from what he imagines to be the needs, feelings, and thoughts
of others.

The child thinks of himself and his mother as a single emotional

unit. Masterson calls this a state of "Iike-mindedness" from the child's
perspective.

(2) The integration of contradictory, opposite, affect states.

 6

In early development, the child uses the defensive operation of "splitting,"

keeping apart contradictory affect states, with their associated self and object
representations-memories and fantasies about what the self and others are
like. The toddler tends to perceive or categorize experiences along
global dimensions of good or bad, all or nothing, black or white. It is a
developmental achievement to be able to perceive people, experiences, or
the self as good and bad (at the same time), as neither all nor nothing, and as
multi-colored (neither all white nor all black) (Mahler, 1975).

(3) The unfolding of the capacities of the emerging, individuated self.

The child, through experimentation and reinforcement, learns that the

emerging self can and should primarily be creative and spontaneous and
self-acknowledging, and not primarily reactive and compliant with the
wishes and expectations of others.

Object Relations Theory

This developmental process described above is driven by a combination of
fate, the push of the innate developmental forces, and an adequate nurturing
environment. Crucial to the process is the mother's (or primary caretaker's)
ability to foster and support the unique, individuative aspects of the child's
emerging self. The parent supports the child's self-activation, reinforcing
separation and the emergence of the child's real self.

Object relations theory is the psychoanalytically based study of the

internalization of early interactions between child and parents.

Klein, 1995,s.8
What Is the Abandonment Depression?

A basic assumption of the Masterson Approach is that the developmental

arrest of the real self stems from the failure of the combined forces of nature,
nurture, and fate and results in a disorder of the self. Individuals with
disorders of the self present to themselves and to the world what
Masterson terms a "false self."

It is the function of the false self to come to the rescue and create a
shield of distortion and pleasure for the embattled, impaired real self. It
is the role of the false self to save the individual from knowing the truth
 7

about the impaired real self. from penetrating the deeper causes of
unhappiness. and from seeing the self as it reaDy is: vulnerable. afraid.
and unable to let the real self emerge.

The false self defends against a range of painful affects-including

anxiety, depression, panic, rage, guilt, helplessness and hopelessness,
and emptiness and void-which are known collectively, in the Masterson
Approach, as the "abandonment depression."

Everyone with a disorder of the self experiences (or, rather, defends against
experiencing) each of these painful feelings to some degree. They are the
feelings which inevitably accompanied the child's experience of not having
the emerging real self acknowledged, supported, and affirmed by significant
caretakers.

The patient with a disorder of the self experiences life as the endless
repetition of this vicious cycle.

Klein, 1995,s.9
The Borderline Disorder of the Self
In the DSM-IV, the borderline personality disorder is characterized by these
criteria:

interpersonal chaos,
identity diffusion,
affective instability (anger, emptiness),
impulsivity (including suicidal preoccupation), and
fear of abandonment.

This describes the most severe type of borderline disorder of the self. To
understand the entire spectrum of the borderline disorder of the self,
the clinician must focus on the developmental arrest and associated
intrapsychic structures.

In the borderline disorder of the self, the necessary support for healthy
self-activation was not available. Rather than emotional reward for healthy
self-activation and discouragement of infantile, regressive behavior found
in normal development, in the borderline patient's developmental history we
find the opposite: reward for regression and withdrawal for healthy self-
 8

activation. This pathologic relational form became established as the

model for relationship in the mind of the borderline patient.

What does the internal world (intrapsychic map) look like for the borderline?
The internal world of object relationships is first and foremost
characterized by splitting; experience of self and others is divided into
rigid categories of aU good or aU bad, totaUy gratifying or totally
frustrating. Everything is black or white in the interpersonal world of
the borderline patient. There are no emotional shades of gray (or any
other colors, for that matter).

The persistence of splitting in support of the false self is the focus of the
developmental arrest in the borderline. That is why the internal world of
the borderline patient consists of split object relations units, or split
representations of the self and other people. Masterson has described these
as the Rewarding Object Relations part-Unit (RORU) and the Withdrawing
Object Relations part-Unit (WORU), each with its own self and object
representation and linking, or associated, affect (see Figure 3).
 9

Figure 1. Split Object Relations of the ~erl;;>

Rewarding or Ubldlnal Part-Unit WIthdrawing or Aggressive
(RORU) Part-Unlt (WORU)

Part Object Representation: Part Object Representation:

a rnB*nal part-object which
oIIant approval for ~
and Clinging behavior I a rnB*nal part-object
which wI\hcRwa. 18 III9Y
and critical 01 eIIorIII \OWaId
eapanIIion-IndI

AFFECT i5 afFECT
ABANDONMENT DEPRESSION
hop I _and
helFllII-
8i,ijiIIi_ and \lOkI
guilt
Part SeH-Representation: Part SeH-Representation:
a part lIIIII.. epi" B iIaIIoolo1 part 1IIIII... _IIIaIIoo1 01
being the goad. PII8IMi
being 1Mdeqo ..... bad. ugly.
chIIO-Iftqua and specIaV
gI8I1dIoaa
an InIecI. 811:.

Developmental Arrest of the Ego:

Ego DaflCl..-poar I8IIIIy p8icapllon. tn..traIIon 1DI8i'ance.1mpuI8a conInII. ego boundarIeL
PrlmIlMi Ego ~ Mechai"II. epllIIing .:dng out, clinging. 1MIkIIInce. denial. projec:IIon.
pnljecIMt Id8i illlIcaIIon.
SpIll Ego--nIIIIIy ego plus JMIIhOIOgIc (or pIeaIn) ego.

The object representation of the RORU provides reward or approval for

regressive behavior. The associated self-representation is that of being a
good, compliant child, and the linking affect is that of feeljng good .

The object representation of the WORU is attacking or withdrawing in

response to the person's efforts to activate the self. The associated self-
representation is of being bad, ugly, and inadequate, and the linking affect is
that offeeling bad (the abandonment depression).

Because of the splitting defense, the borderline patient is unable to

integrate these two part-units (the aU-approving caretaker and the all-
rejecting caretaker, each with its attendant self-representations and
affects) into a more realistic whole.

Klein, 1995,s.10
 10

The defense of splitting combined with the paradigm of reward for

regression and withdrawal for genuine self-activation leads to the
disorders-of-the-self triad described above: self-activation leads to
anxiety and depression, which leads to defense. Genuine self-activation
(not just compliantly submitting to one's parents' wishes and
expectations) leads to the painful feeling of abandonment (loss of the
object or the approval of the object), which leads the child/patient to try
to defend against this potentially traumatic, painfulsituation.

The patient can defend against these painful feelings by allying with
(acting out in behavior with) the rewarding part-unit or the
withdrawing part-unit. There is no other choice. Genuine, healthy self-
activation only leads to more pain. The patient must defend. This means
that the patient must ally himself with one or the other of the distorted
part-units.

Usually, the patient will try to activate the rewarding part-unit. While
the patient must behave in a regressive or compliant maladaptive
fashion, his affective state is one of feeling good or taken care of, and the
patient is able to deny the maladaptive behavior.

If the patient is frustrated in his efforts at being rewarded for this

behavior, the withdrawing part-unit will be activated because of the
splitting defense. When the withdrawing part-unit is activated, the other
or "object" is, as described above,

Klein, 1995,s.11
experienced as withdrawing or attacking, the self is experienced as
"bad" and "inadequate," and the associated affect is the abandonment
depression. This state of affairs cannot be pennitted to persist. Guided by
the disorders-of-the-self triad, the patient must quickly defend. The patient
denies his own bad feelings, projecting them instead onto the object, and
attac.ks the object as cold, inadequate, uDcaring, or bad. In this fashion,
the patient at the very least expresses his rage and feels in control. Better
still, the expression of the rage effectively coerces or manipulates the object
into rewarding the patient for his regressive behavior (the object steps
into, and reactivates, the RORU). The borderline patient is caught in a
terrible bind! If he (or she) acts in a healthy, adaptive fasbion, he will
(owing to the now internalized model of withdrawal for healthy self-
 11

activation) feel terrible and threatened with the loss of the significant
object. If, on the other hand, he acts in a regressed, maladaptive fashion,
he will feel better, albeit at a tremendous cost in terms of healthy adaptation.

This is the clinical situation confronting the therapist called upon to treat the
borderline patient. The split object relations part-units of the borderline
are the legacy of the patient's past. The patient creates endless
reproductions of this dilemma from this original template.

The Narcissistic Disorder of the Self

The narcissistic disorder of the self can be differentiated into two

distinct subtypes, the exhibitionistic and the closet. As aUuded to above,
the DSM-IV contains a description of only one of these two subtypes:
the exhibitionistic. The diagnostic criteria include:
a grandiose sense of self-importance,
fantasies of perfection,
a sense of entitlement,
hypersensitivity to criticism, and
a lack of empathy for others.

These symptoms listed in the DSM-IV are the exhibitionistic narcissist's

calling card and must be evaluated fIrst. As with the borderline disorder, to
understand the narcissistic disorder of the self the clinician must first turn his
or her attention to the developmental arrest and then to the intrapsychic
structure. The pictures for both are quite different from that of the
borderline disorder of the self. As in the developmental history of the
borderline, the history of the narcissist reveals a failure to receive the
support necessary for the emergence of the real self. However,
the nature of the failure is different. In the case of the exhibitionistic
narcissist, the parent (caretaker) idealizes the child to shape the cbild to
his/her own needs. The child defends against the painful affects
associated with the experience of lack of support for the real self by
identifying with the parent's idealization. The child emerges from
this early period of life with an inDated or grandiose sense of self which
requires constant shoring up; he feels unique, admired, and adored
through the pursuit of "perfect mirroring" of his grandiosity and
perfection by others.
 12

KJein, 1995,s.12
Wbere tbe borderline struggles to find a way to feel connected to tbe
object (to get tbe object onto tbe same emotional roller coaster, if you
will), tbe narcissist, by contrast, feels 'fused" witb tbe object; be
experiences no separation between bimself and tbe object. His
tbougbts, needs, and feelings, are, be believes, identical to tbose of
tbe object, and, furtbermore must be.
Masterson has explicated this experience of fusion in terms of "one-
mindedness" or "like-mindedness." Tbe narcissist expects tbe otber to be
"on tbe same page," so to speak, as be is with regard to feelings,
perceptions, and agendas; in otber words, be expects tbe object to feel
tbe same way, perceive and understand reality in tbe same fasbion, and
sbare tbe same concerns, with the same sense of urgency and
priority. Only the experience of "perfect mirroring" or matcbing of
bis beliefs, concerns, and needs will support tbis defense.

The persistence of the need for perfect mirroring in support of the grandiose
self is the focus of the developmental arrest in the patient with a narcissistic
disorder. Tbe nature of tbe developmental arrest in tbe narcissist results
in an intrapsycbic structure tbat is different from tbat of tbe borderline
in botb form and content.

Form
The intrapsychic structure of the borderline, as described above, consists
of split object relations units or split representations of the self and other
people. Tbe intrapsycbic structure of tbe narcissist, by contrast, consists
of fused object relations units. Masterson bas described tbese as tbe
defensive fused object relations partunit and tbe aggressive fused object
relations part-unit (see Figure 4).

Content
Tbe defensive fused part-unit consists of an omnipotent object
representation tbat contains all power, perfection, direction, and
"narcissistic supplies" (or mirroring capabilities); a grandiose self-
representation (tbe self is experienced as being superior, elite, deserving
of special entitlements, and so on); and a linking affect offeeling perfect,
special, adored, and admired. Tbe exbibitionistic narcissist projects tbe
grandiose self, exbibits entitlement, and expects perfect mirroring of tbe
grandiosity and perfection by otbers.
 13

The underlying aggressive object relations unit consists of a fused object

representation that is harsh, punitive, and attacking; a self-
representation of being humiliated, attacked, and empty; and a linking
affect of abandonment depression. For the patient with a
narcissistic disorder of the self, the abandonment depression can
be precipitated either by efforts at true self-activation (i.e., the pursuit of
realistic self-expressive goals as opposed to the narcissistic goals of
perfection, adoration, money, power, beauty, and so on) or by the perception
of the object's failure to provide perfect mirroring; self-activation or the
absence of mirroring leads to abandonment depression, which leads
to defense. The narcissistic patient experiences the
abandonment depression as the self fragmenting or falling apart (rather
than as the loss of the object experienced by the borderline).

Klein, 1995,s.13
To defend against the abandonment depression, the patient with an
exhibitionistic narcissistic defense projects his grandiosity and seeks
mirroring from the "perfect object." The failure to receive such
mirroring or "like-mindedness" results in the narcissist's devaluing,
avoiding, or writing off those who fail to supply the needed narcissistic
supplies. The projection of grandiosity and the dismissal of those who
don't share the narcissist's views is the narcissist's basic
modus operandi. The operation of this defensive unit is so uniqe
and airtight that it effectively conceals from the casual observer the
underlying pathological or aggressive fused unit.

Fig.4
 14

Defensive, Ubldlnel Fused Part-Unit Aggreaalve Fused Part-Unlt

ljM1p AfIIc;t
AbandoIomart depi BllkIn. aaIf
f8IIng III*l

Ell!! [)aIanM MecberJ!eme

SpIItIIng. 1MIidIInoe. denial. IICItng out. clinging. p!ojecIIon. p!OjecII\IIIldeulltlcalion.

Klein, 1995,s.14
The Closet Narcissistic Disorder of the Self
There is much confusion among clinicians about the diagnosis and
psychotherapy of the closet narcissistic disorder of the self. It is a
common clinical experience for a therapist to feel baffled by a
therapeutic impasse with a so-called "borderline" patient. The patient's
clinical picture looks borderline:

depression,
difficulty with self-assertim,
apparent clinging in relationships,
difficulties with anger,
an inadequate sense of self, and
denial of destructive behavior.

The therapist uses the therapeutic interventions indicated for the borderline
patient, but rather than leading to therapeutic progress, the therapist
experiences only growing frustration as the patient responds by either
 15

increasing attack and resistance or by seeming to respond, but without a

change in affect or therapeutic relationship.

ffhe problem is that the patient who looks like a "borderline" but
doesn't act like a borderline may well in fact have a "closet" narcissistic
disorder of the self. Unfortunately, as of the latest revision to the DSM,
there is still no provision for the closet narcissistic disorder of the self.

The intrapsychic structure of the closet narcissistic disorder is the same

as that of the exhibitionistic narcissistic disorder (review Figure 4).
There are, however, two key differences between them:

(1) There is an emotional investment in the omnipotent object" rather

than in the grandiose self. While the exhibitionistic narcissist seems
vTJL6;~"'61u ':.Am pervious to the object, the closet narcissist is exquisitely dependent
on and vulnerable to the object.

What accounts for this difference? Most often, in the early stages of
development, the mother attacks the child's normal grandiosity, rather
than supporting it, and insists that the child mirror her own needs as a
condition of receiving "narcissistic supplies."

The child withdraws the narcissism into the closet because it is too
painful to leave the grandiose self exposed. To further defend against
the attack and to protect the grandiose sense of self, the child accedes to
the parental conditions. Rather than seeking mirroring of the
grandiosity by others, the child instead idealizes others still seeking
"one-mindedness," but in this case by "basking in the glow" of the
idealized object. This idealization of the other in the service of the
grandiose self is characteristic of the patient with a closet
narcissistic disorder of the self.

(2) The closet narcissist cannot maintain the continuous activation of

defense as the exhibitionistic narcissist can. This is because the
exhibitionistic narcissist is essentially indifferent to the object (except
insofar as the object provides perfect mirroring), while the closet
narcissist has, as described above, made an emotional investment in the
object, and is therefore more vulnerable to failures of like-minded ness
and ensuing depression. The abandonment depression is precipitated in
 16

the closet narcissist either by efforts at self-activation, or by failures in

the ability to

Klein, 1995,s. IS
idealize the other and so bask in the reflected glow.

The disorders-of-the-self triad (self-activation depression defense), seen so

readily in patients with a borderline disorder of the self but only seen in
exhibitionistic narcissistic patients later in treatment when the defenses have
been consistently breached, is also readily apparent in closet
narcissistic patients at the start of treatment.

These key differences between the exhibitionistic and the closet

narcissistic disorders help to clarify why closet narcissistic patients have
not been identified as narcissistic.

In addition, as noted above, the clinical picture looks borderline. There

are three main sources of this confusion:

(1) The idealizing defense of the false self of the patient with a closet
narcissistic disorder may be confused with the clinging defense of the
borderline disorder. Both seem to need the object desperately (albeit for
different reasons).

(2) The closet narcissist is much more likely to present with a depressed,
deflated, inadequate self rather than with a grandiose, inflated false self.
Like the borderline patient, the closet narcissist is also more likely to be
conscious of associated feelings of helplessness, hopelessness,
emptiness, and void.

(3) The closet narcissist may seem to respond to confrontation, the

intervention of choice with borderlines. However, the fact that

there is no consequent change in affect or in the therapeutic aUiance

reveals that the response is not genuine, but a result of a defensive wish
to please the therapist.

Differential Diagnosis
 17

How then can the therapist distinguish between the closet narcissistic
disorder and the borderline disorder? Four key areas differentiate one
from the other:

(1) There is a qualitative difference between idealizing and clinging. The

borderline patient who is clinging will accept a few words of approval,
whereas the closet narcissist seeks perfect admiration aU the time.

(2) To make the diagnosis, one evaluates the same intrapsychic

structures as in the exhibitionistic disorder; that is, the grandiose self-
omnipotent object defensive fused unit and the underlying
aggressive fused unit. For example, the patient looks to the therapist
for a "like-minded" response, assuming that the therapist has the same
thoughts and feelings as the patient and wiD respond exactly as the
patient needs.

(3) Key elements of the abandonment depression are different for the
patient with a closet narcissistic disorder and the patient with a
borderline disorder. The closet narcissist's depression is marked
by feelings of humiliation and shame and of the self falling apart, in
contrast to the borderline's experience of the loss of the object.

(4) In those cases in which it is difficult to make the differentiation, it is

necessary to decide on one or the other diagnosis and to implement that
decision through the therapeutic stance taken. The patient's responses to
the interventions must confirm the diagnosis.

Klein, 1995,s.21
The Closet Narcissistic Disorder of the Self

This patient begins treatment idealizing the therapist. The therapist then
interprets the projection: "It is so painful for you to focus on yourself that
you turn to me in order to defend against, or soothe, the pain." Here the key
words are pain, self, and defense. This key interpretation helps the patient to
feel "understood."

interpretation of narcissistic vulnerability.

 18

Klein, 1995,s.22
the patient is exquisitely sensitive to the therapist and easily
disappointed by failures of idealization (experienced as separateness,
not being "on the same page," and failures in one-minded ness).

It is important to stress that the therapist cannot confront the projections of

the narcissistic patient because that would trigger the underlying aggressive
'.!!!iJ: and the patient would see the therapist's action as an attack and re~ond
with pr~ection, devaluation, or avoidance.

Again, one does not confront a defense as with the borderline patient, but
rather interprets it as a defense against narcissistic pain. For example, one
might confront a borderline patient who is late for a session by pointing out
that this is destructive to his objective; that he is depriving himself of time to
do the work. In contrast, with a patient with a narcissistic disorder, one
would interpret it as follows: "It must be very painful for you to talk about
yourself here, and you must have felt the need to withdraw to soothe that
pain."

Klein, 1995,s.29
Developmental History

Throughout his childhood, he felt that the family revolved around his
father, an overbearing, strict disciplinarian who felt that it was
important to teach his son how to be "a real man" and his sisters "real
women, like their mother." Essentially, this meant to be "on call" for
the father. He remembered most vividly bis motber telling the children
not to disturb their father and to obey him, rules she herself followed.

He recalled feeling that what he wanted was never important. "I had no
agenda that was my own. I felt that I bad to please Mom and Dad. That
was my agenda, and I was only concerned to do it well."

Although he worked hard to please them, he remembered that he never

felt that be was "good enough" for bis fatber, and thougb he felt close to
bis motber, "she always seemed down, depressed .... I wondered if she
 19

was disappointed in me. It made me just try harder to help her, to make
her feel better."

Thoughout high school and college, the patient's life was generally
uneventful, though feelings of depression and unh.appiness seemed to
hover.

Though never especially popular, he had always had at least one very
close friend, though different ones at different periods in his life: one in
grade school, one in high school, and one in college.

Klein, 1995,s.30
there was no readily identifiable "illness" which could and should be
medicated and alleviated.

Rather, David C. presented very much with the kind of vague, diffuse,
pervasive, and disturbing symptoms typical of a disorder of the self.

Klein, 1995,s.51
Abandonment Depression
A complex of painful affects (including anxiety, depression, panic, rage,
guilt, helplessness and hopelessness, emptiness and void), which are
known collectively in the Masterson Approach as the "abandonment
depression," and are associated with failures ofsupport for the child's
real self in early development, not with literal abandon ment.

Confrontation
A therapeutic intervention designed to empathically bring to a patient's
attention the destructive or maladaptive aspects of a particular defensive
behavior. Confrontations may take the form of a question or statement
pointing out the contradiction in a patient's statements or between the
patient's actions and feelings. Confrontation is the intervention of choice
with a borderline patient.

Defense
Defense-anyone of several maneuvers (i.e., avoidance, denial, projection)
used to keep feelings that would otherwise be too painful or overwhelming
at bay.
 20

Idealizing defense
The idealization of another person in order to obtain "narcissistic
supplies" by "basking in the other's glow" (characteristic of the closet
narcissist).

Grandiosity defense
The pursuit of adoration or perfect mirroring of one's uniqueness or
specialness as a defense against feelings of vulnerability (characteristic of
the exhibitionistic narcissist).

Splitting defense
A defense which keeps contradictory affect states separated (rom
one another; the effect of this defense (characteristic of the borderline)
is that eJlperiences of self and others are either aU good or aU bad.

Disorder of the Self

Masterson's tenn for "personality disorder," denoting deficits in the ability
to perceive reality without self-protective distortions, and to deal with
problems in the real world assertively and creatively.

Klein, 1995,s.52
Disorders of the self derive from failures in early childhood to
receive support for the emerging real self. The individual with
a disorder of the self presents to the world what is called a "false self to
defend against feelings of vulnerability associated with the "impaired
real self." (See definitions under "self below).

Disorders-of-the-Self Triad
According to Masterson, attempts at self-activation (see below) or other
events involving eJlposure of the real self lead to one or more of
the affects associated with the abandonment depression
(anuety, depression, etc.), which, in turn, leads to further defense.
The patient with a disorder of the self eJlperiences life as the endless
repetition of this cycle.

Fusion or "One-Mindedness" 7, 11-13

This refers to an experience of self and others as fused or identical. The
individual with a narcissistic disorder of the self fails to appreciate (in
 21

any way other than inteUectually) that others are indeed distinct-having
needs, wishes, thoughts, and feelings separate from his own. Masterson
has described this as the narcissist's need for "one-mindedness" or
for "being on the same page" as the other.

Interpretation-a therapeutic intervention designed to heighten the patient's

awareness of unconscious defenses, including devaluation, avoidance, and
projection.

Mirroring Interpretation of Narcissistic Vulnerability A therapeutic

intervention that combines mirroring of the patient's pain with interpretation
of the defense designed to ward off that pain. A mirroring interpretation of
narcissistic vulnerability is the intervention of choice with narcissists of
the exhibitionistic as we)) as the closet variety.

Linking Affect-an affect associated with a particular representation of self

and others.

Object Relations Theory

A psychoanalytic th.eory to account for how the child's early interactions
with the mother or other primary caretaker become internalized, resulting
in images of the self and others (self and object representations) and
expectations (whether realistic or distorted) about what can be expected in
relationships.

Object Relations Unit

An object relations unit consists of a particular self-representation, a
particular object representation, and a linking affect associated with those
internalized images.

Klein, 1995,s.53
Object Relations Part-Unit-Failures of support for the child's emerging self
result in both an impaired real self (see below) and a "false" or defensive
self, each with its associated object relations units, which are referred to as
"part-units. "

Part-Units of the Borderline

 22

The two part-units of the borderline are the rewarding unit and the
withdrawing unit.

Part-Units of the Narcissist

The two part-units of the narcissist are the ag~ressive fused unit and the

-
defensive fused unit.

Projection
A defense mechanism whereby the individual projects an internal image of
the self or other onto the external world.

Self
False Self
The "false self is the defensive structure which protects the individual
from painful affects associated with lack of support for the developing
real self. The purpose of this defensive shield is not to deal with reality,
but to defend against pain.

Impaired Self
The "impaired selr is a deficit state that derives from a combined
failure of nature, nurture, and fate to provide adequate support for
healthy development of the real self. The person with an impaired
real self lacks a sense that the self is adequate and worthy of support,
and compensates for that deficit with various defenses.

Real Self
The "real self refers to the self that can see "reality" without distortion
and act alltonomously to support the self in the external world, soothing
painful affects without distorting reality to accomplish that, pursuing
goals in the face of obstacles, and so on. The development of the real self
is, according to Masterson, a developmental achievement, not a
maturational given. Characteristics of the real self are outlined in Figure 1
of this manual (on page 6).
Self-Activation
A key concept in the Masterson Approach, this refers to the ability to
identify one's genuine wislles and to fake autonomous action both to
express those wishes in the world, and to defend them when under
attack. The ability to self-activate is impaired in individuals with disor-
 23

Klein, 1995,s.54
den of tbe self, owing to tbe cbild's baving been eitber punisbed for
attempts at genuine self-activation, or inappropriately ide!!!!.zed for
fulfilling tbe caretaker's needs ratber tban tbe cbild's own needs.

Therapeutic Alliance
A relationship in which the patient sees the therapist as he or she really is,
both good and bad at the same time; it is what Masterson caJls a "real object
relationship." The development of a therapeutic alliance is one of the initial
goals of therapy with patients with disorders of the self.

Therapeutic Neutrality
A cornerstone of the Masterson Approach, therapeutic neutrality refers to the
neutral stance of the therapist to support the patient's attempts at self-
activation without becoming personally involved in the patient's life. It is
a respectful stance aimed at promoting the therapeutic conditions which will
enable the patient to see his or her defenses, and overcome them.

Transference
In a transference relationship, the patient projects his (or her) fantasies about
who the therapist is, but is also aware that he is projecting. A transference
relationship, therefore, presupposes the capacity for a "real object
relationship" with the therapist, i.e., a therapeutic aJliance.

Transference Acting Out

In contrast to transference, transference acting out is characterized by the
projection of internal images onto the therapist with no awareness of the
reality existence of the therapist.