SELF PSYCHOLOGY

AND DIAGNOSTIC
ASSESSMENT
♦♦♦
IDENTIFYING SELFOBJECT
FUNCTIONS THROUGH
PSYCHOLOGICAL TESTING
This page intentionally left blank
SELF PSYCHOLOGY
AND DIAGNOSTIC
ASSESSMENT
♦♦♦
IDENTIFYING SELFOBJECT
FUNCTIONS THROUGH
PSYCHOLOGICAL TESTING

Marshall L. Silverstein
Long Island University

| J Routledge
cj Taylor &. Francis Group
www.routledgementalhealth.com
Copyright © 1999 by Lawrence Erlbaum Associates, Inc.
All rights reserved. No part of this book may be reproduced in
any form, by photostat, microfilm, retrieval system, or any other
means, without prior written permission of the publisher.

Reprinted 2009 by Routledge

Cover design by Kathryn Houghtaling Lacey

Cover art by Vladimir M. Pechanec

Library of Congress Cataloging-in-Publication Data

Self psychology and diagnostic assessment: identifying

selfobject functions through psychological testing / Marshall L.
Silverstein
p. cm.
Includes bibliographical references and indexes.
ISBN 0-8058-2280-1 (hardcover : alk. paper)

1. Self psychology. 2. Projective techniques. I. Title.

RC455.4.S42S55 1998 98-27593
616.89’075—dc21 CIP

10 9 8 7 6 5 4 3 2 1
 For my devoted parents,
Jack
(1891-1963 )
and Gertrude
(1915-1998 )
who, despite all odds,
provided the kernel fo r a resilient self
and fo r Marian Tolpin, M.D.,
who fortified it
This page intentionally left blank
 Contents

Preface ix

PART I: PSYCHOANALYTIC SELF PSYCHOLOGY

1 The Shift From Classical Drive Theory to Self 3
Psychology
2 Self Psychology: Major Concepts 20

3 The Central Role of Selfobject Functions 42

PART II: SELFOBJECT FUNCTIONS:

PSYCHODIAGNOSTIC INDICATIONS
4 Content Analysis of Psychodiagnostic Testing: A 65
Pathway to Understanding Self States
5 Clinical Indications of Self object Functions: 115
Mirroring
6 Clinical Indications of Selfobject Functions: 156
Idealization and Twinship
7 Ms. T.: Mirroring 192

8 Mr. L.: Idealization and Twinship 223

Postscript: Summary and Reflections 274

References 281

Author Index 289

Subject Index 293

vii
This page intentionally left blank
 Preface

A patient delivered projective test responses that included a Rorschach

percept of a well-made but faded shirt, a Thematic Apperception Test (TAT)
story about a depressed woman tied to her parents and unable to strike out
on her own, and a drawing of a person described as hunched over or
defeated. These responses suggested depression. Inquiry revealed that the
patient elaborated these responses by commenting that the shirt was thrown
away and that because the depressed woman could not make her mother
understand her dilemma, she gave up her aspirations and was too beaten
down to leave her parents. The patient also stated that because the hunched-
over figure was laughed at, the person hid in shame. Statements about
depression or even low self-esteem might be applied to this patient. But
such descriptions fail to go far enough.The responses richly depicted a
diminished and devitalized self. The patient felt depleted and unable to turn
to the world with confidence or pride. Such a person cannot expect others
to understand in sufficient depth these feelings of being underpowered or
to respond with some recognition that the person needs to be made to feel
intrinsically worthwhile.
Another patient produced Rorschach responses of “a high priestess
delivering a blessing to her subjects,” “the gods discussing humanity among
themselves,” and “a warrior from heaven dressed in full regalia.” On the
TAT, this patient described “a surreal representation of Noah’s ark and how
he saved the animals from destruction.” These responses seemed to convey
vigor through an emphasis on exalted states, vitality, and power until the
patient elaborated these images on inquiry by commenting that the warrior
was defective, the ark might be destroyed in a storm, and the gods discussing
humanity were impotent.
These two patterns represent self states of devitalization and their result­
ing self disorders, to use Heinz Kohut’s term to describe such conditions.
The first patient seemed unable to summon resources to effect a repair of
the self disorder and was prone to give up and wither. The second patient

ix
x PREFACE

revealed some degree of resilience, at least to the extent of hoping that

through idealization there was a chance to reinvigorate a depleted self.
Although the patient might have tried to establish a compensatory structure
as a pathway toward some restoration of a diminished self, however, the
attempt was unsuccessful. The initial appearance of grandiosity was only a
thin, defensive veneer exposed as such on a sufficiently probing inquiry,
and the patient’s responses concealed a self state just as injured and
devalued as that of the first patient.
This book is about understanding clinical material of this nature. I am
particularly concerned here with three problems: clinical identification of
the predominant psychological patterns (self states) such as the devitaliza­
tion or idealization shown in these two examples; patients’ attempts to
repair an injury to the self, to restore self-esteem by developing compensa­
tory structure (such as turning to a strong or vibrant source for idealization
when an underlying state of devitalization is prominent); and clinical
manifestations or sequelae of these disorders of the self (disintegration
products such as narcissistic rage and affect states such as empty depres­
sion or chronic boredom and lack of zest).
The preceding vignettes portray clinical phenomena of self disorders as
revealed on several projective tests, and the interpretations of these disor­
ders encapsulate some seminal contributions of Heinz Kohut’s psychology
of the self. The vignettes serve as a springboard for the conceptual and
technical discussion of psychoanalytic self psychology, particularly of the
selfobject functions of mirroring, idealization, and twinship.
This book attempts to meet two difficult and unpopular goals: first, to
provide a thorough, accurate, and sophisticated presentation of self
psychology; second, to demonstrate that interpreting content on projec­
tive psychological tests promotes a deep understanding of self states and
their resulting disorders.
My first goal, stating the views of self psychology, is difficult because
the material is not simple and easy to appreciate without the clinical
experience of working with patients in this framework. Self psychology
has sometimes been considered a theory of pathological narcissism, but it
is not. Self psychology has been misunderstood partly because narcissistic
personality and behavior disorders are definable (in the sense that they are
described in the Diagnostic and Statistical Manual o f Mental Disorders
[4th ed., DSM-IV]), whereas self disorders are not unfortunately clear-cut
and easily comprehended. Indeed, Kohut began his attempt to understand
self disorders as forms of narcissistic pathology more than 25 years ago
PREFACE xi

(Kohut, 1959, 1966, 1971), but his broadened and expanded views (1977,
1984) about the self and its disorders extended well beyond narcissism. The
inherent confusion of this situation makes the discussion of self psychology
unpopular because it can seem conceptually unclear despite being clinically
palpable and vivid.
My second goal, using content analysis of projective test findings to
characterize self states, is also difficult. Phenomenologic data are always
vague and do not lead to clearly agreed-on interpretations of clinical
meaning. The analysis of test content and sequence analysis is unpopular
at a time that psychologists rightfully expect and can achieve psychometric
sophistication. Some clinicians may find the study of content distasteful
because the results of this approach are unverifiable and therefore
logically unsupportable and may even appear scientifically regressive.
These practitioners of psychodiagnostic testing are satisfied with nothing
less than valid and reliable empirical scores and should expect nothing less.
Although content analysis cannot provide this degree of rigor, it is valuable
in a different way if clinicians follow the highest standards of logical inquiry
and practice careful, clinical inferential thinking.
I intend to combine the rich insights of self psychology with an honest
attempt to approach content analysis with restraint and logical rigor. I
strive to make the best use of suboptimal clinical material to reveal deep
levels of the painfully experienced affect states that Kohut’s psychology
of the self has managed to explain. My discussion of psychoanalytic self
psychology does not disappoint in its complete and often painstaking
accuracy about central concepts, including transmuting internalization,
compensatory structure, empathic understanding, and, of course, the
crucially significant selfobject functions. This book is not an “easy
read”; it sacrifices nothing of self psychology’s complexity and nuances.
Thus, the book is not everyone’s “cup of tea”; certainly it is not for the
faint of heart.

ORGANIZATION OF PARTS I AND II

One way of thinking about the convergence between the psychology of the
self and projective testing is by asking: What do patients convey through
projective test content about the self state, about its vitality or weakness
and its attempts to recover from injury? How do people use Rorschach
xii PREFACE

percepts, the characters described in TAT stories, and drawings of human

figures to convey feeling competent, whole, buoyant in contrast to feeling
brittle, undermined, devalued, and consequently unable to recover from
vulnerable states of disrepair? These basic questions I address in this book.
In Part I, I trace the development and major concepts of Kohut’s
psychology of the self, including his crystallized view about the central
role of a cohesive and buoyant self in achieving psychological well-be­
ing. Although Kohut’s views were originally firmly anchored in the
predominant drive theory and ego psychology of classical psychoanaly­
sis, I detail the evolution of his thinking beyond its representing an
extension of ego psychology in chapter 1. In chapters 2 and 3 , 1 discuss
the major concepts of self psychology; chapter 3, in particular, is devoted
entirely to the concept of selfobject functions.
The chapters of Part II contain clinical illustrations of projective test
content indicating self states and their associated selfobject functions. I
present self psychological interpretations alongside more familiar or
conventional ego psychological interpretations of these projective test
responses. The self psychological viewpoint, as formulated by Kohut,
offers a compelling basis for understanding projective test content. In
many cases, I argue that a self psychological view offers a more pheno-
menologically accurate picture of the personality than does a conven­
tional framework.
Chapter 4 provides a systematic, detailed review of the principal
approaches to content analysis in the clinical interpretation of projective
tests. I specifically advocate the content analysis approach to reveal
important aspects of the self, notably its cohesion or vulnerability and
mechanisms to repair self-esteem in the face of injury. The case for using
content analysis is based on principles first laid down by Rapaport and
Schafer. I apply it here to promote a clinically reasonable means to
augment empirical scores on psychodiagnostic tests that are otherwise
insufficient to describe self states such as devitalization or depletion.
After establishing this groundwork, I consider the convergence of self
psychology and content analysis in projective testing. I then demonstrate
the clinical and conceptual characteristics of mirroring (chap. 5) and
idealization and twinship (chap. 6) by providing ample illustrations of
projective test responses. These examples reflect the principal features
and subtleties of expression of these three major selfobject functions.
Chapters 7 and 8 contain complete projective test protocols of two
patients for further understanding a self psychological viewpoint.
PREFACE xiii

CONCEPTUAL AND CLINICAL OBJECTIVES

People have commonly revealed sentiments of shame and feelings of

diminished abilities and compromised self-worth through projective test
responses. These responses can include percepts such as faltering objects,
unflattering human figure drawings such as a hobo, or TAT stories about
characters feeling incompetent. Many patients can more easily make up a
story about a failure than talk about similar feeling states in themselves
during a clinical interview. When a major depressive episode or dysthymic
disorder is acute and feelings of worthlessness predominate, such affect
states are to be expected and are common, but in many other clinical
conditions, diminished self-esteem is not typically experienced close to the
surface. Clinicians may therefore miss the self state altogether, particu­
larly if a patient manifests a superficial bravado or defensive minimiza­
tion of a self disorder.
Although self-esteem is certainly an important characteristic of the
sense of the self and self-depreciation is a frequent consequence of a self
disorder, a more crucial consideration involved in a psychological under­
standing of the self is its resilience. Resilience usually appears in people’s
capacity to repair injuries on their own or, more typically, to turn to another
in expectation of appropriate, empathic responsiveness for help with
revitalizing the self. Injuries and rebuffs occur frequently in life and
become less devastating when not too recurrent, intense, or traumatic.
More important than the severity of the injury for an understanding of the
self is the capacity of an accurately responsive environment to take note
that an injury has occurred.
Kohut regarded this capacity as the most crucial characteristic of selfob­
ject functions. Such optimal responsiveness promotes a self’s sustaining
or restorative capacity to be invigorated, robust, and cohesive. Narcissistic
injuries in and of themselves are not necessarily pathogenic, but selfobject
failures in an already compromised or vulnerable self state produce either
a narcissistic personality disorder or a narcissistic behavior disorder. Mild
disturbances can appear as subclinical disruptions of self-esteem interfer­
ing with the vitality that supports a person’s ability to reconstitute. This
quality of resilience is the measure of self-cohesion.
As it is in the clinical histoiy, so it is in the analysis of diagnostic testing
material: Somewhere in the test protocols is a representation of the pa­
tient’s attempt to bring about what he or she needs to repair an undermined
xiv PREFACE

self state. A Rorschach response of an injured butterfly incapable of flying,

a wilted flower, a carcass left to decay in the hot sun, or a similar percept
describes the self state as less than optimally intact or vigorous. Equally
important, such responses that typically receive morbid codes as special
scores guide the search throughout the remainder of the test protocol for the
restorative selfobject function needed to repair this devitalized self. From
the standpoint of psychodiagnostic testing, a person’s response of a decay­
ing leaf, for example, may not be important by itself. What may be more
crucial is the person’s ability to respond next, on either the same Rorschach
card or the following one, in a manner that does not continue the theme of
devitalization. Being able to “bounce back” from the injured self state
indicates some degree of resilience of the self.
Among the most typical examples of disturbances representing impaired
cohesiveness of the self, the psychodiagnostic testing manifestations of
depleted energy, emptiness, and devitalization are the most readily elicited.
Thus, for example, test responses with references to something broken, split
open, lacking power or strength, looking drab or ragged, or appearing dirty,
mention of a skeleton or of something beautiful but obscured by junk are
typical manifestations of this aspect of human experience. Many morbid
Rorschach percepts convey the unique quality of a devitalized self state.
Thus, responses with morbid contents such as an object bleeding or left to
die or decay, something old or rotting away, or a faded object (such as a
photograph, leaf, or even a person) are good examples of this phenomenon.
All or even most morbid percepts on the Rorschach test are not by definition
aspects of compromised self-esteem, but a clinician can empathically grasp
a great many responses of this type from the standpoint of an unmirrored
self as described by Kohut. Thus, it is useful to consider a self psychological
interpretation to enhance the clinical meaning or relevance of such percepts.
Particular projective test responses may also suggest the disintegration
products that characterize many self disorders, such as perversions, addic­
tions, or overt fragmentation phenomena. Disintegration products, repre­
senting desperate attempts to sustain self-esteem in the face of threatened
loss of self-regulating structures, can be represented by responses indicating
states of an incapacity to experience an object or person as solid or tangible
or a breakdown of firm boundaries. Imagery from the TAT and figure
drawings may also characterize a self state of appreciable distress, a state
that fails to hold its own or is incapable of restoring corrective functions.
Examples can include stories of people unable to hold themselves up or
experiencing devastating loss from which they do not recover, and drawings
PREFACE xv

of a person, tree, or house in midair without grounding or roots or blown

apart by the elements. Such imagery is also characteristic of psychotic or
psychosis-prone states, borderline personality disorders, or transient frag­
mentation phenomena. Comorbid psychopathology or other theoretical
views about the primary disturbance do not, however, preclude the role of
a vulnerable self in disrepair. The self state and its selfobject needs are
important influences on severe as well as on nonpsychotic conditions.
Restorative selfobject functions do not necessarily appear in the response
proper, such as those previously noted. More typically, what is needed to
repair the devalued self emerges from elaborations of the central response.
Thus, it is important for clinicians to unobtrusively elicit verbalizations that
extend the primary response, such as an injured bird needing someone to attend
to its broken wing or a wilted flower waiting to be watered. Sometimes, these
indications do not immediately follow the response suggesting an undermined
self state but occur later during the test or on another test. Often there may be
no indication about the self state on a popular projective test, such as the
Rorschach, but the particular “pull” or character of an instrument like the TAT
or figure drawings may be more revealing. For example, a person may tell a
story about the young man on Card 7BM of the TAT as distressed over a
disappointment and turning to confide in the older man. The person may
describe this latter figure as listening attentively (mirroring selfobject func­
tion) or offering advice that the younger man eagerly accepts from admira­
tion for the older man (idealization) or from a desire to be exactly like the older
man in his resolution of the problem (twinship).
On occasion, clinicians can distinguish the projective test content of
somewhat better compensated patients in overabstract, distanced, or philo­
sophically detached responses, which include obsessional preoccupations
with ideas or depersonalized images of great figures that are mythical or
from the distant past. Other examples are mystical, abstract, human-like
content, typically coded (H) or (Hd) in Exner’s (1993) Comprehensive
System, such as “Valkyries images” or, on figure drawings, “a woman from
the Elizabethan court.” Examples like these may represent attempts to
establish a connection or bond with an idealized mythic figure; such
responses are frequently preceded or followed by responses signifying
injury or devaluation. Responses about grand or powerful images also
demonstrate the unique role of psychodiagnostic tests for identifying com­
pensatory structure, one of the less well-known concepts of the psychology
of the self.
xvi PREFACE

ACKNOWLEDGMENTS
I have chosen to discuss only the classical version of self psychology
associated with Heinz Kohut. This version is both sufficiently encompass­
ing and difficult to comprehend that a discussion of other outgrowths of self
psychology (such as intersubjectivity) only diffuses my primary objective.
Although I never knew or studied with Kohut, his views have substantially
infused my own clinical practice and my thinking for more than 25 years.
In preparing this book, I have benefitted from the helpful comments of
many colleagues, most of whom are at the Chicago Institute for Psycho­
analysis, Michael Reese Medical Center, and Long Island University. The
preparation of this book was facilitated by a sabbatical leave from Long
Island University and by a grant from the C. W. Post Research Committee
of Long Island University. Irving Weiner, Susan Milmoe, Nadine Simms,
and the production staff of Lawrence Erlbaum Associates provided steady
guidance and clarity during the production stage. I am particularly grateful
to Joanne Marengo, Michael Simon, and Marian Tolpin, for reading several
drafts of the manuscript and for their enduring support of this effort.
I trust that my thinking about psychological testing will enrich the
ongoing study of the psychology of the self, and I also believe that the
contributions of self psychology will foster a deepening understanding of
personality as revealed through psychodiagnostic testing.
 Parti
Psychoanalytic Self Psychology
This page intentionally left blank
 1 The Shift From Classical Drive
Theory To Self Psychology

In the introduction to the final installment of The Search fo r the Self \ the
definitive collection of Heinz Kohut’s papers and letters, Omstein (1990)
succinctly captured one of Kohut’s principal contributions. He wrote: “Ko-
hut maintained from early on that there were areas of human experience that
could not be adequately explored with the aid of drive psychology and ego
psychology and considered this fact as one of the most compelling reasons
for introducing self psychology” (p. 9).
In this statement, Omstein conveyed that self psychology had evolved to
become a theory in its own right, one that was more than an expansion or
development of classical drive theory. Nevertheless, it is difficult to think of
another conceptual system in psychoanalysis that is as incompletely under­
stood as is the psychology of the self. Nevertheless, self psychology has
achieved a position of importance despite criticisms of its most central
features. This chapter and the two chapters that follow outline the progres­
sion of self psychology.
In the present chapter, I describe the development of Kohut’s thinking,
beginning with his initial formulations about narcissism and the clinical
phenomena that gave rise to his ideas about the selfobject functions of
mirroring, idealization, and twinship. In Chapter 2 ,1 discuss Kohut’s formu­
lations of the crucial concepts of empathy, compensatory structure, and
transmuting internalization. Chapter 2 also includes Kohut’s reformulated
understanding of dreams and the oedipal situation and his attempt to define
the self and its properties as a mental structure. Finally, the third and final
chapter on the central principles of self psychology is entirely devoted to a
comprehensive description of the selfobject functions, which represent the
conceptual anchor for the self psychological approach to diagnostic psycho­
logical testing, the chief focus of the remainder of this book.
THEORETICAL ORIGINS OF SELF PSYCHOLOGY
In his initial formulation of narcissism, a formulation that he subsequently
developed into an expanded psychology of the self by 1977, Kohut (1971)
3
4 CHAPTER 1

viewed his ideas as an extension of the predominant drive (id) and ego
psychology of the day. This view was particularly prominent in his earliest
writings on narcissism, beginning in 1966 and culminating in The Analysis
o f the Self (1911). The 1971 book was Kohut’s first comprehensive state­
ment about the analytic understanding and treatment of narcissistic person­
ality and behavior disorders although Kohut’s important 1959 paper on the
empathic-introspective method of obtaining analytic data and on their
clinical understanding foreshadowed the book.
In several respects, the impetus for Kohut’s views came from shortcom­
ings in classical analytic treatment, which Kohut believed was limited in
its ability to reach major areas of patients’ distress and internal experience.
(Ornstein’s [1990] statement, quoted previously, addressed exactly this
point.) Kohut thus discovered that an enfeebled self needed to be acknow­
ledged or responded to in a way that was more accepting of people’s
discomfort and that did not leave patients feeling undermined by analytic
treatment, including analysts’ interpretations that patients perceived as
assaults or criticisms.
Kohut (1977) believed that although clinical improvement occurred, at
least from the patients’ viewpoint, many people often felt unfulfilled or
dissatisfied with their lives so that some aspects of the experience of the
self were left essentially untouched. His well-known paper The Two
Analyses of Mr. Z (1979) is an excellent illustration of exactly this problem.
In this paper, Kohut described in detail the outcome of an analysis, con­
ducted in a traditional manner, followed 5 years later by a second period
of analysis informed by a self psychological viewpoint. Despite an other­
wise successful treatment that produced substantial amelioration of symp­
toms, Kohut maintained that the first analysis could not have produced the
results that the second analysis had.
Kohut’s (1971) early thinking about the self emphasized clinical
description of narcissistic personality disorders and the ways that psy­
choanalysts treated these conditions. The description of the transferences
that emerged in treating such patients became the centerpiece of Kohut’s
attempt to understand this form of psychopathology. His theorizing
extended the idea of separate lines of development from classical drive
theory to include a developmental line for the self based on his new view
of narcissism. Kohut saw his views as a natural extension of drive theory,
an “adjacent territory” as Ornstein (1978, p. 98) put it, rather than a
variant of the object relations schools.
SHIFT FROM DRIVE THEORY TO SELF PSYCHOLOGY 5

Kohut maintained this position throughout his career, although he

substantially broadened his views about the differences between self
psychology and ego psychology. As he increasingly came to realize, his
contributions came into focus as an independent theoretical system,
often at variance with some of the central tenets of mainstream psycho­
analysis. Kohut recognized the inevitability of his views’ standing apart
from drive theory formulations, notably that of the oedipal conflict.
Other therapeutic advances, such as that pioneered by Melanie Klein
(1935/1975), laid the groundwork for contemporary British object rela­
tions theory. Kohut considered, however, that using these theories did not
help analysts to effectively mobilize patients’ needs for self-cohesion or
self-esteem. In his view of the self, people crucially needed an empathically
attuned responsiveness to provide the basis for feeling psychologically
invigorated and energetic. Whereas Kohut considered Klein’s emphasis on
aggression as extreme (“Klein’s essential attitude is that the baby is e v il...
a powder keg of envy, rage, and destructiveness” [Kohut, 1996, p. 104]), he
preferred to think of aggression as an understandable reaction to unrespon-
ded-to “rightfully expressed wishes” (Kohut, 1996, p. 104).
One criticism of self psychology has been that Kohut failed to account
sufficiently for the clinical and theoretical importance of aggression. This
criticism is related to another—that Kohut ignored the viewpoints of major
object relations theorists such as Fairbaim (1941), Balint (1968), and
Winnicott (1953). Kohut dissociated his views from object relations theo­
ries, as well as from Mahler’s (1968) and Bowlby’s (1969) work, not
because he ignored these theorists’ work but rather because his own views
were at a variance with the object relations and instinctual drive emphases
of some of these theories, including their views about aggression.
According to Kohut’s view of how self-cohesion is interrupted, ego
psychology could not sufficiently account for a weakened or unresponded-
to self. Kohut (1977,1984) came to believe with increasing conviction that
analysts who emphasized drives had only limited success in treating
disorders of the self. Because Kohut regarded drives as secondary to a
fundamental disturbance of cohesion of the self, his view was that injury to
the self was more crucial than were libidinal or aggressive impulses. Kohut
departed from the structural theory formulation of the drive (impulse) that
produced anxiety, which then gave rise to defenses resulting in symptom
formation. Instead, he considered disruptions of self-cohesion and dimin­
ished self-esteem as the primary psychopathology, which appears clinically
6 CHAPTER 1

in disorders of the self. He saw ego deficits or weaknesses as defensive

reactions to destabilization of self-cohesion (Kohut, 1977, p. 74).
In Kohut’s view, the self disorders resulted from chronic or pronounced
failures to respond to a person’s need for mirroring or idealization. These
failures predisposed people to depression, anxiety, rage reactions, and a
variety of behavior disorders that attempt to relieve intolerable tension
states associated with compromised self-cohesion. In this interpretation of
symptom formation, the threat to the cohesiveness of the self, not unaccept­
able drive states or impulses, is the fundamental core of psychopathology.
Kohut began with the problem of analytically treating people with
disorders that did not respond well to interpretations based on standard
theoretical principles. He referred to such conditions as narcissistic
personality disorders and the narcissistic behavior disorders. He de­
scribed two transference patterns, mirroring and idealization, which
originated from different sectors of the self, the grandiose-exhibitionistic
and the idealized parent imago poles (the bipolar self). This view
permitted a comprehensive clinical understanding of the psychopathol­
ogy on the basis of his new understanding of these narcissistic distur­
bances. From this formulation, Kohut (1971) established a basis of
therapeutic action for disorders of the self.
Kohut’s psychology of the self continued to develop beyond the scope
of narcissistic pathology; Kohut first set forth this enlarged view in The
Restoration o f the Self (1977) and crystallized it in How Does Analysis
Cure? (1984). Self psychology came to constitute, in Omstein’s (1990)
phrase, “a new continent.” Kohut himself wrote in the 1984 book:

Self psychology is now attempting to demonstrate, for example, that all

forms of psychopathology are based either on defects in the structure of
the self, on distortions of the self, or on weakness of the self.
... Self psychology holds that pathogenic conflicts in the object-instinctual
realm—that is, pathogenic conflicts in the realm of object love and object
hate and in particular the set of conflicts called the Oedipus complex—are
not the primary cause of psychopathology but its result, (p. 53)

Kohut understood that oedipal dynamics could masquerade as distur­

bances of a self state. He was careful not to confine his understanding of
clinical observations to one or the other position in isolation. Kohut stressed
the importance of careful listening to the appearance of oscillations in
clinical material. Thus, he commented in a lecture:
SHIFT FROM DRIVE THEORY TO SELF PSYCHOLOGY 7

The more one knows, the more you have a grasp of the totality of the life
histories and of the basic disturbance in the personality, the more you will
be able, with a variety of configurations in your mind, to watch and see
and find out what area the pathology finally falls into. All these variants do
occur. If I have contributed something to analysis, it is not just to have
replaced one conceptual thing with another... .Such individuals do some­
times secondarily retreat from these oedipal positions into narcissistic
vulnerability. That is perfectly true. But the secondary narcissistic vulner­
abilities or the secondary oral dependency attitudes you see in some
individuals are a defense against the deeper going, more deeply situated
anxieties of the oedipal period. (Kohut, 1996, pp. 118-119)

In reference to development, Kohut did not argue against the presence

of in-phase drives to assert oral, anal, or phallic-oedipal wishes or urges.
He did consider these drives as secondary, however, to mothers’ re­
sponses to these stages in development. For example, mothers might
welcome and encourage or display out-of-step rejection or unawareness
of their children during the various stages of psychological development.
Mothers might show a depressive incapacity to respond encouragingly
to such steps and might display outright thwarting of children’s expres­
sions of autonomy and accomplishment. Rage reactions to these and
similar kinds of empathic unattunement did not represent, therefore,
primary aggressive or hostile wishes. Instead, rage or withdrawal or
devitalization-depletion reactions by children reflected disappointment
over mothers’ faulty, unempathic responsiveness. This situation pro­
vides a good illustration of selfobject failure.
In Kohut’s view, children at each developmental stage endeavored to
“show their stuff’ and sought to produce a “gleam” in their mothers’ eye.
Normal children seem to say “look at me” or “look at what I can do”; they
act in ways that seek only to be regarded as lovable, worthwhile, or
competent. It is a normal expectation that mothers respond in keeping with
their children’s needs. It is also normal that children respond with anger
when their legitimate needs go unmet, in the same way that it is normal for
children to feel injured when told that healthy urges are unwelcome or
should be inhibited.
Referring to the remobilization of drive derivatives in transference,
Kohut said:

The patient’s rage is not the manifestation of aggressions directed out­

ward against the analyst who by his correct interpretations seems to be on
8 CHAPTER 1

the side of the dangerous drives and has to be defended against. The
patient’s rage is “narcissistic rage.”
... Concretely speaking, whenever a patient reacts with rage to the
analyst’s interpretations, he has experienced him, from the point of view
of the archaic self that has been activated in analysis, as a nonempathic
attacker of the integrity of the self. The analyst does not witness the
emergence of a primary primitive-aggressive drive, he witnesses the
disintegration of the preceding primary configuration, the breakup of the
primary self-experience in which, in the child’s perception, the child and
the empathic self-object are one. (Kohut, 1977, pp. 90, 91)

It is not difficult to see that this view represents a significant reformula­

tion of the childhood experiences crucial for sustaining a vigorous and
cohesive self. Self psychologically informed analysts or psychotherapists
attempt to understand that there has been an injury to the self and then to
explain this circumstance to their patients. This understanding also influ­
ences techniques of interpretation. It is one thing to tell patients that they
are angry; it is something else to explain to patients that they are angry
because a need has been misunderstood. Treatment proceeds more effica­
ciously if therapists do not interpret patients’ wishes as defensive deriva­
tives of infantile drives that should be abandoned or rechanneled.
Kohut also believed that patients perceived the excessive reserve or
underresponsiveness of traditional analysis, based on preventing contami­
nation of transference, as unempathic unless tempered with “emotional
undertones and overtones, which, arising from the depths of the analyst’s
psyche, make themselves heard despite the analyst’s conscious theoretical
convictions” (Kohut, 1977, p. 258). Treatment, however, need not neces­
sarily be amicable or friendly, although casual observers may sometimes
misinterpret treatment in this way. On the importance of empathy, Kohut
maintained that “man can no more survive psychologically in a psychologi­
cal milieu that does not respond empathically to him, than he can survive
physically in an atmosphere that contains no oxygen” (Kohut, 1977, p. 253).
One consequence of therapists’ customary reserved stance is the remo­
bilization of patients’ disappointment, rage, or withdrawal in the face of
what they frequently perceive as unempathic responsiveness. This experi­
ence can re-expose patients to the very conditions that produced the prob­
lems for which they sought help in the first place. Such a reaction can be
particularly pronounced in patients who experienced a chronically under-
responsive or understimulating parental environment. Thus, an overly
reserved therapeutic stance can iatrogenically provoke rage or withdrawal
SHIFT FROM DRIVE THEORY TO SELF PSYCHOLOGY 9

reactions. If these reactions are incorrectly interpreted as manifestations

of drive derivatives, patients can continue to feel misunderstood, and
treatment is often undermined. It was Kohut’s impression that therapists
whose treatment approach was influenced by a conflict-defense model
only imperfectly understood pathological self-esteem and the causes of the
self disorder. Thus, they rarely interpreted this disorder to therapeutic
advantage.

SELF PSYCHOLOGY:
EARLY CLINICAL CONSIDERATIONS

Selfobject Functions and Mirroring

Kohut’s (1971) reformulations took shape in his attempts to understand
why conventional transference interpretations seemed to be particularly
inappropriate for several of his patients. He reported the analysis of a female
patient, Miss F., who maintained a long period of intensely angry refusal to
hear anything other than a repetition of her own statements about herself.
Treatment centered on interpreting unyielding resistances. Eventually, Ko­
hut reconsidered the transference meaning of his function for this patient
and decided that he had become an impersonal function rather than an
object of love and hate in her transference.
In modifying his understanding of the genetics of her anger, Kohut could
explain to his patient how her re-enactment with him revived an attempt to
cope with an unresponsive, depressed mother. Thus, Kohut discovered that
her stubborn resistance was not fundamentally a negative therapeutic reac­
tion or a defense. Instead, he reconceptualized what at first appeared to
resemble a defense as an attempt to obtain an echoing or approving response
from the analyst. Genetically, this attempt represented a transference revival
of parental failure to respond to the patient’s desire to simply be heard or
listened to. This function of being attentive as an echoing presence, of
affirming and admiring, is what people need to sustain a cohesive self. It is
the mirroring selfobject function; its mobilization in treatment becomes the
mirroring transference (described in greater detail in chap. 3).
Kohut realized that many patients’ internal experiences of the self and
the ensuing self-esteem problems that these gave rise to were not understood
accurately or in depth in traditional analytic or psychodynamic treatment.
Unable to effect a genuine therapeutic result in patients like Miss F., Kohut
10 CHAPTER 1

realized that the principal reason for treatment failure resulted from misin­
terpreting mirroring by using a conceptual framework based on regressions
from oedipal conflicts and libidinal and aggressive drives. He discovered
that a revival of mirroring in treatment fulfilled the usual criteria for a
genuine transference: inappropriateness to the ongoing work, its function
as a resistance, and its genetic basis. Accordingly, Kohut believed that
mirroring represented a transference reaction that could be analyzed with­
out modifying standard technique. The meaning of the transference reac­
tion, of course, had to be broadened to include a mirroring need rather than
what was formerly considered a transference revival of libidinal or aggres­
sive wishes.
From clinical material such as his work with Miss F. and his observa­
tions in other analyses, Kohut formulated the concept of the selfobject
function. The transference represented the way that selfobject functions
appear clinically; thus, he proposed the term self object transference. An
analyst or psychotherapist had to perform a particular function for the
patient’s weakened self that could not carry out this function. The selfobject
function is first and foremost a mental representation of what the under­
mined self requires to restore optimal functioning. This function is per­
ceived and responded to as a needed or vital extension of the patient. One
important feature of the selfobject, therefore, is its restorative nature: It
exists for repairing devalued or injured self-esteem. The selfobject can refer
to the person who serves or fulfills the function, and it is usually experienced
in reference to another person. The person who provides the needed
self-reparative function is not the selfobject, however, this person embodies
the selfobject function. People do not experience the selfobject as having
its own center of initiative with its own wishes and needs and they do not
react to it as an object of love or hate.
A selfobject transference may be detected in experiences such as an
analyst’s or therapist’s sense that there is only one person in the room. In
this experience, a therapist’s presence is felt to be mostly incidental to a
vulnerable patient’s need for someone to be there listening. The therapist is
not experienced primarily as a person with his or her own needs; he or she
does not really matter much beyond affirming some vitally needed function
to buoy up or vitalize the patient who experiences vulnerable self-cohesion.
The patient is not, however, oblivious to the analyst’s existence. Indeed,
quite the reverse: Intense affects often surround the therapist’s lapses or
absence. The need is clearly present, but it is not reciprocal; it goes in just
one direction. It is similar to casual or everyday experiences in which two
SHIFT FROM DRIVE THEORY TO SELF PSYCHOLOGY 11

people converse, and one person feels incidental or irrelevant beyond the
other’s need for a responsive, listening presence. The interaction is one
sided and unreciprocated: One person exists not in his or her own right, but
only insofar as the other person needs him or her.
If this description resembles the conventional definition of selfishness
or feeling “used,” it is merely coincidental. Selfobject functions rarely
represent self-preoccupation or self-aggrandizement. The appearance of
selfishness or neglect of another’s needs or feelings may accompany but
does not define what is fundamentally a need for the other person to shore
up a deeply felt disturbance of self-esteem or self-cohesion.
As conceptualized metapsychologically, selfobject transferences are dif­
ferentiated from classical transference neuroses in that the selfobject is not
cathected with object libido. Kohut (1971) regarded narcissism as a separate
line of development in contrast to that of object love. It should be remem­
bered that Kohut’s (1971) original work emphasized selfobject functions to
explain narcissistic pathology. With the extension of his discovery of the
narcissistic transferences to encompass the structural neuroses as well,
Kohut (1977, 1984) subsequently preferred the concept of selfobject trans­
ferences or functions over that of narcissistic transferences.
It is important to avoid confusing the concept of narcissistic transfer­
ences or selfobject functions with egocentricity or with the Egocentricity
Index from the Comprehensive System for the Rorschach (Exner, 1993).
The meaning of self-focusing or self-preoccupation for Exner’s index is
neutral with respect to selfobject needs or functions, in the same way that
it is neutral for general psychological traits of selfishness or grandiosity.

Idealization
The second major selfobject function that Kohut identified was the ideal­
izing transference. In an early case, Kohut (1968, 1971) reported the treat­
ment of a patient, Mr. A., who turned repeatedly to older men or senior male
colleagues for signs of approval and praise for his work. This praise was
necessary for Mr. A. to feel capable and whole, and his search for approval
was re-enacted in the transference.
Although the patient sought treatment because of disturbing homosexual
preoccupations, these were thought of as secondary. Fundamentally, the
patient turned to men for a feeling of invigorated self-esteem. This behavior
had apparently met with welcoming acceptance by Mr. A.’s father, and it
was revived in the transference as well. Mr. A. had however experienced
12 CHAPTER 1

disappointment when circumstances in his father’s life failed to support

the patient’s idealization of the father. This experience left him prone to
depression and rage. In the transference, prolonged periods of haughty
isolation were precipitated by feelings of disapproval or of being insuf­
ficiently understood. At such times, it was difficult for Mr. A. to work
effectively.
In another example, Kohut (1971) described his work with another
analyst engaged in treating a patient. During a brief period in the analysis
of the woman, Miss L., she experienced being flooded by intensely felt
tension states early in treatment. At this time, she also reported dreams
about an idealized priest whom she had known during her adolescence.
Although it was too soon to understand her potential for fragmentation at
this early stage, the analyst commented to Miss L., in reference to one of
her dreams, that he was not himself Catholic. His reason for this revelation
had to do with the patient’s tenuous reality testing at that point. The
analysis was at an impasse for 2 years, at which point the analyst
consulted with Kohut about Miss L.
In the course of the consultation, and in light of other evidence, it
became clear that, at the early stage of treatment, the analyst had not
recognized that the dream signified the patient’s need to revive an
idealizing selfobject transference. The analyst had inadvertently failed
to see the dream as a wish to bring forward the patient’s need for a figure
toward whom she could again feel awe and admiration. The patient
subsequently understood the analyst’s failure as a rebuff of her initial
and tentative transference step representing her wish to revive an ideal­
ized good and healthy version of herself.
Instead, she submerged the idealizing transference, and treatment was
essentially at a stalemate for some time. Not until the patient’s idealizing
selfobject need was recognized and understood analytically could treat­
ment proceed. Ornstein (1978) elaborated further on the consequences
of misunderstanding budding attempts at idealizations as reaction for­
mations against hostile impulses and noted that blocked analyses lead­
ing to stalemates were an inevitable result of this error.
Kohut (1971, 1984) also believed that attempts to prematurely inter­
pret idealization only inhibited the full emergence of these needs, par­
ticularly early in treatment. Consequently, the need for idealization
remained unanalyzed and misunderstood, a situation predisposing to
lingering, diffuse feelings of dissatisfaction or lack of zest even in an
otherwise successful treatment.
SHIFT FROM DRIVE THEORY TO SELF PSYCHOLOGY 13

Another example of an idealizing selfobject transference illustrates what

happens when the person to whom the patient turns for idealization is
psychologically incapable of providing this function. The patient, Mr. K.,
expressed strong admiration toward the analyst, a reaction repeating an
intensely felt admiration of his father (Kohut, 1971). The patient had turned
to the father when his mother withdrew from him at age 3 after the birth of
his brother. The father had apparently been unable to comfortably accept
this idealizing need; he rejected the boy’s admiring overtures and belittled
and criticized the boy’s attempts to attach himself to him.
Mr. K. reattempted to repair this injury to his self-esteem at the hands
of his father by turning again to the mother through athletic accomplish­
ments, which his mother had previously fostered. Thus, shifts can and do
occur in the unfolding of these transference patterns: A renewed intensifi­
cation of the grandiose-exhibitionistic self can occur after a traumatic
interference with attempts at establishing an idealizing parent imago sel­
fobject function. Kohut regarded this development as a secondary mirror
transference and thought it best understood as a protective measure to guard
against potential injury to self-esteem when the central idealizing transfer­
ence becomes mobilized. This development also demonstrates oscillations
between mirroring and idealization when a redirection of idealizing wishes
goes unrecognized or is ignored.

CLASSICAL TRANSFERENCES
AND SELFOBJECT TRANSFERENCES

In the development of the psychology of the self, transferences were

generally thought of as selfobject functions (Kohut, 1977,1984). (In chap.
3 , 1 describe in greater detail the central characteristics of mirroring and
idealization.) These transferences represented the central features of Ko­
hut’s (1971) understanding of narcissistic personality and behavior disor­
ders. Later, Kohut (1984) proposed that a particular subtype of the mirroring
transference, twinship, was more correctly differentiated out of mirroring.
He considered twinship as a third predominant constellation in its own right.
(I also describe twinship in greater detail in chap. 3.) These mirroring and
twinship selfobject patterns, together with idealization, may be differen­
tially predominant at particular phases of treatment. Kohut believed that the
transference representing the most urgent selfobject need emerges earliest
14 CHAPTER 1

in treatment, although he did not presume that one selfobject function was
more primitive or archaic than another.
Kohut developed his formulations of self psychology by attempting to
analyze patients who were characteristically difficult to treat, but he came
to believe that his theoretical views could be applied just as readily to
treating the usual patients who sought analysis or psychotherapy. According
to this point of view, therapists could also clinically understand patients
with a structural neurosis and could treat them according to the principal
concepts of self psychology. Therefore, Kohut’s formulations about selfob­
ject functions could be applied to equal or superior advantage in patients
with no prominent developmental arrests or propensity for regression and
with the capacity for object love.
The cohesiveness of the self is the crucial clinical problem in the
differential diagnosis of narcissistic disorders (currently usually referred to
as self disorders) and structural (oedipal) neuroses or borderline disorders.
The issue of evaluating the robustness (cohesion) of the self as a mental
structure entails more than simply distinguishing prominent clinical char­
acteristics such as diminished enthusiasm or zest (Goldberg, 1978). Self­
cohesion is judged or assessed by the stability of the self in the face of
regression. Clinical manifestations are important considerations in this
determination, including the degree of devitalization or emptiness, the
presence of perverse activities and addictions, and the severity of transient
fragmentation states (M. Tolpin, 1978). It is the evaluation of cohesiveness
that remains central.
For example, dependency in the transference can mean something other
than oral longings or fear of object loss. It can represent reliance on a
selfobject to sustain self-cohesion. The patients whom Kohut originally
studied and treated, those with narcissistic personality disorders and nar­
cissistic behavior disorders, were markedly dependent on the analyst’s
responsiveness or presence despite high levels of functioning. Such patients
appeared independent in many external aspects of their lives, however. A
clinging quality to their dependency was either absent or not prominent.
These patients were prone to react with rage, subsyndromal depression, or
sometimes haughty or cold withdrawal occasioned by even minor em-
pathic failures. Their sensitivity to feeling slighted extended to interrup­
tions of appointment or vacation schedules as well as to the therapist’s
imperfect memory for details about the patient’s life. Kohut saw these
patients as different in kind from those with dependency-passivity as
conceptualized in drive theory or ego psychology.
SHIFT FROM DRIVE THEORY TO SELF PSYCHOLOGY 15

Differential Diagnosis
The clinical appearance of severe self disorders can be indistinguishable
from that of borderline disorders or psychotic presentations. Kohut’s deci­
sive test was observing a patient’s reaction to the therapist’s preliminary or
trial interpretations of defenses (Goldberg, 1978). Either the emergence of
oedipal material, for example, or self-protective measures to rescue an
injured self from fragmentation or regression normally decided the issue.
Verbalizations are diagnostically noncontributory; a self disorder can
readily be mistaken on the surface for what appears to be a phallic-oedipal
conflict when a therapist assumes one-to-one correspondence between
verbal contents and specific meanings. On interview, a therapist can catalog
descriptions of symptoms much as Kemberg (1975) did for borderline
pathology. Kohut (1971), however, preferred to wait for the decisive trans­
ference configuration to emerge clearly and thus to minimize unreliable or
premature diagnostic closure. The same caution applies to interpreting
surface contents of projective test responses, particularly when the inquiry
was too conservative or insufficient. For example, on the Rorschach, a
percept of blood sometimes represents rage, sometimes guilt, and at other
times devitalization of the self. Only a larger context extending beyond the
level of specific or discrete responses ultimately settles the issue.
Goldberg (1978) also cautioned against premature decisions about trans­
ference interpretations because a patient can perceive incorrect appraisals
of the nature of the transference made too early as narcissistic injuries. The
patient may then conceal the true selfobject transference. This reaction
intensifies defenses iatrogenically and sometimes gives rise to sexualiza-
tions or other extemalizations outside the treatment proper. The early
appearance of a mirroring transference can also quickly give way to a
predominant idealizing transference—another reason to view early trans­
ference manifestations as tentative or preliminary. Therapists must wait for
the central transference pattern to become established and should offer
minimal interference.
This point is also pertinent in reference to the use of diagnostic psycho­
logical testing to identify selfobject functions. Because several selfobject
needs can often appear, examiners must consider the total protocol to
determine the predominant pattern without forgetting that multiple selfob­
ject functions are frequently present in many patients. For example, a
helmet percept on the Rorschach can suggest a vigorous self seeking
admiring, mirroring selfobject responsiveness. Alternatively, the helmet
16 CHAPTER 1

can represent an idealizing longing or a devitalized self seeking protection.

Naturally, examiners must carefully study the full protocol to best resolve
this type of diagnostic decision.

Specifying Selfobject Functions

In addition to the main selfobject functions of mirroring, idealization,
and twinship, Kohut and Wolf (1978) and Wolf (1988) described other
clinical forms of self disorders, including merger-hungry and contact-
shunning personalities. Lachmann (1986) contributed the adversarial
type, and all of these were added to the mirror-hungry, ideal-hungry, and
alter-ego personalities that were already somewhat familiar from Ko­
hut’s previous writings. Kohut (1984) derived the alter-ego personality
from his impression that the twinship or alter-ego function was properly a
separate and distinct selfobject function bridging mirroring and idealiza­
tion, rather than a subtype of mirroring.
Kohut perhaps had some reservations about categorizing or subtyping
the selfobject functions in a way corresponding to these new personality
types, which also included Wolf’s (1988) further categorization of syn­
dromes of self disorders that he described as overstimulated, understimu­
lated, fragmenting, and overburdened. Kohut believed that these
syndromes had heuristic value, much as Abraham’s (1921/1927) descrip­
tions of oral and anal characters had to an earlier generation of psycho­
analytic theorists. Kohut and Wolf (1978) and Kohut (1984), however,
expressed concern about the potential for oversimplifying by devising
convenient categories or typologies that might, in the end, only impede
scientific progress.
Nevertheless, although the eventual status of merger-hungry, contact-
shunning, and adversarial personalities remains to be determined, Kohut
did not want his final statements to close off further inquiry in the
evolving psychology of the self. Goldberg (1988) also stressed this point.
Kohut was clearly mindful of the problems arising from the disputes
among Freud’s most fervent defenders and others who also wished to
further the development of psychoanalytic theory, but sometimes in
different directions. Particularly with reference to delineating selfobject
functions, Kohut (1984) allowed for additional possibilities beyond his
own contributions. He regarded his collaborative work with Wolf as one
good example of a useful heuristic direction, although he did not neces­
sarily consider this work as a final statement.
SHIFT FROM DRIVE THEORY TO SELF PSYCHOLOGY 17

SELF PSYCHOLOGY AND CONTEMPORARY

PSYCHOANALYTIC THEORY
By 1977, in The Restoration o f the Self Kohut considered self psychologi­
cally informed views about psychopathology and its treatment to be a more
complete explanation than that of structural conflict. This position repre­
sented a theoretical advance in which the self, with its line of development
separate from that of object love, accounted for many clinical disturbances.
Kohut continued to develop his ideas still further in How Does Analysis
Cure? written to convey his final thoughts and published posthumously in
1984. In this book, he stated that self psychology represented more than an
incremental theoretical advance in psychoanalysis.
Kohut did not believe it necessary to devalue classical drive theory by
identifying the gaps in what it could explain. He once said: “If you always
want to lock horns with Freud, all that you do is deprive yourself of all his
greatness” (Kohut, 1996, p. 67). Surely lacking the “imperialistic, all-em-
bracing ambitions” (Eagle, 1984, p. 41) that have been attributed to him,
Kohut became increasingly convinced that the perspective of self psychol­
ogy was greater than he had previously believed. Not without some regret,
he came to regard the central conceptual position of self psychology as
superseding the structural theory. This position extended beyond narcissis­
tic disorders to incorporate the majority of analyzable psychological disor­
ders, including structural neuroses. Kohut’s views also stimulated
reconceptualizing unanalyzable conditions as well, such as the psychoses
(Galatzer-Levy, 1988; Malin, 1988).
From this perspective, Kohut’s theoretical positions rightly appear as
the description of a psychology of the self rather than as a theory of
narcissism or narcissistic disorders. Several major psychoanalysts took
issue with Kohut’s position (Curtis, 1986; Loewald, 1980; Wallerstein,
1986/1995), both conceptually as well as clinically. Concurrent develop­
ments in psychoanalysis also led to a general shift from a conflict model
toward various deficit models of psychopathology. Most of these ap­
proaches included treatment views representing varying degrees of depar­
ture from standard psychoanalytic techniques.
One important development in contemporary psychoanalysis has been
the tendency to treat people with a greater severity of disturbance than had
commonly been the practice during previous generations. Thus, conceptu­
alizing deficit states or preoedipal psychopathology has stimulated greater
interest in recent years than have issues surrounding conflict, ego function,
18 CHAPTER 1

and defense. Overlapping views about psychological deficit have inevitably

produced confusion about various theoretical positions, and questions of
mutual influence among theories have inevitably arisen.
For example, in reference to self psychology, it can be argued that
Kohut’s views are very close to those of Jacobson (1964), Mahler (1968),
and Winnicott (1953). These similarities can make it difficult to describe
the uniqueness of any one theorist’s contribution. Certain aspects of what
has been called the interpersonal school, although substantially different
from Kohut’s psychology of the self in many fundamental ways, neverthe­
less lead to some confusion about their similarities and differences. Often,
this confusion has been based on a misunderstanding of crucial concepts
of self psychology. The same consideration applies to intersubjectivity
theory, an outgrowth of self psychology championed by analysts such as
Stolorow, Brandchaft, and Atwood (1987). Self psychologists such as
Bacal (1985) and Basch (1984) have taken positions that also represent
departures from Kohut’s views, although they are still predominantly
anchored within self psychology.
A critical comparison of theoretical systems is well beyond the scope of
this book. There are excellent sources for comparisons of theories (Bacal
& Newman, 1990; Eagle, 1984; Pine, 1988; Summers, 1994), and their
primary contribution lies in point-by-point critical analyses of the many
changes in the field of psychoanalysis in recent decades.
In this chapter and the two that follow, I confine the scope of the
description of self psychology to Kohut’s views. My purpose in taking what
some may consider a narrow view is influenced by carefully considering
the unique application of Kohut’s particular contributions in psychoanalysis
to the field of psychodiagnostic testing. The field of projective assessment
has also undergone critical developments paralleling the appearance of new
currents in psychoanalytic theory during the 4 decades since ego psychol­
ogy achieved its prominence. Thus, absorbing a large body of analytic
theory into the diagnostic testing and assessment literature pioneered by
Rapaport and Schafer posed a difficult challenge. Kissen (1986), Kwawer,
Lemer, Lemer, and Sugarman (1980), P. M. Lemer (1991), H. D. Lemer &
P. M. Lemer (1988), and Schachtel (1966) have made major contributions
to this effort. To add to this body of work, the central focus of the present
book remains centered on the singular influence of Kohut’s psychology of
the self.
Another reason for emphasizing the work of Kohut alone is that the
concepts he introduced are sufficiently difficult to grasp accurately so that
SHIFT FROM DRIVE THEORY TO SELF PSYCHOLOGY 19

the main principles of self psychology are frequently superficially under­

stood. Thus, I strive for an accurate, in-depth understanding of self psychol­
ogy to arrive at a sophisticated integration of psychoanalytic self
psychology and psychodiagnostic assessment of projective tests.
 2 Self Psychology:
Major Concepts

In the previous chapter, I introduced many of the central concepts of

psychoanalytic self psychology. In framing my discussion around the
development of Kohut’s thinking, I emphasized that the psychology of the
self evolved beyond its theoretical foundations in drive theory and ego
psychology into a conceptual system in its own right. In this chapter, I
discuss the major concepts of self psychology in greater detail.
A problematic aspect of self psychology has always been formulating
accurate and understandable definitions of its concepts. This problem is
similar to that of defining metapsychological concepts such as ego or
drive. For major concepts such as the self, selfobject functions, and
empathy, however, the available literature on meanings and clinical
manifestations is less extensive than that available for concepts like ego
and drive.
Here I describe several central concepts of self psychology, including the
definition of the self and its properties, empathy, compensatory structure,
and transmuting internalization. I also discuss several self psychological
concepts that differ from classical drive theory, as outlined in chapter 1,
such as the self state dream and the self psychological understanding of
oedipal dynamics. I quote liberally from Kohut’s major writings, particu­
larly the tape-recorded lectures that he gave over a 4-year period between
1972 and 1976 to candidates at the Chicago Institute for Psychoanalysis.
These lectures were compiled and edited by P. Tolpin and M. Tolpin
(Kohut, 1996) and were published in a book whose contents enhance the
clarity of Kohut’s ideas by taking advantage of his evocative manner of
speaking. Therefore, his examples and clarifications of ideas come across
more vividly than in his formal writings.
I devote chapter 3 entirely to an in-depth description of one of the most
important contributions of the psychology of the self, selfobject functions.
I reserve chapter 3 for a discussion of selfobject functions because this

20
SELF PSYCHOLOGY: MAJOR CONCEPTS 21

concept is particularly significant for a self psychological approach to

projective test content.

CONCEPT OF THE SELF

As a term, the self has multiple reference points, not only in the body of
psychoanalytic theory, but also in clinical, social, and developmental psy­
chology. Even popularized views about self-image or self-esteem in clini­
cal psychology and the lay press include a concept of the self. The problem
of defining the self psychological view of the self is compounded by
Kohut’s preference for terms such as cohesive, vigorous, and harmonious
(described next) to refer to properties or characteristics of the self.
Kohut’s (1984) clearest statement about the self was that it represented
a mental content. Earlier, he had stated that he could not give an exact
definition because the self is a generalization itself derived from other
(experience-near) data. Kohut thought of the self as a mental content or
configuration, and he preferred not to regard it as a mental structure at the
same level of abstraction as the tripartite structures of id, ego, and superego.
Kohut considered the concept of the self to be reducible no further than to
the idea of a mental content.
Although he was hesitant to consider the self as a psychic structure
parallel to the ego, Kohut did think that the properties of the self could be
described. He distinguished between what he referred to as constituents
and attributes. The constituent parts were originally mirroring and ideali­
zation; he later added twinship, which was differentiated from the mirroring
pole or sector.
Attributes of the self are its particular qualities of cohesion, vigor
(vitality), and harmony (Kohut, 1984). Cohesiveness refers to experience
as whole and enduring, ranging from healthy intactness to varying states of
fragmentation. To avoid any potential confusion of terms, I should stress
that Kohut’s reference to wholeness as a feature of the cohesive self is not
the same as Melanie Klein’s (1930) differentiation between whole and part
objects, a central concept of the British object relations school. For Kohut,
self-cohesion referred to a sustained, enduring experience of the self as
together or intact (in that sense, whole). The attribute of the self that Kohut
described as its vigor or vitality entails how people experience themselves
as invigorated rather than enfeebled, devitalized, and unable to hold up their
heads to face the world. Feeling invigorated is thus a different dimension
from the sense of being unable to hold oneself together, a sense that has
22 CHAPTER 2

more to do with self-cohesion. Finally, inner harmony of the self is repre­

sented by the feeling of calmness or being soothed. The absence of this
sense of balance gives rise to the internal experience of chaotic turmoil in
which a person senses that the world does not work as it should or that the
bottom has dropped out. This feeling leads to experiences in which things
and events are seriously out of kilter, in which people cannot rely on orderly
expectations about reality to provide an ongoing sense of a dependable
world. Such experiences, which may occur in both psychotic and nonpsy-
chotic states, are reminiscent of the children’s story of Chicken Little, who
fears that the sky is falling. It matters little whether the metaphor of the
bottom dropping out or the metaphor of the sky falling down is invoked.
The crucial experience is that of one’s sense of equilibrium or predict­
ability becoming destabilized as a result of a self that has faltered such that
the person can no longer feel sufficiently grounded (to continue my meta­
phor) by the calm provided by the presence of a comforting selfobject.
Kohut distinguished the self from the concept of identity. He considered
that identity represented a superficial, conscious experience; it was the way
that people describe themselves outwardly with regard to the social envi­
ronment. This clarification is necessary to differentiate the psychological
connotation of the self in depth from the social or sociocultural environ­
ment. Social reality is separate and distinct from intrapsychic life or the
depth psychological frame of reference.
There is thus little doubt that the frequent equation of self and identity is
misguided and usually incorrect. Kohut never intended the term identity to
be synonymous with or equivalent to the concept of the self. My main reason
for emphasizing this point is that clinicians, particularly those who are
unfamiliar with the language of depth psychology or metapsychology, have
frequently suggested that the sense of self is similar to identity, notably
when they are pressed to give a clear definition of the self. These two
concepts are by no means similar or equivalent, and their relation is not
especially strong or even important from the standpoint of psychoanalytic
self psychology.
In How Does Analysis Cure? Kohut (1984) discussed his view of the
concept of the self in relation to other major constructs in psychoanalysis.
He wrote this book close to the anticipated end of his life, largely in response
to criticisms by both friendly colleagues and critics who had urged him to
address concepts that he had left unclarified since The Restoration o f the
Self (Kohut, 1977). This lack of clarity may well have impeded under­
standing Kohut’s use and meaning of the concept of the self, as a complex
SELF PSYCHOLOGY: MAJOR CONCEPTS 23

mental system whose clinical relevance has had greater appeal than has its
metapsychological precision (Gedo & Goldberg, 1973).

EMPATHIC UNDERSTANDING OF SELF STATES

Definitional (Conceptual) Considerations

Although Kohut (1959) introduced his thinking on empathy early, he

continually expanded his view of its clinical significance. Empathy became
increasingly important in his work, even as recently as an address entitled
“On Empathy” delivered in the week before his death (Omstein, 1990).
Although empathy represents one of Kohut’s most far-reaching contribu­
tions, it is also probably the most poorly understood of all concepts
associated with self psychology. It is important to fully describe this
concept, including its evolution and the misunderstandings that have devel­
oped around it. Empathy is also a focal point for reconceptualizing psy­
chodiagnostic testing content as informed by self psychology.
Empathic understanding, as it characterizes therapeutic actions, has
nothing to do with being or acting pleasant, friendly, or warm. Kohut (1984)
eschewed an overly friendly, warm, or sympathetic disposition or therapeu­
tic attitude and noted that such overt responses are neither indicated nor
therapeutic in any real sense. Wolf (1988) commented:

To be empathic does not mean to be doing something good for the

patient. Indeed, the knowledge gained by being empathic can be used
for or against the patient’s benefit ... .The essence of a certain kind of
salesmanship (or advertising) is exactly the salesman’s empathic “in
tuneness’’ with the customer’s needs and wishes, (p. 132)

On a similar note, Basch (1983) observed:

[S]ome of the world’s greatest scoundrels have been exquisitely and

unerringly attuned to grasping the significance of the unconscious or
unspoken affective communications of others and have used that knowl­
edge to achieve base aims. Is this too empathy? Yes it is. (pp. 119-120).

Although Kohut did not see a therapeutic need for undue warmth,
feigned interest, or sympathy, he did not intend treating therapists to act
coldly. Indeed, few clinicians disagree that people in treatment do not
24 CHAPTER 2

improve in a cold, distant atmosphere with a therapist who practices with

uninvolved listening or understanding. He commented:

[0]n the whole, self psychologists tend to work in a more relaxed fashion,
are more easygoing with their patients, have fewer misgivings about
making themselves emotionally available to their patients if the need
arises, and generally behave in a (comparatively speaking) less reserved
manner than the majority of analysts. (Kohut, 1984, p. 81)

Kohut understood that patients also improve when therapists use tech­
niques that do not emphasize empathic listening or understanding. Empathy,
as described by Kohut and his colleagues, simply refers to therapists’ listening
to the communications of patients in a particular way. Empathy is a way of
introspectively gathering data from which therapists attempt to explain to
patients what a therapist understands about crucial aspects of a patient’s life.
Empathy is the way that analysts comprehend the impact of crucial figures on
others’ development.
This idea is not a radical departure from major principles of analytic
treatment, at least for the predominant psychodynamic therapies. The critical
differences materialize in the way that therapists understand, conceptualize,
and interpret patients’ communications. Empathic listening refers to the way
that analysts become sustainedly immersed in what patients say. Analysts or
psychotherapists reconstruct what they hear, not in an “experience-distant”
manner (from the vantage point of a higher order abstract theory about mental
processes), but in an “experience-near” manner (remaining close to the pa­
tient’s phenomenological experience).
Kohut compared this mode of listening to the basic psychological bond
that allows people to grasp one another’s intentions or motives and to make
them intelligible. He saw empathy as “the capacity to think and feel oneself
into the inner life of another person. It is our lifelong ability to experience
what another person experiences” (Kohut, 1984, p. 82). Kohut stated that
empathy is present at all levels of development as early as a mother’s
accurate, empathic grasp of her infant’s states of satisfaction and distress.
Empathy includes a mother’s psychological capacity to respond adequately
and thus to provide the substrate for the nuclear or emerging self of infancy.
Freud (1921/1955) considered empathy to be the mechanism through
which individuals can assume any attitude at all about another person.
Kohut (1996) provided a good example of empathy serving as a basis for
calming, when it is accurately attuned, or for exacerbating an already
distressed self state. A person who is upset by something turns to another
SELF PSYCHOLOGY: MAJOR CONCEPTS 25

person for supportive understanding. Kohut compared this empathic failure

to merging with faulty maternal empathic responsiveness. He (1996) wrote:

The mother picks the child up. What does the friend do? The friend puts
an arm around the other’s shoulder and imitates the picking up. Although
he may feel like a small baby, you put your arm around him and say “I
know how you must feel. ... Feeling your calmness while you are united
with the other person allows this person now to merge with you .... A
mother who says, “Oh, for goodness sake, don’t cry, there’s nothing to be
anxious about,” does not allow this particular kind of merger and does not
help the child. She rejects and pushes the child away. A mother who goes
to pieces over the child’s anxieties also doesn’t encourage the merger.
Why? Because why do you want to merge into something that is as
anxious as you yourself are, or even more so? A mother who misunder­
stands the child and thinks that he’s anxious when he’s in pain or in pain
when he’s anxious is also no good. (p. 7)

As noted previously, Kohut also considered empathy as a method of

inquiry, a means of data gathering. Empathy, in this view, is not something
actively done or effected. It is the way that a clinician listens to, and later
on understands, a patient’s communications in treatment or on projective
test responses. Clinicians attempt to vicariously understand what the com­
munication conveys about a patient’s existence or experiences of the self
and of the world. As a therapeutic technique, empathy is a requisite
condition for therapeutic interpretation or clarification. It is not by itself
the therapeutic intervention. Thus, Basch (1983) wrote:

Empathic understanding is not curative in the psychoanalytic sense; cure

is the function of interpretation. By the same token, empathic under­
standing is not a substitute for interpretation; rather, it lays the groundwork
that makes interpretation appropriate and effective, (pp. 123-124)

As Kohut came to believe with increasing certainty, “experience-

near” reconstructions about a patient’s life or psychological world pro­
vided the optimal understanding of self states. This level of understanding,
obtained through sustained empathic immersion, yielded the greatest
therapeutic efficacy.

Clinical (Technical) Considerations

Despite these attempts to define empathy, its intended meaning has still
confused both traditional psychoanalysts and other psychodynamic clini­
26 CHAPTER 2

cians. Even the term itself is unfortunate, because of its surplus meanings.
Kohut frequently struggled with others’ misunderstanding of his meaning
of empathy as a primary tool of investigation. In an effort to clarify
empathic understanding, Kohut (1984) wrote:

My answer is that the greater relaxation of the self psychologist, his greater
freedom to respond with deeply reverberating understanding and reso­
nant emotionality, and the generally calmer and friendlier atmosphere of
self psychological treatment—these developments do not rest on the self
psychologist’s increased use of empathy, on the fact that he is “more
empathic” than his non-self psychological colleagues. They rest instead
on the expanded scope of empathy that is the product of the self
psychologist’s expanded theoretical understanding, (p. 82)

Although he addressed the way that empathy produces mutative change,

he found it necessary to differentiate empathic listening as a technical tool
from its casual or familiar connotation. Kohut (1984) noted:

Clearly, it is not enough for the analyst to be “nice” to his patients, to be

“understanding,” warmhearted, endowed with the human touch ... all the
evidence now available indicates that being nice, friendly, understanding,
warmhearted, and in possession of the human touch cures neither the
classical neuroses nor the analyzable disturbances of the self. (p. 95)

Thus, acting or appearing “nice” is trivial or irrelevant to the nature of

empathic listening. Like the earlier example of the artifacts that may result
from exaggerated reserve, he differentiated this quality of acting “nice” for
its own sake from acting in a more or less normal or expectable way.
According to Kohut, empathic understanding as a technical approach
provides a means for recognizing psychological dynamics that might oth­
erwise be unnoticed. This technique is particularly helpful in distinguishing
between object-libidinal and selfobject needs. It fosters the therapeutic
action of transference interpretations if remobilized selfobject needs can be
recognized and examined to gain understanding. This approach contrasts
with the drive theory view in which transference phenomena are considered
intrusions that stand in the way of unearthing archaic needs and wishes.
Drive theory leads to a position of therapeutic action characterized by
defense interpretations of unwelcome intrusions that encumber the real goal
of treatment. Defenses, therefore, are viewed as stubborn resistances that
obstruct therapeutic progress, and most work during treatment revolves
SELF PSYCHOLOGY: MAJOR CONCEPTS 27

around the interpretation of defenses, resistance, and their transference

manifestations.
Kohut thought that interpreting defenses as interferences meant over­
looking their emotional value to patients. By dismissively viewing defenses
as something to be got rid of, the very selfobject failures that patients had
experienced in early development were repeated. In some instances, patients
were re-exposed to narcissistic injury and received no help to repair these
injuries of their undermined selves. Because defenses in Kohut’s view were
attempts to hold onto, if not strengthen, vulnerable self-cohesion, patients
often experienced defense interpretations as humiliations or assaults, par­
ticularly if therapists insistently repeated the interpretations in the belief
that it is advantageous to remove stubborn resistances.
One criticism of self psychology has been that empathic under­
standing provides little more than a corrective emotional experience.
This criticism is, however, a misinterpretation of Kohut’s use of empathy
and is based on misunderstanding empathy as providing warmth or
comfort to an injured patient. The reference to corrective emotional
experience derives from Franz Alexander’s (Alexander & French, 1946)
method of brief psychoanalysis. In much the same way that some viewed
Alexander’s much-maligned corrective emotional experience as an ap­
proach to treatment that was distinctively not psychoanalysis, critics
questioned the use of empathy as an analytic tool.
P. Tolpin (1983) emphasized that the selfobject transference is correc­
tive in that patients’ unresponded-to needs of early development are
understood and responded to differently. By empathically apprehending
the clinical material as arising from faulty selfobject responsiveness
rather than from conflict surrounding drive regulation, therapists can
establish the corrective, cohesion-building, transmuting internalizations
that are crucial in treatment. Kohut, in regard to the misperception of
empathy as corrective emotional experience, wrote:

I am not an advocate of the corrective emotional experience. I don’t think

one needs to give the patient a commendation. But what needs to be
made clear to the patient is that you recognize what he wants at this
particular moment. It is not therapeutically correct to say, “This is a
resistance, so let’s go back to your drives and defenses.” By doing that
you slap him down just as he is moving forward, and you misunderstand
what is really going on in the patient and in the analysis at that particular
moment. (Kohut, 1996, pp. 220-221)
28 CHAPTER 2

Critics have further charged that empathy constitutes gratification of

archaic wishes, that it bypasses genuine clinical understanding leading
to the correct interpretation of resistances and defenses in the transfer­
ence. Although this misunderstanding of Kohut’s use of empathy is by
now rarely heard, some clinicians nevertheless regard empathic-intro-
spective understanding as too far removed from the central treatment
objective of interpretation. This misunderstanding fails to take note of
Kohut’s consistent stress on the two-part analytic effort of empathic
understanding followed by clarification of dynamics together with their
genetic roots.
In a forceful statement on this issue, Kohut wrote:

Let me remind you that you don’t have to mirror the patient to be effective
as his analyst. That is really a total mistake. The meaning of mirroring, the
essence of that concept, is not that you have to play-act with your patient
and praise him and respond to him and say that he is wonderful. No such
nonsense. But you do have to show the patient over and over again how
he defensively retreats because he expects that he will not get what he
wants and that he doesn’t dare to let himself know what he wants. (Kohut,
1996, p. 373)

In Goldberg’s (1978, pp. 447-448) view:

The analyst does not actively soothe; he interprets the analysand’s yearn­
ing to be soothed. The analyst does not actively mirror; he interprets the
need for confirming responses. The analyst does not actively admire or
approve grandiose expectations; he explains their role in the psychic
economy. The analyst does not fall into passive silence; he explains why
his interventions are felt to be intrusive. Of course, the analyst’s mere
presence, or the fact that he understands, all have soothing and self-con­
firming effects on the patient, and they are so interpreted. Thus, the analytic
ambience that makes analytic work possible becomes itself an object for
analytic interpretation. The whole analytic process in this way blocks
exploitation for mere gratification.

Goldberg addressed here the erroneous implication that self psychologi­

cal treatment is psychotherapy, and supportive rather than interpretive
therapy at that (Levine, 1979; Wallerstein, 1986/1995). Kohut and his
colleagues always maintained that a self psychologically informed treat­
ment fulfilled all the criteria for analysis. The self is reconstructed to permit
a newly revitalized self to unfold (Goldberg, 1990). Empathy is a technique
for introspectively gathering data, from which the resulting understandings
SELF PSYCHOLOGY: MAJOR CONCEPTS 29

are used to frame interpretations. Empathic understanding is not warmth or

support. Support may sometimes be indicated therapeutically, but it is not
itself intensive psychotherapy or psychoanalysis.
Despite self psychologists’ clear admonitions about confusing empathy
with gratification, Kohut knew that therapists sometimes had to do exactly
that. Even when such a response was indicated (and virtually all psycho­
therapists and analysts are familiar with the need for such responses in
different degrees), judicious care about what is done and why it is being done
must remain in the forefront of therapeutic activity. Kohut stated in a lecture:

What one does for the patient is really not giving him what he has missed.
As a matter of fact, most patients are very sensitive about that and dislike
it intensely. If you do that they feel patronized; they feel treated like
children, as though you have given to them as to a beggar. I think it is
much more sophisticated, and much more a real gift, when one recognizes
the need and explains it from one adult to another ... .He [the patient]
can occasionally say, “Yes, I know that, but really I do need something.”
Then maybe from time to time one can, recognizing an enormous need,
give something that one knows is, for the time being, necessary. I have a
nice phrase for it: I call it the “reluctant compliance with the childhood
wish.” (Elson, 1987, p. 39)

Kohut also realized that the traditional stance of analytic neutrality

produced a serious and sometimes detrimental problem in treatment. The
analyst’s neutrality that intends to stimulate regression as well as to avoid
contaminating the transference produces an artifact that Kohut described
in the following way:

[T]here is an old confusion ... between analytic neutrality, considered as

a sterile field in which one must work antiseptically, as a kind of physical
or emotional zero point, and the average friendliness and empathic
behavior that a patient has the right to expect from a person who has
devoted his life to empathically merging with them. That expectably
empathic behavior is the true zero or base line in analytic work. It is not
some peculiarly remote, emotionally dessicated behavior ... That kind of
behavior does not bring out any psychologically important realities in
patients, but it does produce peculiar artifacts that may then be misunder­
stood and interpreted as basic pathology. Of course, it isn’t essential
pathology, but a reaction to mistreatment... it is in essence an iatrogenic
disease. (Kohut, 1996, p. 325)

Even more forcefully, Kohut stated:

30 CHAPTER 2

If the patient gets ... silent, oddly unanswering treatment, he will really
have been misled and betrayed, and he will, of course, be deeply
disappointed and enraged. This is not the expression of repressed or
otherwise neurotically defended-against or characterologically deter­
mined rage, which now, because of the skillful therapeutic mobilization
of his central conflicts, erupts to reveal his true enraged self and the
consequent guilt ... That is all utterly spurious; they are all artifacts.
(Kohut, 1996, pp. 250-251)

TRANSMUTING INTERNALIZATION
If empathic understanding is the way that therapists identify patients’
concerns or injuries, the primary therapeutic technique for conveying these
insights remains interpretation. The therapeutic objective is to repair the
self disorder by interpretations emphasizing momentary disruptions of
empathic attunement and its destabilizing effects. Through the gradual
internalization of these insights, patients rebuild or fortify the injured or
devitalized self. Kohut proposed the term transmuting internalization to
refer to this process.
Interpretive work is rarely based on resolving intrapsychic conflict.
Patients establish a selfobject transference that inevitably becomes dis­
rupted in the normal course of treatment by the empathic unavailability of
the analyst or psychotherapist. Patients experience this unavailability as
an injury to self-esteem. Therapists attempt to convey what they understand
to have taken place, including the genetic origins of the patient’s reaction.
Frustration produced by selfobject failure is inevitable in the treatment
relationship. It reveals the pre-existing state of self-cohesion before under­
taking treatment and may lead to regression based on a patient’s specific
form of psychopathology.
In the invariable frustrations experienced in treatment, patients are re-ex­
posed in the transference to empathic failures of childhood. This experience
particularly revives early failures or traumatic disappointments of parental
empathic attunement or responsiveness to the selfobject needs of the young
child. The many ways in which these early injuries are remobilized by the
momentary empathic misattunements or poorly timed interpretations are
part and parcel of analytic or psychotherapeutic treatment.
That these remobilizations are inevitable misunderstandings or misteps
of therapists or analysts is to be expected. Misunderstandings occur when
therapists attempt to grapple with patients’ unconscious dynamics, particu­
larly early in treatment. That patients experience these misunderstandings
SELF PSYCHOLOGY: MAJOR CONCEPTS 31

as injuries or frustrations is not important. What is important is that they

are understood and interpreted to patients as revivals in treatment of early
injuries to self-cohesion. When they are understood in this way and consis­
tently interpreted as such, the process of working through builds a new,
revitalized self. This process and the newly acquired solidification of
self-cohesion are the transmuting internalizations. Gradually, as this proc­
ess unfolds, self-esteem is fortified.
The transmuting internalizations become the basis for seeing, in the
transference, the various ways in which patients attempt to protect themselves.
When misunderstood, patients momentarily experience a threat to a self
struggling to maintain viability or vigor. When therapists recognize that a
disruption of the self state has occurred, pointing this out to a patient becomes
the reparative or mutative agent in treatment. In time, as a therapist or analyst
comes to understand the genetic roots in early development, this material is
also included in the interpretation. With repeated interpretations, the process
of transmuting internalization gradually strengthens the devitalized self. In a
broad sense, transmuting internalizations are the way that treatment enables an
enfeebled self to survive and flourish. Through transmuting internalizations,
the self is strengthened to remain buoyant and psychologically alive.
Kohut (1984) eschewed the term resistance because of its pejorative
implication as something unwanted that interferes with treatment and that
must be eradicated. He believed that this view is usually incompatible with
promoting transmuting internalizations. When therapists view defenses as
resistances, they sometimes react to them as stubborn, unyielding aspects
of the patient to be fought and overcome. There is a difference between a
patient’s being told that he or she is resisting and a patient’s being told that
he or she acts in a certain way for self-protection or self-cohesion. In the
second situation, the interpretation is empathically attuned to the patient’s
need. The first comment makes the patient feel undermined or bad; what­
ever its therapeutic function, it does not foster self-cohesion. Interpretations
about resistances, therefore, do not lead to transmuting internalizations that
repair a self disorder. Referring to an interpretation of a dream of his
well-known patient, Mr. Z., Kohut (1984) wrote:

An intruding father loaded with identificatory gifts is psychologically

different from an available idealizable father. Our confusion of the two
situations is an outgrowth of mechanistic, non-psychological thinking.
“Intrusion” is unresponsive to the child’s needs; it is not guided by
empathy with the child. “Availability,” in the psychological sense in which
I use the term here, is responsiveness; it is guided by empathy, (p. 149)
32 CHAPTER 2

Defenses are self-protective in the face of a selfobject milieu that is

unresponsive to what the self requires to sustain vitalization. Self psycholo­
gists consider defenses to represent the best attempts that a patient can manage
to keep a weakened self psychologically afloat. Like the example of Kohut’s
patient Mr. Z., the patient’s need is for an available selfobject. Defenses are not
stubborn intrusions that counteract a therapist’s efforts at removing encumber-
ances to uncovering conflict.
Through repeated interpretations of selfobject needs, transmuting internali­
zations are built up. Patients in a self psychologically informed treatment do
not generally understand that they are struggling against aspects of their inner
life, aspects that must be overcome or purged. Interpretation remains the
primary therapeutic technique, but the content of what is interpreted is different.
The self psychological approach interprets interruptions that have interfered
with ongoing psychological development. This process fosters the continu­
ation of arrested development in an empathically responsive environment,
promotes the repair of injuries to the self, and thus fosters optimal self-esteem.
Ultimately, through this process of transmuting internalization, the idealizing
transference becomes transformed into an idealization of the superego, and the
successful working through of the grandiose-exhibitionistic transference re­
sults in the strengthening of reasonable ambitions and goals.
The transmuting internalizations that lead to bolstering of self-cohesion
represent another essential difference between classical analysis and self
psychologically informed treatment. Drive theory stresses the importance of
interpreting conflicts and the resistances (defenses) that have developed around
these conflicts and their genetic origins. Self psychology favors interpretation
of selfobject needs, the way that these have been misunderstood or unrespon­
ded to, and the genetic origins of this form of disturbance. The cure is the
transmuting internalizations that patients acquire as the self disorder is gradu­
ally repaired. With self disorders, this process represents the basis of therapeu­
tic action. For this reason, the psychology of the self has been viewed as a
deficit model of psychopathology, in contrast to the conflict model of classical
psychoanalytic theory.

COMPENSATORY STRUCTURES
The concept of compensatory structures is less familiar than other concepts
in self psychology. Clinicians and theorists whose primary acquaintance
with self psychology came from writings before and including The Analysis
o f the Self( Kohut, 1971) may not be very aware of this concept, which may
SELF PSYCHOLOGY: MAJOR CONCEPTS 33

also hold particular interest for those concerned with diagnostic psycho­
logical assessment. Many clinical examples that I present in chapters 4
through 8 illustrate that successful and unsuccessful attempts to develop
compensatory structures can be identified by using diagnostic testing meth­
ods. Psychodiagnostic tests can demonstrate the relative balance among
primary, defensive, and compensatory structures.
Kohut first described the concept of compensatory structures in The
Restoration o f the Self(\911). The concept centers on attempting to secure
another route to achieve a firmed-up sense of self when the primary pole or
sector of the self has been injured in early development. Thus, it is possible
to repair self-cohesion if another sector of the self can provide the selfobject
responsiveness of the original primary structure that was deficient. Typi­
cally, the compromised primary structure is the grandiose-exhibitionistic
pole and its associated mirroring selfobject function. The idealized parent
imago pole can also be the defective primary structure, although this
situation is less frequent. In either circumstance, Kohut believed that
children tried to repair the deficit in the impaired primary structure, if the
injury was not too extensive, by seeking an alternative route to strengthen­
ing the self. Compensatory structure represents a second chance to restore
self-cohesion and usually appears as idealization in an attempt to compen­
sate for derailed or chronically interrupted mirroring.
In contrast, defenses operate in much the same way as in ego psycho­
logical theory. That is, defensive operations function to protect an injured
or devitalized self that has been limited in acquiring compensatory struc­
tures. Defenses, therefore, do not provide the possibility of a self-reparative
mechanism: the appearance of defenses signifies the failure of compensa­
tory structures.
Defensive structures interfere with self-cohesion by limiting the po­
tential to promote a consolidation of the self. In contrast, compensatory
structures represent the possibility of reinvigorated self-cohesion and
thus permit development to move forward. Attaining compensatory
structures allows self-cohesion to become strengthened and produces a
functional rehabilitation of the self. If a compensatory structure does not
succeed, then defenses are the best compromise solutions possible.
Kohut (1977) suggested that the work of treatment is to create com­
pensatory structures from defenses, if self-cohesion has not been trau-
matically damaged by failures of selfobject responsiveness in the
weakened sector of the self. Failure to acquire compensatory structures
34 CHAPTER 2

predisposes people to the familiar defensive operations, but defenses may

be converted to compensatory structures through treatment.
Kohut was also careful to distinguish compensatory structures from
sublimation. He was impressed by some productive and creative individuals’
high degree of achievement which, he believed, came about through a
preponderance of compensatory structures despite histories of childhood
traumatization and selfobject failure. The resilience lay in these productive
individuals’ capacity to acquire new structures in precisely this way. M.
Tolpin’s (1993) reinterpretation of certain clinical features of Anna O., Freud
and Breuer’s well-known patient, is a good example of this phenomenon.
The idealized parent imago pole of the self is usually mobilized to
compensate for a mirroring defect of the grandiose-exhibitionistic pole or
sector. Thus, idealizing responsiveness from selfobjects may remedy de­
ficiencies of mirroring. Similarly, a twinship selfobject function may
buttress self-esteem when a need for mirroring or affirming has gone
unrecognized. Twinship may also develop as a compensatory structure if
selfobject needs for idealization were not met. Mirroring selfobject needs
sometimes compensate for unresponsive or unavailable idealization or
twinship when patients seek these selfobject functions, but this pattern is
clinically less frequent.
Goldberg (1995) noted that for a structure to be truly compensatory rather
than defensive, the compensatory structure had to operate like neutraliza­
tion of a libidinal or aggressive drive. That is, a compensatory structure
should be relatively free of pathological regression and therefore conflict
free. Otherwise, the structure might represent a “temporary respite” (Gold­
berg, 1995) rather than an effective solution to repair self-esteem.
Kohut considered that the self consisted of a combination of primary,
defensive, and compensatory structures. Kohut (1984) also believed that
healthy people are characterized by a combination of primary and compen­
satory structures in varying degrees. In these relative states of psychological
health, primary structures predominate, although some compensatory
structures coexist, and some defensive structures may also be present.
Psychopathology, in contrast, is based largely on defensive structures,
although well-integrated patients show some compensatory structures and
very few intact primary structures (Omstein, 1990). This picture is one
viewpoint of the meaning of cure: transforming defensive structures into
compensatory structures leads to a rehabilitation of the self.
Kohut thought that partially successful compensatory structures led to
narcissistic personality disorders. The absence of compensatory structures
SELF PSYCHOLOGY: MAJOR CONCEPTS 35

often produced features associated with narcissistic behavior disorders, such

as acted-out sexualizations, perversions, and prominent or severe somatiza­
tion phenomena. Goldberg (1995) considered most forms of perversions as
indications of failed development of compensatory structures. In his view,
homosexuality was either a perversion or a product of a compensatory
structure, depending on the clinical determination about whether the homo­
sexual adaptation represented a well-developed compensatory structure or
whether it functioned at the level of most sexual perversions.
Kohut also considered treatment implications of the relations among
primary, compensatory, and defensive structures. He recognized that al­
though some selfobject needs were not empathically or vigorously re­
sponded to in childhood, neither were these completely thwarted in most
treatable self disorders. When people acquire compensatory structures, they
have another opportunity to secure formerly unresponded-to selfobject
needs. These compensatory structures therefore represent admixtures of
partially frustrated needs, together with the more securely firmed-up pri­
mary structures of another pole or sector of the self. As long as the frustrated
selfobject functions did not become inflexible defensive structures or
entrenched behavior disorders such as perversions or somatization reac­
tions, Kohut believed that these selfobject needs could be remobilized in
treatment and transformed into workable compensatory structures.
Many patients, however, experience the revival of frustrated aspects of
self development with fearfulness and anticipate further disappointment in
their treatment. When a therapist interprets a patient’s selfobject needs as
able to be remobilized rather than making simplistic statements of good will
masquerading as empathic understanding, the injured self can proceed from
its previously arrested point in development to acquire firmness or cohesion.
If the self has attained sufficient firmness to permit further strengthen­
ing through treatment-derived transmuting internalizations, patients can
probably acquire compensatory structures. Effective treatment consists of
further strengthening these sectors of the self to enable them to “grow with
special vigor” (Kohut, 1984, p. 205). Patients can then seek accurately
attuned selfobject responsiveness when available from the people in their
lives. Kohut compared the process of acquiring compensatory structures
to a biological adaptation to unfavorable environmental events:

Just as a tree will, within certain limits, be able to grow around an obstacle
so that it can ultimately expose its leaves to the life-sustaining rays of the
sun, so will the self in its developmental search abandon the effort to
36 CHAPTER 2

continue in one particular direction and try to move forward in another.

(Kohut, 1984, p. 205)

Although vestiges of the damaged pole or sector of the self do not

disappear, the compensatory structures of the other sectors can take over
the selfobject functions of the disabled sector. Eventually, as these compen­
satory structures mature, their strengthening leads to the unfolding of
ambitions, talents, and ideals. The damaged sector does not usually become
cured, however, although it may sometimes be revivable after compensa­
tory structures in the other sectors become strengthened.
Kohut regarded the self as seriously damaged when an attempt to acquire
compensatory structures leads again to selfobject failure or unresponsiveness.
In this circumstance, treatment efforts are uncertain or require special modifi­
cations. In terms of Kohut’s metaphor of a tree sprouting new roots, a tree with
no viable means of rerouting its course fails to thrive when more or less
permanently deprived of what it needs for survival. Circumstances may
effectively block the enfeebled self from obtaining the “psychological oxygen”
needed to survive life demands with sufficient resilience. (Kohut often used
the phrase psychological oxygen in his writings on self psychology.)
Usually, compensatory structures are reconstructed from a history of
turning away from the mother and toward the father with admiration. These
compensations typically follow chronic or traumatic disappointment in or
unresponsiveness from the mother. Turning to the father in the hope of
finding an adequate idealizing selfobject may help stave off the deleterious
effects of faulty maternal mirroring. Thus, the father may be approached
psychologically to serve selfobject functions of both mirroring and ideali­
zation, but Kohut regarded the failure of both selfobject functions to lead
to the eventual development of a self disorder.
Children may sometimes turn back to the parent, usually the mother, who
originally provided faulty mirroring selfobject needs in an attempt to
buttress selfobject failure if the father has been unable to serve a suitable
selfobject function for idealization. This form of repeated selfobject failure
usually leads to a self disorder as well. An exception may occur in a
situation in which the mother’s early selfobject failures were attributable
to depression but the disorder later remitted. If the father is unable to
successfully fulfill an idealizing selfobject function, a return to the mother
for mirroring may succeed if the mother recovers from depression.
Kohut regarded compensatory structures as important for regulating
drives. In the view of self psychology, drives are not inborn; they appear in
SELF PSYCHOLOGY: MAJOR CONCEPTS 37

the form of breakdown or disintegration products, such as perversions or

rage attacks:

[DJrives in adults are generally disintegration products... [T]he baby cries,

and then the baby cries angrily when whatever needs to be done is not
done immediately. But there is no original need to destroy; the original
need is to establish an equilibrium. (Kohut, 1996, p. 199)

Kohut believed that archaic drive states in the form of disintegration

products make their appearance following either traumatic or prolonged
empathic failures of an expectable environment or selfobject milieu. Thus,
drives are the diffuse, unneutralized reactions to an appreciable interference
with the optimal functioning of the self-selfobject unit.
As a result, drive states as disintegration products are prolonged or
intensified in the face of failure to establish compensatory structures.
Because disintegration products are drive or tension discharges, they cannot
provide sufficient self-sustaining responsiveness. The self is thus experi­
enced as devalued or depleted and lacking in psychological oxygen or zest.
The initial failure of a primary structure, along with the failure of success­
fully restorative compensatory structures, exposes patients to a selfobject
environment that they cannot experience as alive. Rather than patients’
feeling energetic, proud, and invigorated:

They become fixated on drives because their budding selves were over­
looked, were not responded to. They turned to drive-gratification (and
later remained fixated on it) because they tried to relieve their depres­
sion—they tried to escape the horrible feeling that nobody was respond­
ing to them. Such people may have had mothers who satisfied their drives
continuously, yet failed to respond to the whole child who expected
mirroring responses; they failed to respond with pride and pleasure to the
child’s increasingly independent self. (Kohut, 1996, pp. 208-209)

THE SELF PSYCHOLOGICAL VIEW

OF THE OEDIPAL PHASE
AND THE INTERPRETATION OF DREAMS

The Oedipus complex is a major explanatory concept of classical psy­

choanalytic theory so that Kohut’s de-emphasis of the oedipal phase’s
central significance is an important departure from classical psycho­
38 CHAPTER 2

analysis. Although Kohut initially considered his reconceptualization of

oedipal dynamics as an expanded version of psychoanalytic theory, he
ultimately became convinced that Freud’s view of the oedipal situation
was uncompelling.
In The Restoration o f the S elf Kohut (1977) first stated his reservations
about the adequacy of Freud’s explanation, not the analytically derived
data. Kohut initially believed that the self psychological view of the
oedipal situation could coexist with the classical view. Thus, patients with
primary self disorders could be differentiated from those with predomi­
nantly structural neuroses. Yet Kohut regarded structural theory as inade­
quate to explain self disorders: “[D]rive theory and its developments
explain Guilty Man, but they do not explain Tragic Man” (1977, pp. 224).
Kohut regarded the urges or longings expressed at this stage of devel­
opment as a playful desire for affectionate intimacy or sensual closeness.
For children, the psychological issue was not that of sexual stirrings. For
the oedipal boy, measuring his strength or importance alongside that of the
father is an issue of self-esteem, not competitive or destructive wishes.
Such wishes Kohut considered misinterpretations of the crucial dynamics.
With regard to the self, the pathological interference takes the form of
unattuned empathic failures such as rejection or repudiation from the
oedipal child’s parents. This rejection produces an injury to a buoyant self
in hope of recognition or acceptance. The consequent self-depreciation or
propensity to feelings of disappointment or inadequacy represents, there­
fore, a byproduct of disturbed self-cohesion occurring when a healthy
welcoming of this developmental step is rebuffed.
Kohut did not consider the oedipal situation as a fulcrum of psycho­
logical development. Rather, he viewed it as yet another opportunity to
solidify self-esteem:

Think of a child who is marginally responded to or only occasionally

responded to, sometimes lonesome, sometimes feeling unaccepted, ex­
posed to a cold mother who is not able to tune in empathically with the
child or is only minimally able to do so. Such a child has a father to whom
he can turn for some confirmation and organization of his self by identi­
fying with him, by merging into him as a strong male ideal .... The
Oedipus complex, then, is not the rock the psychic self hits and on which
it is broken apart. It is, in fact, the other way around. In this instance, the
intense onrush of Oedipal feelings becomes the organizing center around
which an otherwise fragile self can become coherent again ...
SELF PSYCHOLOGY: MAJOR CONCEPTS 39

[T]hese individuals repeat their Oedipal conflicts in order to continue the

excitement of that stimulating experience, an experience that protects
them against underlying or parallel fears of being unstimulated, of being
lonesome, depressed, and about to fragment ... It would be the last
childhood state in which strong infantile or childhood drives help the self
to stay together. (Kohut, 1996, pp. 262-263)

Thus, it was not the emergence of libidinal and aggressive drives that
produced conflict in an oedipal child. Rather, the unresponded-to or empa-
thically unattuned response to the emerging self represented the primary
threat. Conflict, the cornerstone of psychopathology according to the struc­
tural theory, was secondary to impaired self-cohesion. This position is a
main reason that many psychoanalytic clinicians have considered the psy­
chology of the self to have a “misplaced (and largely incorrect) emphasis”
(Wallerstein, 1986/1995).
From the standpoint of the psychology of the self, a pathogenic oedipal
phase is not an inevitable, necessary, or universal part of normal develop­
ment. Such a phase may appear when there has been appreciable empathic
failure at this stage of relatively normal development. Kohut reserved the
term Oedipus complex for pathological disturbances arising from the par­
ents’ unattuned or unempathic reactions to children’s needs for selfobject
responsiveness at this stage of development.
Kohut did not consider pathological sexualizations as misplaced or
frustrated libidinal urges or view assertiveness as derived from an aggres­
sive drive. He thought that many traditional analysts overestimated fear of
the parents as a neurotic manifestation of castration anxiety. Kohut believed
that attempts to treat oedipal-phase injuries to the self as structural disorders
would fail. As an example, Kohut provided the illustration of the jealous
erotized material of “pseudohysterics”:

The more you interpret the Oedipal period, the worse they get because
they are afraid those ideas will be taken away from them. Why? Because
it is the continuous activity in the romantic conflict sphere of the Oedipal
background that gives them the sense of being alive. Now, side by side,
you see indications of deeper pathology ... You must undercut the sup­
posed Oedipal issues by telling the patient you think that all this romantic
falling in love probably covers a great sense of neediness ... that he really
wants something much more basic from you ... And then the patient will
feel understood, and there will be a toning down of all the romantic and
jealous and suicide threatening fireworks, and one can perhaps begin to
go to work on the depressive sense of the self. (Kohut, 1996, pp. 116-117)
40 CHAPTER 2

To Kohut, it was not inevitable that “seeming Oedipal material”

(Kohut, 1996, p. 346) had to be analyzed, particularly when this material
began to emerge toward the end of treatment. Although he did not
trivialize oedipal dynamics, his primary interest was clearly in those
aspects of the oedipal phase promoting self-cohesion:

It is nothing else but the final paragraph of the long book of a successful
analysis. It need not be analyzed. If it is analyzed, then fine, it won’t do any
harm. It will be a little lapse, but if you have understood a person for so
many years then one final misunderstanding won’t destroy him and all the
work you’ve done. The patient will feel rebuffed because now he really
can love or really can hate you; now he is strong enough to do that. And
the fact that he can do that now is what you should recognize and
congratulate him about.” (Kohut, 1996, pp. 346-347)

Another instance of Kohut’s technical and conceptual departure from

traditional psychoanalytic theory and practice is his approach to the
analysis of dreams. He distinguished two types of dreams, one of which
expressed conflict-based themes that could be understood in the custom­
ary way. The second type represented the mobilization of unmanageable
tension states, arising from fear of overstimulation or dissolution of the
self. This second type of dream, which Kohut called self-state dreams
(Kohut, 1977), occurs less frequently than the first (P. Tolpin, 1983) and
should not be approached in the same way as the first kind, by eliciting
associations.
Ornstein (1987) did not believe that the distinction between these two
types of dreams was critical; he regarded all dreams as representing the
self state. Self-state dreams do not typically lead to the emergence of
material that is consistent with or interpretible in the framework of drive
theory. The associative content characteristically generates only further
material pertaining to the state of the self and the self-selfobject envi­
ronment, particularly about its vulnerability to injury or fragmentation.
Kohut considered one of the salient features of the self-state dream to
be its significance for understanding the experience of the self reacting
to an empathic failure or momentary fluctuation in attunement. Fre­
quently, self-state dreams are reactions to rebuffs or misunderstandings,
including those occurring in a patient’s selfobject transference during
treatment. In Kohut’s (1977, 1984) view, interpretations are best framed
by remaining close to the manifest content. This approach demonstrates
to patients that dreams reflect something about their current life, some­
SELF PSYCHOLOGY: MAJOR CONCEPTS 41

thing that threatens a viable self organization or stable self experience

(Gabel, 1994; P. Tolpin, 1983). Fosshage (1989) contributed the idea that
the self-state dream may point to a glimmer or budding of reintegration of
the self, an emergence that consolidated important current experiences
with structural changes of the self.
To those interested in personality assessment, it is not surprising that
the relevance of the self-state dream, with its meaning contained in the
manifest content, frequently parallels the relevance of similar material in
projective test content. Reconstructing meaning about the self state from
content is a central point to which I devote the major portion of the second
half of this book.
 3 The Central Role
of Selfobject Functions

In the first two chapters of this book, I showed that Kohut viewed narcis­
sistic personality disorders as nonresponsive to the conventional interpre­
tations of conflict and defense derived from drive theory and ego
psychology. He discovered that patients with these disorders, when cor­
rectly understood, nevertheless formed stable and recognizable transfer­
ences, which permitted psychoanalytic treatment to proceed without a need
for technical modifications. Kohut originally identified two basic transfer­
ence patterns of mirroring and idealization, which represented the bipolar
self, and first referred to these as narcissistic transferences. His original
emphasis on narcissistic pathology and narcissistic transferences evolved
into a broad concept of the self and the self’s requirements for responsive­
ness, the self-selfobject environment. Thus, he came to see mirroring and
idealization (and later, twinship) as selfobject functions that sustain and
invigorate self-esteem. The mobilization of these functions in treatment
takes the form of a selfobject transference.
“[T]hat dimension of our experience of another person relates to this
person’s functions in shoring up our self’ (Kohut, 1984, pp. 49-50). This
perception led Kohut to develop the concept of selfobject function, which
describes a psychological state that is experienced in depth, the innermost
experience of a self that is either buoyant and firm or injured and devitalized.
The actual relationship between one person and another is secondary and
frequently irrelevant.
The selfobject is necessary to sustain optimal self-cohesion or self-es­
teem. Although Kohut considered selfobject functions to be necessary for
healthy self-esteem throughout life, he recognized their particular impor­
tance when the self is injured or undermined. At these moments, the
primary function of the selfobject is to repair an enfeebled or devitalized
self. Through the attempt to revive or rebuild a diminished or depreciated
self state, selfobject functions are most evident clinically.

42
SELFOBJECT FUNCTIONS 43

In this chapter, I describe in detail the unique importance of selfobject

functions in the psychology of the self and continue the theoretical discus­
sion of the major concepts of self psychology. The material in this chapter
has three parts: First, concepts of what a selfobject is and is not; second,
clinical consideration of how selfobject functions are apprehended or
identified in treatment; third, the three selfobject functions of mirroring,
idealization, and twinship. These selfobject functions are not only central
to Kohut’s work; they are also crucial for a self psychological reconceptu­
alization of psychodiagnostic testing content.

SELFOBJECT FUNCTIONS:
CONCEPTUAL DEFINITION

When selfobject needs are mobilized in a patient’s relationship with

another person, that person is not experienced or reacted to primarily as an
individual with needs and wishes (that is, with a center of initiative). Rather,
the person exists largely to provide a needed function for the patient. The
patient does not “use” the other in the common sense of the word but relates
to the person as though his or her raison d’etre is as an extension to the
patient. The process is not a form of boundary disturbance or a cognitive
failure in which a person providing a selfobject function has lost his or her
independent existence. Instead, the psychological essence of how the person
is experienced predominates in the individual’s sense of the other person.
In effect, other people become what they are needed to be or to provide.
A selfobject function represents a transference that is an internal mental
representation of need states. Such functions are crucial for maintaining a
cohesive self or stable self-esteem. They appear clinically and in interper­
sonal relationships as ways of relating to others on the basis of perceived
properties of individuals for satisfying particular needs.
Selfobjects, therefore, are crucial functions for sustaining or strengthen­
ing the self, in health as well as in psychopathology. Their mobilization is
signaled through affirming, accurately attuned, and optimal responsiveness
so that selfobjects serve to bolster the self. Selfobject functions are the
needs for mirroring, idealization, or twinship, needs that patients seek to
satisfy by engaging with the analyst as a transference object. Understanding
selfobject needs provides a basis for talking to patients about what they lack
(that is, what selfobject functions they seek) in the transference and ulti­
mately in life. Kohut regarded mirroring, idealization, and twinship as
44 CHAPTER 3

selfobject functions that revive the need for a viable presence when the self
lacks sufficient resilience for sustaining itself.
How is a selfobject best defined? What is and is not a selfobject? It is
simpler to say what a selfobject is not: It is not another person. A selfobject
is a purpose or function that another person serves; it is the psychological
function. It is both correct and incorrect to think of selfobject functions as
simply experiences of need states that other persons satisfy or provide for
and that the self is unable to carry out independently in the absence of such
assistance. Another person may sometimes function in this manner, but
interpersonal relationships constitute only a simplistic view of a person’s
in-depth intrapsychic states.
Thus, to say that a selfobject is another person is correct but only to a
point. It is more accurate to consider the selfobject phenomenologically as
a function that a person needs as a substitute for a missing, defective, or
deficient aspect of the self. In this respect, the selfobject function is
reparative or restorative. A misplaced emphasis on the nature or quality of
interpersonal relationships for understanding selfobject functions (such as
cooperative, paternal, or malevolent) serves only to direct attention from
the central issue. De-emphasizing the interpersonal context promotes an
appreciation that self-cohesion is primarily an internal experience of
feeling invigorated and whole.
In reference to defining a selfobject, Basch (1994, p. 2) wrote:

What exactly is a selfobject? A selfobject is not a person. A selfobject is an

intrapsychic event, an experience. So, for example, when the analyst
assists a patient to cope with the anxiety generated by heretofore unsus­
pected feelings, the analyst is not a selfobject; rather, he or she functions
to promote the patient’s selfobject experience.

Perhaps this phenomenon is best conveyed through the often-reported

experiences of analysts and psychotherapists who have felt that they are
not “in the room” or are not even noticed by a patient. Therapists first
recognize these experiences psychologically when a patient becomes
angry or disappointed by the therapist’s failure to function as an extension
of the patient’s self. This narcissistic breach is only compounded when the
analyst or therapist does not recognize what is occurring and misinterprets
the selfobject failure incorrectly as a displaced drive or wish, usually as
destructive rage.
This phenomenon initially led Kohut (1971) to discover the mirroring
selfobject function during his analysis of a patient, Miss F. This patient
SELFOBJECT FUNCTIONS 45

urgently demanded that the analyst only restate her own opinions about
events in her life and not offer any interpretations of his own. Rather than
insisting that this transference reaction represented a reactivation of libidinal
conflict and interpreting her anger and feelings of being undermined from
that viewpoint, Kohut pursued an approach based on the fact that the patient
relegated him to little more than an impersonal function. In his attempt to
understand the meaning of this experience for Miss F., Kohut ultimately
discovered the phenomenon he came to describe as mirror transference.
A selfobject is not characterized by self-preoccupation or selfishness.
Turning to others to provide a selfobject need is not the same as being
selfish, self-absorbed, or even self-aggrandizing. Although these features
may sometimes be present, selfishness is not equivalent to selfobject need.
Selfobject needs may exist side by side with the capacity to appreciate
another person’s separate existence or needs (including selfobject needs).
Selfobject needs are not always experienced with reference to another
person. They may be realized through other means, including satisfactions
derived from literature, the arts, or abstract ideas. Selfobject functions may
even take the form of gratifications or states of relief provided by a drug or
erotized object such as a fetish, and in such cases, they are no less psycho­
logically compelling.
Other self psychologists have subsequently proposed different meanings of
the term selfobject. Some of these definitions are based on the way that people
experience having selfobject functions (Stolorow, Brandschaft, & Atwood,
1987) or relationships (Bacal, 1994; Rowe, 1994). In Basch’s (1994) view,
however, the crucial characteristic of a selfobject function is the way that
another person responds affectively, acts, or otherwise fosters an experience
for the individual so as to promote a firmed-up, invigorated sense of self. In
this way, the self becomes a cohesive and enduring mental structure.
Whatever the similarity between a selfobject and an interpersonal rela­
tionship, the selfobject clearly does not assume a relational meaning.
Clinicians associated with psychoanalytic self psychology have at times
casually mentioned selfobject transferences as if they were describing a
relationship. Self psychologically informed practitioners or theoreticians,
however, do not consider a selfobject to be a person (Wolf, 1988). However
tempting it is to think of selfobject functions as an interpersonal quality or
relationship, selfobject functions are still fundamentally stable psychic
structures formed as a result of optimal frustration in early development. If
the normal, ongoing internalizations of selfobject functions are interfered
46 CHAPTER 3

with in early development, the stable, internalized structures of self-cohe­

sion fail to develop in a sufficiently robust or reliable manner.

CLINICAL AND DEVELOPMENTAL

CONSIDERATIONS

In normal development, selfobject failures occur regularly but briefly as

part of the “ups and downs of self-esteem” of a cohesive self that strives to
“straighten it out again” (Kohut, 1996, p. 73). These failures are easily
repaired in a selfobject environment capable of providing empathically
corrective responses in a timely manner. More out-of-step empathic rup­
tures may also occur, and these predispose people to temporary fragmen­
tation states. Empathic failures are reversible under circumstances in
which some degree of self structure has already been established.
Sometimes, however, fragmentation-prone self states remain as uninte­
grated self structures that are isolated or affectively walled off. A fall in
self-esteem or a diminished capacity to experience pleasure in major life
activities frequently accompanies such states. Deficiencies of the idealized
parent imago sector may produce disturbances of drive regulation and
insufficient development of the ego ideal. These disturbances give rise to a
sense of inadequacy of values or guiding principles and ultimately lead to
impoverished capacities for empathy, humor, and wisdom. Deficiencies of
the grandiose-exhibitionistic pole may interfere with, if not cripple, reali­
zation of ambitions, strivings, or goals.
An enfeebled self attempts to preserve whatever selfobject responsive­
ness can be salvaged from the experience of an unrewarding or hurtful
environment. This attempt often takes the form of grossly misaligned
behaviors, prominent among which are various addictions, perversions,
certain forms of sociopathy, and vague cravings for mystical unions with
omnipotent figures or images. These self-destructive and ultimately unre­
sourceful attempts to repair a self threatened by fragmentation have their
roots in childhood experiences of parental selfobject failures. Such addic­
tive or antisocial behaviors occur with some regularity or frequency, and
represent desperate attempts to buoy self-esteem. An addiction or fetish, for
example, substitutes for a self-regulating psychic structure. Such adaptive
failures, which Kohut referred to as disintegration products, constitute an
emerging but thwarted self, not yet capable of performing self-sustaining
functions on its own (M. Tolpin, 1978).
SELFOBJECT FUNCTIONS 47

Other disintegration products in adulthood are remnants of children’s

insufficient attempts at calming themselves in the face of threatened self­
cohesion. These can include compulsivity, ritualistic activities, and the
pathological breakdown of normal assertion into chronic narcissistic rage.
Attempts to substitute for missing structure may take the form of sexuali-
zations such as lonely masturbatory stimulation (with or without associated
fantasy), promiscuity (with or without depressive voyeuristic and exhibi-
tionistic acts or related sexualizations), or both (Goldberg, 1995). Morrison
(1984) expanded on Kohut’s (1977) view that narcissistic rage was closely
linked to affect states associated with shame: Narcissistic rage arises as a
final disintegration or breakdown product in the face of some aspect of the
shame reaction, which is itself the result of a sense of helplessness stemming
from selfobject unavailability or failure.
M. Tolpin (1978) has described depletion depression, a phenomenon
characterized by emptiness and having its roots in similar childhood states
that were unrelieved through faulty parental responsiveness. M. Tolpin and
Kohut (1980) later described experiences of children whose parents as
selfobjects have “psychologically vanished” so that feelings of energetic
buoyancy and self-confidence are replaced by emptiness and devitalization:

They [such children] feel unreal, shadowy, ghost-like, empty; their human
surroundings, their possessions, their world, become dead, devoid of
substantiality; they suffer a drop and loss in self-esteem (they feel “smaller, ”
“ordinary,” instead of proud of themselves and what they can do); they
are depleted and depressed (“underpowered”) ... the healthily proud and
jaunty aspects of the patient’s childhood self, their body-mind-self no
longer works right, (p. 430)

Kohut observed that some patients with narcissistic pathology have a

disturbed capacity to regulate skin temperature, are unable to feel or keep
warm, and are unusually sensitive to low temperatures such as drafts and
susceptible to simple upper respiratory infections. Indeed, other morbid
hypochondriacal fears and somatic concerns may also indicate a disturbed
self state, particularly if these concerns are excessive and are associated
with fantasies of falling into groundless (psychological) space, of coming
apart, or of feeling “unglued.”
In a more severe form, exclusive of psychotic presentations, clinical
psychopathology may appear as symptomatic narcissistic disturbances or
chronic, ingrained characterologic states. These can include a notable pro­
pensity for any of a variety of addictive behaviors or sexualizations in the
48 CHAPTER 3

form of perversions, promiscuity, or hypo- or hyperarousal or both. Hypo­

chondriacal or somatization reactions, frequently associated with fantasies
of falling apart, fears of disintegration, or boundary disturbances, can occur.
These phenomena are best understood as failures of regulating self-cohe-
siveness. Reactions characterized by rage (understood as narcissistic rage)
and related disintegration products (including depletion depression or anxi­
ety) may also be seen as clinical manifestations of narcissistic pathology.
A related phenomenon concerns the ways that others rebuff or depreci­
ate a person’s efforts to turn with pride in anticipation of mirroring. In
treatment as well as in early development and in virtually all areas of life,
patients (and students, and children) expect with pride or healthy assertion
about their accomplishments a mirroring selfobject response from another
person who should understand the person’s need. When these hopeful
strivings are mobilized, people anticipate an appropriate self-affirming
reaction rather than misunderstandings or responses that diminish self-es­
teem. Failure to react in keeping with legitimate selfobject needs sets in
motion propensities for shame, rage, disintegration products, or related
fragmentation phenomena.
Psychotherapists may unwittingly revive childhood precursors of devalu­
ation when they do not understand patients’ needs. Such revivals often occur
because of incorrect (but not inexact [Glover, 1955]) interpretations and
empathic errors, particularly early in treatment, when therapists attempt to
understand a patient’s central dynamics. Patients may experience such
interpretive errors as hurtful reminders of feeling misunderstood, especially
when a therapist is adamant about being correct because the patient’s reaction
of feeling depreciated revives the therapist’s own feeling of injury. In such
instances, patients frequently reject an interpretation. Once this phenomenon
is correctly identified, however, the therapeutic action should be one of
repairing self-cohesion through interpretation of the injury to the self.
It is unfortunate for treatment when this situation cannot be rectified, as
in situations in which treatment is regularly characterized by chronic
failures to correctly understand a patient’s developmental need or self state.
In these circumstances, symptoms can intensify, iatrogenic regressions can
occur, and ultimately treatment failure or disappointing treatment results.
On this point, Kohut (1984) wrote:

If there is one lesson that I have learned during my life as an analyst, it is

the lesson that what my patients tell me is likely to be true—that many
times when I believed that I was right and my patients were wrong, it
SELFOBJECT FUNCTIONS 49

turned out, though often only after a prolonged search, that my rightness
was superficial whereas their rightness was profound, (p. 94)

Kohut clearly recognized that, in life, selfobject attunement and respon­

siveness are by no means infallible or perfectly consistent. The occasional
lapse in responsiveness creates the very conditions for optimal frustration,
an occurrence that is customary and usual, if not actually necessary in the
course of normal development. In this way, such experiences of optimal
frustration give rise to transmuting internalizations if the frustrations
brought about by lapses in attunement, empathy, or phase-appropriate
selfobject responsiveness are not too prolonged or frequent.
The firming up of a sense of self is ensured in gradual increments through
accurate and timely responsiveness from selfobjects. This bit-by-bit process
is what Kohut meant by transmuting internalization. As described in chapter
2, under optimal circumstances, transmuting internalizations result from the
favorable circumstances of a relatively healthy development in which
primary caregivers as selfobjects provided sufficient empathic attunement
and responsiveness to a growing child. This situation assures an environ­
ment (or selfobject milieu, as Kohut sometimes phrased it) that recognizes
phase-appropriate needs for mirroring and idealization and provides these
reliably and with in-step timeliness.
The vitality of affect surrounding the selfobject milieu is crucial (Lichten-
berg, 1991), whether this environment, in infancy, takes the form of a feeding
that satisfies, a hand that plays pat-a-cake, or a mobile that commands attention
(Beebe & Lachmann, 1988; Stem, 1985). In treatment, this environment
emerges through the affective engagement necessary to solidify the experience
of feeling understood (P. Tolpin, 1988). Psychotherapists, by interpreting the
selfobject deficit, affectively promote salient transmuting internalizations.
These empathically grasped insights about what went wrong in a patient’s
development become an essential ingredient in treatment. Therapists do not
rectify the selfobject deficit by their actions or affective involvements with the
patient. Instead, they empathically grasp the difficulty and find a way to revive
the affective quality of the experience in framing interpretations about how and
why normal selfobject needs went awry.
Kohut emphasized that the self requires selfobject responsiveness for its
maintenance throughout all phases of life. This aspect of mental life, once
formed, does not necessarily remain stable and unchanging. Kohut’s view
was that it is normal to expect selfobjects to respond throughout life with
welcoming admiration to important aspects of life. Selfobject responsive­
50 CHAPTER 3

ness should be accurately attuned to a person’s needs for enlivening engage­

ment. At different times, the self requires its selfobjects to serve as sources
of idealized strength and calmness or to provide a mirroring or twinship
companionate function, which is also a normal or legitimate expectation.
One outcome of a successful self psychologically informed treatment is
that patients are able to extract the needed degree of selfobject responsive­
ness from the people in their lives, or to establish an alternative satisfying
selfobject environment. In the latter case, this favorably responsive envi­
ronment may come about through relationships (such as a healthy spouse
capable of responding in this way) or through rewarding activities (such as
developing a career or interests that provide fulfillment).
Thus, the emphasis on a lifelong need for selfobject responsiveness
represents yet another aspect of the difference between the psychology of
the self and traditional psychoanalytic theory and practice. Whereas in the
classical view the renunciation of archaic needs and wishes, including their
embodiment in the transference, is the goal of successful treatment; in the
self psychological view a favorable outcome implies that the self does not
become independent of its selfobjects but uses them more efficaciously than
before treatment.
To clarify this distinction between traditional and self psychological
views, consider Menninger’s (1958) comments on the successful termina­
tion of a patient in analytic treatment:

By the end of his analysis, he had learned that most of the things he hoped
for he failed to get. Most of his expectations were never realized. Instead
he only learned that one shouldn’t expect to get certain things and then
cry one’s eyes out in disappointment or scratch out other people’s eyes in
rage ... No one ever gets as much love as he wants, no one gives as much
love as he might. Choices can be made but choice involves the assumption
of responsibility and the necessity for renunciation ... Self-improvement
will continue, autonomously, but the treatment, as such, is ended. The
parties part company. The contract has been fulfilled, (pp. 178-179)

In contrast, Lichtenberg (1991) called attention to Kohut’s emphasis on

“the self’s ability to use selfobjects for its own sustenance, including an
increased freedom in choosing selfobjects” (Kohut, 1984, p. 77). For Kohut,
an essential criterion for cure was a lifelong, ongoing selfobject presence
and confirmation (psychological oxygen, as it were) rather than renuncia­
tion. In a letter to a critic questioning his treatment approach, Kohut wrote:
SELFOBJECT FUNCTIONS 51

Throughout his life a person will experience himself as a cohesive

harmonious firm unit in time and space, connected with his past and
pointing meaningfully into a creative-productive future, [but] only as long
as, at each stage in his life, he experiences certain representatives of his
human surroundings as joyfully responding to him, as available to him as
sources of idealized strength and calmness, as being silently present but
in essence like him, and, at any rate, able to grasp his inner life more or
less accurately so that their responses are attuned to his needs and allow
him to grasp their inner life when his is in need of such sustenance.
(Kohut, 1984, p. 52)

PREDOMINANT TRANSFERENCE
CONFIGURATIONS
I now describe the three major selfobject functions that incorporate Kohut’s
(1984) final considerations on the subject. Kohut recognized that self
psychology was not a static theory; accordingly, he acknowledged that
additional selfobject functions beyond the three he described might even­
tually be identified. Kohut actually discussed the mirroring and idealizing
selfobject functions as the two major forms of selfobject transferences as
early as 1966, when he noted that subtypes or variants of these functions
could be identified. Not until 1984 did he differentiate the twinship or
alter-ego selfobject function from mirroring; previously, he had considered
twinship as a subtype of the broad group of mirror transferences. Nearly 20
years later, Kohut (1984) came to view twinship as having a status inde­
pendent of mirroring. Kohut and Wolf (1978) and Wolf (1988) also de­
scribed several other possibilities of this sort, although at present the status
of selfobject functions remains largely confined to the three major forms
(mirroring, idealization, and twinship) described next.

Mirroring
Kohut (1971, 1977) was impressed by the importance of young children’s
wishes to experience prideful satisfaction surrounding their accomplishments.
He was particularly aware of children’s desires to have these budding steps
recognized and admired. Thus, this mirroring or echoing response (“the gleam
in the mother’s eye”) serves as the prototype for the mirroring selfobject
function, arising from the grandiose-exhibitionistic pole of the self.
Admittedly, grandiosity is an unfortunate phrase in view of the pejorative
connotation of the term narcissism. The term, however, stems from the
52 CHAPTER 3

perspective of normal young children’s inability to grasp their limitations

and their tendency, therefore, to overestimate their abilities (M. Tolpin &
Kohut, 1980). Kohut (1971) originally conceptualized this idea in the
framework of narcissism because he wanted to expand on this aspect of
psychological experience while remaining closely allied with structural
theory. Kohut (1977, 1984) increasingly departed from certain classical
psychoanalytic formulations, and it remains a matter of conjecture whether
he would have retained the term grandiose-exhibitionistic self.
Kohut stressed the importance of children’s needs to have their achieve­
ments affirmed, in a phase-appropriate and timely manner, originally by the
mother, but throughout life as well. In this way, the responsiveness of the
adequately mirroring selfobject leads to the internalization of stable and
enduring feelings of self-esteem, which serves as the basis for sustained
feelings of worthwhileness, buoyancy, and vitality. Ultimately, mirroring
gives rise to a person’s ambitions, goals, and strivings, as these develop and
crystallize in adulthood.
The self is particularly prone to fragmentation in the face of injury or
assault. Its viability can be compromised by chronically occurring selfob­
ject failures. Clinicians see this fragmentation when they understand how
empathic failures of mirroring selfobject responsiveness occurred. Selfob­
ject failures predispose people to develop pathological forms of narcissistic
personality or behavior disorders when the failures are severe. These
disorders are frequently characterized by symptomatic phenomena of
empty depression and a failure to achieve genuine enjoyment from work or
pleasurable activities. There is a characteristic lack of zest expressed as
prolonged experiences of boredom or ennui, accompanied by chronic
dissatisfaction or disappointment. Impoverished initiative or ambition is
notable and leads to a failure to achieve goals commensurate with native
talents or skills. This phenomenon is the horizontal split (Kohut, 1971),
representing the repression barrier, in which feelings of emptiness, bore­
dom, and hypochondria are clinical manifestations of the split between
experience of the self (self state) and the self’s relation to reality.
Patients with narcissistic personality and behavior disorders for whom
the central selfobject disturbance centers on defective mirroring are particu­
larly hypersensitive to criticism. Such patients react strongly to even minor
slights and show a limited capacity to recover easily. Their clinical picture
is dominated by symptomatic manifestations of experiences of shame or
rage on exposure of their shortcomings. Kohut considered shame to be a
reaction that occurred when selfobjects failed to respond admiringly to a
SELFOBJECT FUNCTIONS 53

child’s joyful enthusiasm. This view of shame differs from the familiar
object libidinal interpretation of shame as a response triggered by failure to
sufficiently satisfy the demands of the ego ideal.
Similarly, Kohut viewed narcissistic rage as an understandable reaction
to selfobject failure. His position contrasts with the predominant drive
theory interpretation of rage as derived from an inborn aggressive drive.
For some patients, narcissistic rage reactions assume primitive forms of
discharge, such as the disintegration products of fragmenting self-cohesion.
Thus, aggression not based on healthy assertion is thought of as a break­
down into isolated fragments of previously structuralized aspects of the self.
The characterologic description of many patients with defects of the
grandiose-exhibitionistic self includes prominent features of coldness,
sometimes accompanied by arrogance. These manifestations of arrogance
or self-aggrandizement defensively conceal feelings of shame and depre­
ciation. Often, however, self-depreciation emerges quickly and sometimes
surprisingly early in treatment, even when a patient is otherwise relatively
asymptomatic. This phenomenon is the vertical split that was Kohut’s
(1971) way of describing how the experience of grandiosity is walled off
from the experience of reality.
Kohut’s view differs from Kemberg’s (1975) interpretation of grandios­
ity as a defensive reaction to conceal feelings of rage, envy, or dependency.
Kohut’s (1977,1984) subsequent expanded view of mirroring went beyond
its clinical description in psychopathology. In its broadened scope, he
emphasized the importance of in-step confirming, echoing, or affirming
responses that are crucial to mirroring. He understood these mirroring
responses to be normal, expectable, and legitimate needs, setting the stage
for realizing goals in keeping with a person’s talents and skills. Rather than
falling prey to atrophy or derailment through neglect or unattuned respon­
siveness, these more or less normal needs should give rise to a firm and
vigorous sense of the self.
This normal development of the self, strengthened by the availability of
suitably responsive mirroring selfobjects, leads to the capacity to turn to the
world with assurance that one’s efforts are noticed and responded to
empathically. From such a position people derive satisfaction from their
abilities and interests. This reaction is accompanied by confidence and
sufficient vitality or enthusiasm to strive to reach life goals. The need for
mirroring extends from normal appreciation of one’s basic abilities in health
to pathological forms dominated by a profound sense of devitalization of
self-esteem, propensity for sexualization and addictions, and chronic empty
54 CHAPTER 3

depression. This selfobject function of the mirroring, echoing, or confirm­

ing presence is sought in both pathology and health.
In Kohut’s (1971) early description of the mirror transferences, the most
primitive or archaic form, which predominated in severe narcissistic disor­
ders, was merger transference. Merger is characterized by the greatest
regressive disturbance with the least degree of differentiation between self
and object. A second subtype of mirroring was twinship or alter-ego
transference (discussed in detail in a subsequent section because Kohut
[1984] later distinguished twinship as a distinct selfobject transference).
The twinship transference preserved a greater differentiation between self
and object than did merger transference, although the selfobject had to be
a faithful replica of the self.
The third and least archaic mirroring selfobject function is mirroring
proper, or mirror transference in the narrow sense as Kohut (1971) origi­
nally referred to this phenomenon. This transference is developmentally
more advanced with respect to the degree of differentiation between self
and object as independent centers of initiative. Together with a greater
capacity to distinguish self from other, this mirror transference is a less
regressive form of self-selfobject differentiation than are the other two
forms. The need for the selfobject is still, however, primarily that of
providing admiration. The affirming or echoing presence remains central
to sustaining self-cohesion.

Idealization
With idealization, the idealized parent imago, which is Kohut’s term for this
pole or sector of the self, emerges alongside the grandiose-exhibitionistic
pole and becomes another means of strengthening self-esteem.
Although idealization can take the form of holding others in awe,
sometimes even putting them on a pedestal, this aspect of its clinical
appearance is not invariably present. Much more common are the relatively
silent idealizations that are more subtle and less overt. This circumstance
frequently requires close examination over time before it can be defined as
genuine idealization. For this reason, psychodiagnostic testing may be
useful to detect its presence. Idealized selfobjects can be experienced as
omnipotent; when this reaction occurs in the transference, the analyst or
therapist is often revered as powerful and all-knowing. More often, ideali­
zation is mobilized when the need for a calming but strong presence is
predominant. Thus, a young child’s need for both calm strength and limit­
SELFOBJECT FUNCTIONS 55

less power is expressed through this selfobject function. A person who is

looked up to in this way becomes a presence with whom the child can merge
and thereby turn to for restoring equilibrium when the self is experienced
as weakened or injured.
The selfobject responsiveness that is needed requires the presence of the
selfobject to supply a calming feeling without withdrawing from the ideal­
izing need. Otherwise, feelings of abandonment or disappointment can
arise. The idealized selfobject function becomes embodied in those persons
who steady the course when the going gets rough. Ideals or abstract
representations can also provide an idealizing selfobject function, in the
form of religion or related forms of spirituality or of sources of inspiration
such as music, literature, or ideas. Seeing an ideal, such as a beloved art or
musical style or a cherished scientific or philosophical principle, under­
mined or attacked can produce a feeling of being let down or abandoned, if
a patient is inclined to experience idealizing selfobject needs in the form of
ideas or art forms rather than of personal relationships.
Mirroring selfobject functions do not disappear with and are not neces­
sarily replaced by idealization. Rather, all selfobject needs continue to be
present and exist side by side throughout life. At various times, one or
another predominates or becomes pressing. Some therapists have errone­
ously considered Kohut’s view of idealization to represent a transformation
of needs for selfobject responsiveness more highly developed than that of
mirroring. Although idealization often appears as a route to self-cohesion
in normal development, Kohut did not believe that it replaced mirroring or
that it represented a more developmentally advanced selfobject function.
For some people, idealization appears alongside the mirroring needs of
the grandiose-exhibitionistic pole of the self. This phase of selfobject
experience may emerge as a favorable developmental step. Although mir­
roring needs are not renounced, they may be transformed into idealizing
selfobject needs. In this way, children welcome the availability of figures
who can be idealized, who offer an opportunity to revive needs for power
and greatness through “feeling linked to the admired other: the self, in effect,
walking proudly in the shadow of his admired object” (Bacal & Newman,
1990, p. 232).
Idealization becomes important for any hope of repairing the injuries to
the self when mirroring needs have met with selfobject failure. To forestall
the ensuing devitalization of self-esteem, the possibility for a second chance
at buttressing a weakened or vulnerable self presents another opportunity
to attempt repair of the self. This process is the basis for the concept of
56 CHAPTER 3

compensatory structure that I discussed in chapter 2, as Kohut came to see

the complementary roles of these two sectors or poles of the self. The
possibility of turning elsewhere to repair self-cohesion through idealization
may be crucial if the grandiose-exhibitionistic sector is no longer suffi­
ciently robust to sustain invigorating self-esteem.
Another way in which idealizing selfobject needs become mobilized is
through young children’s gradual realization that they lack the omnipotence
associated with the grandiose-exhibitionistic sector of the self. Normally,
this recognition is nontraumatic if sufficient mirroring has enabled children
to feel that they have assets and capabilities.Gradually relinquishing the
need for greatness or omnipotence does not become devastating but pro­
vides the inevitable optimal frustration in normal development promoting
the internalizations Kohut (1971, 1977) regarded as strengthening for the
self. Presumably, the dosing and timing of selfobject disappointment are
not inordinately out of step with a child’s needs so that omnipotent longings
diminish and can be transformed into admiring or idealizing the strength
outside oneself.
Idealization is potentially fraught with land mines. It requires, first,
adequately empathic responsiveness from an idealized selfobject. People
hope for welcoming responses to their idealizing attempts; it can be devas­
tating if instead these needs are repeatedly met with rebuffs. For example,
a parent whom a young child hopes to admire for the parent’s abilities or
strengths may be too narcissistically vulnerable or depressed to provide this
selfobject function. The parent may fail to understand empathically what
the child needs. One result of this selfobject failure is the depletion depres­
sion of a narcissistic personality disorder or the acting-out addictions or
perversions of a narcissistic behavior disorder.
Another result of thwarted idealizing selfobject needs is a continual
clinging to a vaguely sensed ideal of perfection built up in an effort to
maintain an ongoing connection with the idealized object. This process
represents an attempt to create an illusion of stabilization of the self, albeit
an unreliable and transitory perception of equilibrium. This temporary state
remains fragile and does not lead to self-cohesion; instead, it predisposes
to vaguely experienced feelings of emptiness (depletion) or powerlessness.
Intensely held childhood fantasies of parental greatness are typical exam­
ples, along with an adamant refusal to abandon beliefs about a powerful
parent in the face of adversity or loss.
Thus, a young child may fervently refuse to acknowledge the death or
separation of an idealized parent, sometimes with near-delusional intensity.
SELFOBJECT FUNCTIONS 57

The child attempts to preserve self-esteem by holding onto the idealized

object for dear life despite all external evidence that the selfobject is
psychologically absent or unavailable. A well-known literary illustration is
the character of Sally Bowles in the musical Cabaret (adapted from Isher-
wood’s [1935] Berlin Stories), who vigorously holds onto the belief that her
busy, world-traveling father whom she adores and admires will eventually
visit her. Despite years of disappointing cancellations, she refuses to enter­
tain the idea that he has psychologically abandoned her.
The selfobject failure of rebuffed or empathically misunderstood needs
for idealization also prevents children from acquiring a capacity to soothe
or comfort themselves when narcissistically injured. This failure does not
protect a child from experiencing withdrawal or rage when equilibrium is
disturbed, however temporary or fragile this state may have been in the first
place. Deficiencies or disappointments in parents, or other potentially
idealizable figures, may produce a disinclination to turn with sufficient
eagerness to such figures for a calming presence or idealization. In addition,
swings or alternations between idealization and mirroring needs, often
precipitated by disappointment in an idealized object, can occur. Thus,
several selfobject needs may coexist in an unstable way, and these need not
be mutually exclusive. Typically, however, one or another need forms the
basis for the central selfobject transference.
The clinical manifestations of disturbances of the idealizing selfobject
function are identical to those of the grandiose-exhibitionistic sector of the
self. Thus, self disorders arising from selfobject failures of idealization
resemble those associated with defective mirroring and can include pro­
longed periods of an empty, depleted quality of depressive affect or frag­
mentation phenomena associated with intense tension states that are not
easily dispelled. Affect states often expressed as feeling adrift, unanchored,
or “unglued” may also form part of the character pathology of self disorders,
particularly in mild or subclinical varieties. These conditions are the nar­
cissistic personality disorders as Kohut (1971) first described them. Disin­
tegration products, such as the narcissistic behavior disorders in Kohut’s
(1971) original typology, may also occur. Prominent among these are
sexualizations of painful affect states, addictions, or intense outbursts of
helpless anger (narcissistic rage).
In its healthy forms, the idealized parent imago pole of the self is the
basis for the ego ideal (idealization of the superego) that solidifies stand­
ards, values, and goals and leads to the capacity for creativity, humor,
empathy, and wisdom. Naturally, the maturation of such qualities depends
58 CHAPTER 3

on the adequacy of responsiveness of idealizing selfobjects. The develop­

ment of the ego ideal and its mature, adaptive transformations such as humor
and wisdom occur in parallel with internalizations that are crucial to
firmed-up self-cohesion (Kohut, 1966). Thus, young children optimally
undergo gradual disappointments in the idealized object: They gradually
acquire a realistic picture of the true-to-life limitations of the idealized
figure. If these disappointments are indeed gradual and not traumatic in
extent, children can give up unrealistic and excessive idealizations and
remain capable of admiring a person’s virtues and attributes, which are
internalized as part of the child’s system of values.
If the idealized object is experienced as faltering or disillusioning in a too
severe, sudden, or phase-inappropriate manner, children do not acquire the
internalizations necessary for developing optimal self-esteem. In its place,
there remains a chronic dependence on idealizable figures, which Kohut
(1971) referred to as an intense form of object hunger. He argued that this
dependence on idealized objects assumes the desperate quality of a search
for substitutes to compensate for missing parts of vital self structure.
Kohut compared the compelling quality of this dependence on idealized
selfobjects or “object hunger” to the urgency of an addict’s craving for a
soothing drug. In this comparison, the addict needs the drug as a replace­
ment for a defect of self structure. The compelling quality of the drug is its
soothing or calming property of buoying up a self that is too deficient in
cohesiveness to recover from an injury without the substance. For patients
with such dependence, other people as potential idealizing selfobjects are
too unavailable, disappointing, or fearful to become internalized despite the
intensity of the need. Withdrawal from such selfobject needs of others
leaves patients who experience their self disorders in this way with little
recourse other than injurious narcissistic behavior disorders that often take
the form of destructive sexualizations or addictions.
When capable of becoming engaged in treatment, a driven, unrelenting,
idealized selfobject transference sometimes appears in the therapeutic
reactivation of the search for the omnipotent object. This process can
become, in effect, an addiction to the treatment process itself. In unfavorable
treatment environments, related attempts to internalize an idealizing selfob-
ject function can take the form of perpetual reliance on self-help structures
or organizations, such as the popular 12-step programs. Patients in need of
such efforts usually remain chronically dependent on these equivalents of
institutional transferences because structural change (that is, transmuting
internalizations) rarely occur. Counseling or supportive psychotherapy situ­
SELFOBJECT FUNCTIONS 59

ations of this type do not usually bring about the most optimal internaliza­
tions; counselors, therapists, or therapeutic milieus like this are, in effect,
“swallowed whole.” As with hunger, satiation of archaic selfobject needs
requires perpetual nourishment.
Kohut (1971) identified three forms of the idealized parent imago. In the
most archaic type, a merger with the omnipotently perceived selfobject
protects the self from traumatic overstimulation leading to diffuse narcis­
sistic disorganization. In a less archaic form, associated with a greater
degree of differentiation between self and selfobject, the idealized selfob­
ject serves a function of strengthening the enfeebled self in the control or
neutralization of drives. Kohut described a still less archaic form of the
idealizing selfobject transference during the oedipal period of development,
associated with maximal differentiation between self and selfobject; here,
the power and perfection of the selfobject is needed for approval and for
providing guiding ideals and values.

Twinship
Kohut’s (1971) earlier work referred to the “mirroring transference in the
broad sense” and the ’’mirroring transference in the narrow sense.” He
intended the broad designation to refer to the generalized need for mirroring
in all its various forms: merger, twinship (alter ego), and mirroring in the
narrow sense. Kohut (1984) regarded the twinship selfobject function as
sufficiently important in its own right to be differentiated from mirroring.
Thus, twinship is equivalent to mirroring and idealization as an independent
selfobject function. The analysis of one particular patient initially suggested
the twinship function, and clinical observation in several other analyses
further demonstrated it.
The selfobject can be somebody (sometimes a thing or object) with
whom a person can talk or keep company; it can also exist as a silent
presence to evoke when needed. Twinship selfobject needs arise to combat
self states of depletion, loneliness, or related experiences of devitalization
of the self. Kohut considered the twinship function as a person’s experience
of being one among others and deriving a deeply felt sense of security from
this realization. Its central purpose is to represent the need for a selfobject
to operate as a twin or faithful replica of the self. Thus, a person as selfobject
acts like oneself but does not merge with one’s sense of self.
Twinship is a basis for feeling a sense of belonging or psychological
connection. LaFemina (1996) described it thus:
60 CHAPTER 3

Twinship maintains or assists the cohesion and viability of the self. Twinship
does not refer to an actual relationship between two people, nor to the
fantasies of a relationship designed to maintain defensive purposes. A
twinship relationship is established to provide specific narcissistic functions.

An important feature of the twinship selfobject function is that the

’’twin” is experienced as a part of the self, specifically a part that is sensed
as just like oneself. This alter-ego feature provides people with the feeling
of not being alone with their sense of injury or devitalization. The twinship
selfobject offers a sense of calming in that it can be evoked as a silent
presence when a person’s self-esteem is undermined or vulnerable. The
twinship need emerges to reinstate a feeling of companionship, based on
similarity of need or empathic understanding.
Kohut’s (1984) example is that of a person who responds to another so
that the two feel a source of joy or pleasure in each other. Ultimately, the
internal experience is one of feeling invigorated or enlivened. People seek
a selfobject experience to create the feeling that another person is just like
them, a faithful replica. They need another person to share their experiences.
The selfobject is experienced as a “soulmate” in whose presence a person
can feel calmed or soothed. This reaction may occur when the one who
fulfills this selfobject function replicates the person’s self state and need for
empathic responsiveness. Thus, the “soulmate” is experienced as injured or
as a source of greatness or strength, just as the person experiences himself
or herself.
The companionate function may take several forms, and Kohut’s pheno-
menologic description is particularly evocative:

Someone will gradually appear in the patient’s memories from childhood

who, differing from the hypochondriacal, anxious, nonsustaining member
of the family, was, or at least had once been, strong and idealizable ... a
person for whom the patient’s early existence and actions were a source
of genuine joy ... as an alter ego or twin next to whom the child felt alive
(the little girl doing chores in the kitchen next to her mother or grand­
mother; the little boy working in the basement next to his father or
grandfather) will gradually become clear. (Kohut, 1984, p. 204)

Kohut also recognized that twinship functions can be mistakenly de­

duced from the similarity of external resemblances. He emphasized that
“identity of significance, similarity of function” (Kohut, 1984, p. 198)
should be considered the predominant psychological factor. Thus, compari­
sons to twins and people who resemble one another are superficial. It is the
SELFOBJECT FUNCTIONS 61

core of the experience that gives the twinship selfobject its urgency or
importance for a person’s self-cohesion. A child who talks to a beloved toy
or comforting companion, such as a teddy bear, as if the object were
experiencing the feelings that the child experiences, comes closer to the
spirit of twinship. The selfobject may be a person, object, or even an abstract
idea; its form is secondary because the essential function is the companion­
ate or faithful replica quality.
Kohut considered the problem of distinguishing twinship from the other
selfobject functions. In the example of a friend who placed a comforting
hand on a person’s shoulder when the person is troubled or hurt, Kohut
observed that this gesture might represent a twinship selfobject function if
the friend understood exactly how injured the person felt. He dismissed this
possibility, however, by comparing the weakened or injured self that
experienced the invigorating gesture of the hand on the shoulder to an
unhappy baby picked up by the mother. Here, the mother’s ministration
permitted the baby to merge with her calmness and omnipotence. This
interpretation emphasizes that lifting the baby represents a remobilization
of a mirroring selfobject need, as does the arm around the shoulder. Kohut
noted, however, that the gesture of the hand on the back might connote a
twinship function in particular clinical circumstances.
An illustration of healthy twinship is the intense creative relationship
between the playwright Jon Robin Baitz and the actor Ron Rifkin. The depth
of intuitive understanding between them has enhanced the work of both
such that the playwright regards the actor as “my Lear” and the actor says
of the playwright: “Robbie is part of me. You know, we finish sentences for
each other. Certainly he understands something about me that I don’t” (A.
Klein, 1996). Their collaborative relationship was described in a New York
Times article as: “a rare and empathic alliance between playwright and actor,
as if a singular esthetic identity arose out of collaboration” (A. Klein, 1996).
M. Tolpin (1995) gave an illustration of a related but more subtle
twinship dynamic—the lengthy friendship between Anna Freud and
Dorothy Burlingham. Tolpin regarded Dorothy Burlingham as essential to
ensuring the lifesaving self-cohesion of Freud’s daughter. Tolpin considered
their twinship bond as crucial to consolidating what Anna Freud referred to
as her “circle of health.” In this circle, she could hold onto the unwavering,
unconditional, self-affirming regard of Dorothy Burlingham as a firmly
established internalized psychological structure. Thus, through the twinship
with Burlingham, Anna Freud was able to revitalize a profoundly injured
self state. Freud could free herself from unsuccessful attempts at mirroring
62 CHAPTER 3

and insufficiently sustaining idealizations to allow her to pursue work that

was productive and satisfying, work that she accomplished together with
Burlingham. This productive “we-self,” as M. Tolpin (1995) put it, led to
their achieving mutually productive studies of war-traumatized children
and pioneering contributions to child psychoanalysis.
If twinship selfobject needs are massively or chronically interfered with
in the course of normal development, failures to secure these needs can
produce states of acute disconnectedness from people or groups that define
a person’s work or existence. Such failures lead to a feeling of being
distanced from humanity. For some people, these failures can take the form
of feeling alienated from cherished values.
As with mirroring and idealization, but more subtly so, twinship often goes
unnoticed until it is disrupted. For example, a smoothly proceeding psycho­
therapy may suddenly appear to break down if a therapist or analyst is, for the
moment, no longer experienced as thinking just like the patient or having the
same values or views as the patient. This disruption, with its symptomatic
appearance in depression, agitation, or anger, is the marker of the patient’s
selfobject need that has become perturbed. If the analyst or psychotherapist
thought that the patient was predominantly displaying a mirror transference,
he or she would be surprised if the patient were to react strongly with
depression or rage at the analyst’s slight or misunderstanding.
Suddenly, so it appears, the patient reacts with eruptions of affect or
disorganization as though a critical function has been interrupted. An
empathic failure is now experienced around the twinship need. This reaction
may occur alongside other selfobject functions, and in fact mirroring and
twinship needs frequently occur simultaneously. As an example, a patient
becomes anxious when he or she feels that the analyst no longer exists as
an alter ego who is exactly like the patient. If the analyst or therapist is now
perceived to have an independent existence beyond the patient’s selfobject
need for an exact replica, this perception may provoke a fear of loss and
feelings of disconnectedness or isolation.
 Part II
Selfobject Functions:
Psychodiagnostic Indications
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 4 Content Analysis
of Psychodiagnostic Testing:
A Pathway to Understanding
Self States

In previous chapters, I presented the general principles of psychoanalytic

self psychology. Here I propose a framework for conceptualizing these
phenomena by using psychodiagnostic tests. I describe the links that bridge
key concepts of self psychology with psychological testing findings, in the
hope of specifying how self psychological concepts, particularly selfobject
functions, can be evaluated in the test material. It is my intention to
emphasize a way of viewing the material generated by a battery of projec­
tive psychological tests. Thus, unfolding content, associations, fantasy
productions, and manner of engagement with the examiner may produce a
systematic way of understanding this material from the viewpoint of self
psychology. Although I stress conceptual guidelines to the interpretation of
test content derived from Kohut’s ideas, neither specific criteria nor formal
test scores or indices should be expected to emerge from this attempt.
Empirically derived formal scores, algorithms, or combinations of scores
producing decision strategies may eventually be derived; a score-based
interpretive strategy necessarily lags behind a precise articulation of the
theoretical foundation of Kohut’s crucial concepts. The general approaches
to interpreting psychological testing that I present are those described by
Rapaport, Gill, and Schafer (1945,1968), Schachtel (1966), Allison, Blatt,
and Zimet (1968), and Lerner and Lerner (H. D. Lerner & R M. Lemer,
1988; P. M. Lerner, 1991).
I do not attempt to restore a former tradition or to argue for one
conceptual approach over another. Rather, my intent is to provide a theo­
retical structure that makes use of a content-derived interpretive strategy
for examining and understanding self disorders. I begin by reconsidering
indications for diagnostic testing in light of contemporary theoretical for­
mulations of clinical psychopathology. I then review several customary

65
66 CHAPTER 4

approaches to the clinical interpretation of psychodiagnostic testing, includ­

ing those of the Menninger school and the clinical contributions of Ernest
Schachtel to Rorschach psychology, the Lemers, and Exner’s (1991,1993)
Comprehensive System for the Rorschach test. I also include the contribu­
tions of Aronow, Reznikoff, and Moreland (1994) to content analysis as
well as important interpretive approaches to the TAT and figure drawings.
One major section of this chapter concentrates on the inferential strate­
gies of psychodiagnostic testing or assessment of personality. The focus is
on broad principles of inferential thinking rather than on differences in
conceptual frameworks. I discuss the integration of findings across tests in
a battery and devote special emphasis to synthesizing test findings pertinent
to differentiating conflict from deficit states as these were described in
chapters 1 and 2. After establishing this basic foundation, I then state the
case for incorporating a self psychological approach into the armamentar­
ium when using psychological tests to understand self-esteem regulation,
self states or self disorders, and selfobject functions.

DEVELOPMENTS IN PSYCHODIAGNOSTIC
TESTING

My approach to the clinical examples in Part II has been influenced by the

contributions of Roy Schafer (1954,1967). Written more than 40 years ago,
Schafer’s work, building on the pioneering efforts of David Rapaport at the
Menninger Clinic, has been a major influence on clinical thinking about
diagnostic testing. My proposed conceptual formulations differ in several
respects from the theoretical propositions of Schafer and his colleagues, but
the inferential approach that they refined serves as my model. Largely in
respect to their tradition, I use the terms psychodiagnostic and psychologi­
cal testing throughout, instead of the more current terms psychological
assessment or personality assessment. My usage not only acknowledges a
tradition no longer so prevalent in clinical writing and practice, but it also
differentiates my content-based approach from empirical approaches to
studying personality.
As in many fields, not only in psychology but also throughout science
and applied technology, practitioners of psychodiagnostic testing have
become increasingly concerned with reliability and validity of measure­
ment. More and more attention has been paid to sophisticated statistical and
psychometric methods necessary to establish the empirical basis for psy­
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 67

chological tests of personality. Few can fault this development. Admittedly,

advances sometimes have a price, in this case, a diminishing appreciation
of the content behind the verbalizations, the very factor that makes the
familiar projective tests truly projective in the first place.
One reason for the revival of interest in the Rorschach test is that it is
scorable, and it has been subject to the renewed scrutiny that contemporary
psychometric theory and methods can offer and in fact demand. Other
instruments with a strong empirical foundation, such as the Minnesota
Multiphasic Personality Inventory (MMPI-2) and the Millon inventories,
have attracted attention for the same reason. Consequently, tests like the
TAT, figure drawings, and Sentence Completion Test, which never bene­
fited from well-studied empirical foundations, have been relatively ne­
glected, perhaps because the scoring basis for these instruments has been
too inconstant. Their use has declined somewhat, and there has been some
disinclination to examine their potential utility.
The relatively diminished interest in the TAT and related projective tests
contrasts with the resurgence of interest in empirical Rorschach scores and
indexes since the introduction of the Comprehensive System (Exner, 1993).
Furthermore, young clinicians are unfamiliar with many projective meas­
ures, which are no longer widely or routinely taught in clinical psychology
programs. The same is true for content and sequence analysis on the
Rorschach test, despite Lerner (1991) and the recent publication of a second
edition of one of the few volumes on the subject (Aronow et al., 1994).
Beliak’s volume on the TAT survives and has undergone numerous
revisions (Beliak & Abrams, 1997), and Handler’s (1996) review of figure
drawings methods has been a valuable contribution. Other books chroni­
cling tests such as the TAT and projective drawings (Goodenough, 1926;
Harrower, 1965;Holt, 1978; Macho ver, 1949), although considered classics
by many, are nevertheless either out of print or difficult to obtain. Some of
these rest in dusty libraries rather than on the shelves of working clinicians.
Arguably, this fate may be well deserved.
In addition to these problems, several major test instruments have
undergone revisions, such as the Wechsler Adult Intelligence Scale (WAIS),
which has been revised three times after the Wechsler-Bellevue scale in use
in the 1940s and early 1950s and studied by Rapaport and Schafer. The
MMPI-2 and Millon Clinical Multiaxial Inventory (MCMI-III) are the
current versions of these instruments, both of which represent revisions in
the past decade.
68 CHAPTER 4

Certainly, the Comprehensive System for the Rorschach is substantially

different from the Menninger scoring and administration procedures. Ra-
paport had wide-ranging interests in the psychoanalytic implications of
cognitive and perceptual functions. He was particularly interested in recon­
ciling ego psychological views of higher mental processes with the findings
from experimental psychology laboratories. This interest disposed him to
view memory as a particularly important psychological process and influ­
enced his decision that the Rorschach inquiry should be conducted after
each card during the association phase, to minimize potential distortions
arising from memory factors between the two stages of the Rorschach
administration.
The enhanced psychometric advances that invariably come with test
revisions have included improved normative reference groups and careful
attention to contemporary statistical analytic procedures. These interests
have outpaced attention to the in-depth understanding of test instruments
for interpreting psychological phenomena such as conflict, defense, and
self-esteem. One can be more confident of the MCMI-based or Compre­
hensive System-based decision rules for the diagnosis (using current no­
menclature and criteria such as that of DSM-IV) of various psychiatric
disorders than of the pr^-Diagnostic and Statistical Manual o f Mental
Disorders (DSM-I)-influenced diagnostic views available to Rapaport and
his colleagues. It is by no means clear, however, that the understanding of
the use of these instruments for assessing ego functions, conflict-defense
configurations, quality and nature of object relations, and self-esteem
regulation is thorough or of sufficient depth.
The issue remains a matter of emphasis, which for Rapaport et al. (1945,
1968), rested on the overarching rationale of the projective hypothesis:

[E]very reaction of a subject is a reflection, or projection, of his private

world. This approach to testing contrasts sharply with that usually charac­
terized as “psychometric.” The main aim was not to attribute to a person
a percentile rank in the population or any other numerical measure
allegedly representative of him. The aim was rather to understand him: to
give him a chance to express himself in a sufficient number and variety of
controlled situations, the nature of which has been well enough explored
to enable the psychologist to infer, out of the subject’s reactions, the gross
outlines of his personality make-up. (Rapaport et al., 1968, p. 52)

Psychometric enhancements clearly are crucial, as are the more sophis­

ticated statistical methods of measurement diagnostics, such as sensitivity,
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 69

specificity, and power. As Rapaport’s quotation indicates, however, even

newer methods of measurement do not settle the issue decisively. The
scientific basis of psychodiagnostics requires, as it should, careful attention
to sophisticated psychometric properties of the test instruments. Neverthe­
less, there remains a lag in understanding the meaning of the content of
well-constructed tests with reliable scores. This lag may have contributed
to a neglect of the very psychological principles that the Menninger group
developed to such a high clinical standard. Although it is a mistake to
dismiss this approach as simply an art form, those in the field of personality
assessment are probably best advised to pay attention to re-examining the
art to try to do it justice as a science, insofar as the concepts and limits of
understanding permit.

THE CHANGING LANDSCAPE

OF PSYCHOLOGICAL TESTING

Clinical Indications for Assessment

Therapists have generally recognized the clinical interview as the chief

method for understanding a patient’s symptom picture and adaptational
problems. The interview or anamnesis remains the primary reference point
for gathering clinical information to understand specific recent or acute
events (precipitants) superimposed on habitual patterns of reacting to life
events and relating to others (clinical history). Several comprehensive,
in-depth diagnostic interviews are usually necessary to conceptualize a
person’s problem and to devise a treatment approach.
Psychological testing is generally not indicated for this purpose if a
referring clinician is well trained, informed, and accustomed to disciplined
clinical thinking. The routine use of psychological tests is usually atypical,
except possibly for children and adolescent patients. The standard has
generally been, and will probably continue to be ever more so, one of
requesting psychological tests for consultative purposes when clinical
interviews are inconclusive or when differential diagnostic questions re­
main unresolved. This situation includes the majority of symptom-focused
or behavioral disorder complaints requiring either acute treatment or emer­
gency intervention as well as chronic, characterologically based personality
features or syndromes that affect treatment outcome.
70 CHAPTER 4

Sound clinical indications for psychological testing consultation include

the need to distinguish psychotic symptoms of patients with affective or
cognitive disturbances, to determine the predominant features of those with
mixed depressive-manic-anxiety syndromes, and to augment a complete
diagnostic study of treatment-refractory patients. Diagnostic testing can
sometimes be informative, even under suboptimal conditions, for patients
who are uncooperative or noncompliant, including those with acute psy­
chosis and confusional states, and for patients with alcoholism, substance
abuse, and related toxicities that preclude a reliable diagnostic interview.
I have chosen to emphasize the use of psychological testing in the
context of the best-informed contemporary understanding of nosologic and
descriptive symptom-syndrome clinical presentations. It is easy, however,
to think of other examples of acute treatment or forensic intervention
decisions such as removing a child from a home, involuntary hospitaliza­
tion, or documenting a conservatorship need. Furthermore, identifying the
nature and pattern of disturbances of higher cortical processes in distin­
guishing between psychiatric and neurological illnesses has recently come
to occupy a central place in psychodiagnostic testing. The use of person­
ality tests may be valuable when the psychiatric aspects must be examined
as comprehensively as are the neuropsychological components. The as­
sessment of personality and psychopathology is indicated when the psy­
chiatric component is a prominent part of a neurological condition,
particularly when the premorbid personality is important to consider, as in
cases of traumatic head injury.
Another category of diagnostic testing consultations that does not nec­
essarily occur in a specific diagnostic or clinical disposition context is that
of evaluating chronic maladaptive difficulties in living, for which people
occasionally refer themselves for long-term intensive psychotherapy or
psychoanalysis. This psychodiagnostic testing consultation presents some
of the best opportunities for capitalizing on the greatest strengths of tests,
particularly the projective instruments. Few clinicians with sufficient train­
ing and experience to perform this type of in-depth analysis of personality
dynamics of characterologic conditions may now be available. Notwith­
standing this possibility, many people with characterologic states and Axis
II personality disorders continue to seek treatment.
Some of these patients can also be treated to good advantage with
knowledgeably applied pharmacotherapy. For many, pharmacotherapy is
an adjunctive rather than a first-line treatment strategy. For some, behav­
ioral methods may not have offered sufficient symptomatic amelioration.
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 71

For these people, it may be important to use projective tests to carefully

evaluate subtle but stubborn features that can complicate treatment and are
not otherwise readily detected, regardless of the eventual treatment of
choice. These features include both Axis I disorders and the comorbidities
between Axis I and Axis II conditions. Much of the improved understanding
of the biological and genetic relations among such disorders has come about
through the efficacy of pharmacotherapy.
Major advances in nosology and biological psychiatry have had little
bearing on developments in psychological testing. These advances neither
spelled the decline of testing and assessment nor suggested a widening
schism in the uneasy interface between psychology and psychiatry. The
considerable advances in the knowledge of the nature of psychiatric disor­
ders and their somatic treatments have, however, helped to target areas for
psychological testing. Answers to diagnostic questions are now more feasi­
ble with the awareness of and sensitivity to contemporary diagnostic criteria
and symptom complexes. The Comprehensive System, the MMPI-2, and the
MCMI-III have benefited from this refined diagnostic nosology.
At the same time, the failure to keep pace with sophisticated develop­
ments in the fields of both biological psychiatry and psychometric test
development has worked to the disadvantage of instruments such as the TAT
and figure drawings, which are useful for identifying character pathology.
Clinicians have always understood that personality and characterologic
features persist, whether they are secondary to or independent of pharma­
cologically targeted syndromes. These personality characteristics can be
better understood, if not actually better treated, once complete and enduring
remission of the Axis I syndromes is achieved.
As mentioned earlier, chronic personality disturbances may also influ­
ence the clinical outcome of Axis I disorders. These personality features
are sometimes present as distinct personality disorder syndromes or as
premorbid ingrained personality deficiencies. In the latter case, such per­
sonality defects may be subsyndromal but are nevertheless usually persist­
ent and contributory to the clinical picture. When the waters are muddied
as they often are with acute syndromal features and contributing or aggra­
vating personality features hopelessly entangled, it is extremely difficult for
a treating clinician to understand the role of characterologic factors in the
total clinical picture.
Although it was once hoped that psychological testing would help to
unravel these complexities, there has always been a limit to understanding
the meanings of test scores and findings, just as there are limits to construing
72 CHAPTER 4

sometimes confusing and discrepant clinical interview findings. Testing

may help unravel inconsistencies and subtle influences but can also add to
the confusion. As clinical sophistication expands, powerful, targeted treat­
ments of demonstrated efficacy achieve their therapeutic benefit more
rapidly than was once the case, and clinical indications for psychodiagnostic
testing under the worst “battle conditions” diminish. Psychological testing
can achieve its most beneficial result when tests are not taxed beyond their
diagnostic capabilities. Thus one need not expect tests to solve problems
for which empirical evidence has often been dubious, particularly the TAT
and figure drawings. Some psychologists such as Schafer, Schachtel,
Lerner, Holt, and Harrower, have always believed that the greatest useful­
ness of psychological tests lies in their descriptions of the depths of human
experience and the specification of the dynamics of conflict, deficit, psy­
chological structure, defenses, and object relations.

THE EXPANDED VIEW OF SELF DISORDERS

AND PSYCHODIAGNOSTIC ASSESSMENT

Some patients with acute Axis I conditions also have subclinical but still
maladaptive personality disorders that aggravate the Axis I disorder. Such
patients include those with disturbances of self-esteem regulation that may
or may not be recognized as contributing factors to the overall clinical
picture. As for other personality disturbances, disruptions of self-esteem or
prominent selfobject failure are important precipitants for some Axis I
illnesses, including mood disorders, addictions, and sexual perversions.
Therefore, the identification of self disorders is often important.
Some self disorders can exist independently, of course, as the primary
condition, that is, as an Axis II disorder. Self disorders can also underlie
or precipitate many conditions not usually considered to be narcissistic
disorders or related disturbances of self-esteem regulation. These con­
ditions may be secondary to an acute Axis I disorder, such as psychotic
episodes, severe episodes of affective illnesses (including manic and
hypomanic disorders), anxiety syndromes, and subsyndromal conditions
such as dysthymia, with or without a history of comorbid major depres­
sion (so-called double depression) or mania (Akiskal, 1980).
Such self state disturbances often require special diagnostic chal­
lenges to detect them. Careful interviewing with an eye to the clinical
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 73

problem frequently helps to identify an underlying self disorder, but psy­

chodiagnostic testing is sometimes needed to elicit the self state disturbance.
Difficulty in diagnosis can arise because the primary treating clinician does
not recognize the nature of the pathology or because the acute illness is
prominent or urgent enough to disguise a comorbid self disorder.
Indeed, the main purpose of this book is to specify the theoretical links
between the principal concepts of self psychology and their corresponding
psychological test indications. To provide a coherent conceptual approach
for bridging these two areas, I make inferences informed by self psychology
about test indicators and content. This task is the entire focus of Part II.
The clinical inferential process to be discussed here should not be
construed as an effort to describe narcissism or narcissistic personality
disorder. In light of the evolution of psychoanalytic self psychology that I
described in detail in chapters 1, 2, and 3, the view of the self examined
here is derived from a major reformulation of several principles of classical
psychoanalytic theory. I have reconceptualized some psychoanalytic con­
cepts as secondary to repairing or preserving self-esteem and self-cohesion,
such as the drives and the oedipal conflict. This reconceptualization is the
broadened psychoanalytic psychology of the self; it is not a theory of
narcissistic pathology.
In chapter 1 ,1 have already discussed at length how self psychology has
advanced beyond a clinical theory of narcissistic personality disorders. These
conceptual viewpoints influence the interpretation of projective test findings
in ways departing in content, although not in spirit, from those generated by
Schafer (1954), Schachtel (1966), and P. M. Lemer (1991). I approach the
psychology of the self not as an expanded version of drive theory or of
narcissism, but as an appreciably modified version of psychoanalytic theory.
The psychodiagnostic testing examples and vignettes in chapters 5 and 6
illustrate that responses usually conceptualized from drive theory and ego
psychological perspectives can be understood in the alternative psychody­
namic framework of self psychology.

CONCEPTUAL APPROACHES
TO PSYCHODIAGNOSTIC TESTING:
GENERAL PRINCIPLES
Psychological assessment of mental functions has a history over 100 years
old. Major early achievements were the instruments measuring intelligence,
notably the Binet and Wechsler scales. The development of tests for the
74 CHAPTER 4

measurement of personality followed not long thereafter. At that period,

testing centered on identifying traits or temperaments as dimensions of
normal personality, including aberrant forms of these personality features.
Symptomatic illnesses such as obsessions or compulsions, psychotic disor­
ders, and mood disorders received attention later.
Still later, the asymptomatic character neuroses became a subject for
study by using projective tests, primarily under the influence of psychoana­
lytic theory. The framework for using psychological tests was influenced
by the conceptual anchor of Freud’s (1926/1959) second theory of anxiety,
which crystallized in his structural theory and the evolving ego psychology
that followed. In other theoretical frameworks, such as social learning
theory, the interest in psychological tests to examine conflict-defense
configurations was generally minimized in favor of identifying trait or state
personality characteristics more than psychodynamic mechanisms.
During this period, David Rapaport wrote extensively about psycho­
analytic metapsychology. He gave considerable attention to the theoreti­
cal rationale and clinical interpretive importance of projective tests of
personality. Rapaport was also interested in nonprojective tests of cog­
nitive functions as well, particularly their significance for evaluating the
apparatuses of ego autonomy or conflict-free ego spheres. Hermann
Rorschach’s (1921/1981) inkblot technique was known to Rapaport, as
was the monograph outlining Rorschach’s preliminary but still tentative
formulations about personality. Together with Henry Murray’s (1938,
1943) Thematic Apperception Test, these instruments formed the basis
for the first systematic investigation of psychological tests for in-depth
personality analysis, tests informed by psychoanalytic theory at that
point in time (Rapaport, Gill, & Schafer, 1945, 1968).
Rapaport and his colleagues studied these projective tests together with
several other instruments, some nonprojective in nature, like the Babcock-
Levy Story Recall Test, Wechsler-Bellevue scale, and Hanfman and
Kasanin’s Object Sorting Test. Rapaport et al. (1945, 1968) developed an
interpretive framework to use these instruments for the diagnosis of specific
pathologies. Equally important, they described how to use these techniques
to identify predominant conflicts, defense operations, and levels of adapta­
tion. Although Rapaport was perhaps best known and respected as a brilliant
psychoanalytic theoretician, it was principally Roy Schafer (1948, 1954,
1967) who developed the clinical utilization of the Rorschach and TAT to
its fullest. Important contributions by Mayman (1967, 1970), Schachtel
(1966), and Holt (1978), were notable additions to this early work.
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 75

A distinguished contributor to psychoanalytic theory in recent years,

Schafer’s early contributions in the area of diagnostic psychological
testing articulated the major principles of projective test interpretation
identified with the Menninger tradition. Other schools of thought have
also influenced diagnostic psychological testing, notably those based on
preoedipal disturbances of object relations. Kwawer, Lerner, Lerner, and
Sugarman (1980) have applied this viewpoint to psychodiagnostic test­
ing in the past 2 decades. Exner’s (1993) Comprehensive System repre­
sents the most systematic and empirically sound overhaul of scoring
necessary for reliable and valid interpretation of Rorschach signs and
indicators.
The interpretive approach of Rapaport, Schafer, and their colleagues
has had a continuing and far-reaching influence even beyond its appli­
cations to ego psychology. The Rapaport-Schafer system influenced
object relations-based approaches to projective testing as well as some
aspects of the Comprehensive System. It is this specific tradition that I
emphasize in the following description of strategies for interpreting
psychodiagnostic tests, as enhanced by contributions from Schachtel
(1966) and R M. Lerner (1991). Although this selective emphasis does
not ignore different approaches, it emphasizes the Rapaport-Schafer
approach to the clinical interpretation of content. This approach serves
as the basis for incorporating Kohut’s self psychology with the psycho­
analytic concepts influencing diagnostic psychological testing.
One focal point of the Menninger method is the use of a battery of
tests; this method eschews relying on one or two tests as the basis for
deriving the principal findings. Rapaport considered several reasons for
this decision, including the view that all tests are subject to error. Thus,
relying too strongly on one or two instruments maximizes the possibility
that error variance from fluctuating mental states and uncontrolled
influences of premorbid or attitudinal factors contributes to atypical or
confounded clinical findings. This consideration is partially psychomet­
ric and affects both reliability of measurement and validity. Another
reason for Rapaport’s preference for the test battery approach is that
psychopathology is selective in its effects on psychological functioning.
Thus, in view of the operation of conflict-free ego spheres and the
differential sensitivity of various projective tests to particular areas of
personality functioning, multiple tests are necessary to minimize diag­
nostic error resulting from false negatives.
76 CHAPTER 4

CONCEPTUAL APPROACHES
TO PSYCHODIAGNOSTIC TESTING:
SPECIFIC PRINCIPLES

Regardless of whether content, supplementary verbalizations, or exam­

iner-patient interactions are emphasized in a diagnostic study, all ap­
proaches to test interpretation and analysis begin with consideration of
formal test scores. The customary approach starts with the summary of
principal scores, indexes, or percentages based on test protocols like the
Rorschach structural summary, WAIS-III subtest profile or index score
patterns, MMPI-2 clinical scale profiles or two-point configurations, or
some other psychometric pattern. Certain measures are isolated for
special consideration, such as particularly revealing Rorschach re­
sponses or unusual dimensions of the response. For example, responses
in which statistically infrequent determinants, such as vista or texture,
occur might be singled out for particular attention. Inferences are made
on the basis of patterns that conform to empirically derived interpretive
conclusions. Varying levels of importance are attached to interpretive
decisions that can sometimes be considered hierarchically.
For example, a greater importance is attached to a positive Comprehen­
sive System Schizophrenia Index than to any of the findings contributing
to the index, such as thought disorder variables or X-%>Xu%. Thus,
analysis of empirically supported global indexes, ratios, or specific scores
provides the anchor for hierarchical clinical interpretation. Consideration
of the components of the major indexes (second-order indexes or scores)
generates other psychopathology variables that may be important to add
to the total clinical picture. A level of analysis using only the Schizophrenia
Index on the Rorschach or relying exclusively on an elevated 6-8 MMPI-2
configuration to consider the applicability of a schizophrenia diagnosis
does not usually contain sufficient information to determine clinical phe­
nomenology, such as paranoid, schizoid or withdrawn, positive or negative
syndrome type, or chronic versus acute course.
Few psychodiagnosticians disagree with such an approach. Its crucial
value is as a starting point in the clinical workup. The nature and
subsequent levels of analysis are the basis of the controversies in the
field about how far and on which forms of evidence should deeper
investigation proceed. How far to probe and what data to use depend on
the theoretical frameworks of various diagnostic testing specialists.
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 77

Deeper levels of analysis of psychological test material may include

content, sequence analysis of responses, and test behavior and verbaliza­
tions. These areas of inquiry are typically not anchored in an empirically
based foundation beyond theoretical conviction or accumulated clinical
wisdom or experience. Consequently, such inferential strategies as content
analysis are speculative. They require caution and judicious application to
prevent reaching conclusions that may be “fascinating, deep and brilliantly
explanatory, but they may have little or nothing to do with the specific
patient” (Schafer, 1954, p. 141).
Psychological testing is not unlike the clinical thinking that informs
most areas of insight psychotherapy, yet it rarely has the benefit of the
self-corrective steps that psychotherapists can accumulate from experience
with patients that is built up over time. Every clinician’s theoretical persua­
sion dictates the level of depth of analysis that is relevant to conceptualizing
personality. Some clinicians do not consider findings that are not empiri­
cally well grounded. Others regard constructs like object relations, de­
fenses, central conflicts, self-cohesion, or adaptational resiliences as
clinically important and most likely prefer to understand projective test
indicators of these depth psychological characteristics. They also attempt
to make peace with the fact that they are delving into uncharted territory
with test findings that are less firmly grounded than are the higher order
variables that the examiner started with. However, while stepping with care,
and if so disposed, this need not be like walking in quicksand.

ROY SCHAFER: THE MENNINGER TRADITION

Schafer’s comments on clinical evidence for interpretation are just as

important today as over 40 years ago when he first wrote on the subject.
The reason for its importance is different, however: The psychometric
sophistication that is now de rigueur barely existed in the 1940s. Then,
content analysis was considered crucial to interpretation because empirical
scores were thought to be insufficient by themselves. Although under­
standing content was necessary for Rapaport and Schafer, it is possible
today to dispense with this approach entirely, just as students learned basic
arithmetic calculations before calculators became available. Understanding
what content analysis may offer is analogous to understanding the funda­
mental concepts of numerical operations as compared to pushing buttons
on a calculator.
78 CHAPTER 4

Holt, in his 1968 revision of Diagnostic Psychological Testing (Rapaport

et al., 1945, 1968), commented frankly on the psychometric criticisms of
the original work, criticisms so stinging that they overpowered many of the
work’s rich clinical insights. In 1945 (and even in 1968), rigorous ap­
proaches to item analysis, power, diagnostic efficiency statistics (such as
sensitivity and specificity), and multivariate designs were not understood
very well. The issue of the day was determining the optimal balance
between using test scores and content analysis to arrive at a conceptually
disciplined but in-depth clinical analysis of personality. The method es­
chewed surface trait-like characteristics in favor of plumbing every re­
sponse to its very depths, in search of sound inferences that were
theoretically coherent, internally consistent, and rich in meaning.
The issue that prompted Schafer to consider criteria for inferential
thinking was the way to determine an appropriate degree of depth that was
logically and clinically supportable from psychological tests. Interpretation
corresponded to the predominant psychoanalytic nosology of the time,
preceding even DSM-L Thus, the conflict neuroses, such as hysteria and
obsessive-compulsive neurosis, were characteristically emphasized. Con­
temporary clinicians familiar with post-ego psychological psychoanalytic
theory and the substantially reformulated post-DSM-//nomenclature would
recognize few of the classifications highlighted by Rapaport and Schafer in
the same way that the Menninger group understood them.
Consequently, depth of interpretation meant something different before
the influences of DSM-III and its revisions. Clinicians nowadays need not
be overly concerned about what may seem like an archaic terminology to
them. They should be concerned, however, with the main reason that criteria
for depth of interpretation were important in the first place; at the time that
Schafer proposed these criteria, just as now, psychometric approaches went
only so far.
As a result, thematic analysis was necessary to reach the level of
sophisticated understanding sought by Rapaport and Schafer. In contrast,
contemporary psychometric advances make it possible to rely on empirical
scores for clinical test interpretation, supported by a sophisticated reliability
and validity literature. Particularly among nonpsychoanalytic clinicians,
there are a growing number of diagnostic testing specialists who subscribe
to the view that psychometrically based findings are sufficient, and that
content analysis has too little empirical support to be clinically valid.
The issue is not resolved and is partly a matter of clinical temperament.
Apart from the question of whether content analysis is a valid or credible
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 79

method for understanding projective test findings, the issue can benefit
from rethinking to optimize the contributions of psychometric advances
while remaining embedded in psychoanalytic theory. For many clinicians
favorably disposed to psychodynamic formulations, Schafer’s concern
about the proper approach to interpretive criteria cannot, therefore, be
dismissed as misplaced or outdated. Instead, his criteria can be applied
regardless of the psychoanalytic views that have influenced psychodiag­
nostic testing, whether these be ego psychology, object relations, self
psychology, the French school of Lacan (1978), interpersonal approaches
(Greenberg & Mitchell, 1983), or intersubjectivist schools that include
offshoots of self psychology (Stolorow, Brandchaft, & Atwood, 1987).
Schafer (1954) asked: “How are we to decide whether our explorations
have led us home or astray, whether we have glittering gold in hand or just
glitter: And how are we to distinguish between thoroughness and reckless­
ness?” (p. 141). He offered a solution in the form of criteria forjudging
the adequacy of interpretations. These criteria provide a useful basis for
the analysis of content and the observation of patients’ test behavior and
associated verbalizations. They are best thought of as reasonable guides
for arriving at diagnostic decisions rather than definitive, empirically
grounded rules. Schafer’s criteria, therefore, offer discipline to the in­
vestigation of projective test findings based on content analysis. Written
well over 40 years ago, his work provides a cogent, compelling statement
of a systematic, logical strategy for approaching these potentially murky
areas of subjective analysis. These criteria also serve as an excellent
foundation for conceptualizing self psychological concepts through psy­
chodiagnostic tests.

Sufficient Evidence
Foremost among the criteria forjudging the adequacy of clinical interpre­
tation is the issue of sufficient evidence to substantiate an inference. This
criterion is usually satisfied by considering converging lines of evidence,
sometimes based on several recurrences of a particular theme, but at other
times derived from associations to particular test responses. These re­
sponses characteristically serve to clarify or fine-tune the specific connota­
tion underlying a motivation or drive state. Schafer (1954) wrote that
“patients usually help us out by giving not one but a number of images,
score patterns and attitude expressions that confirm, modify, offset or
de-emphasize the interpretive leads provided by one response” (p. 141).
80 CHAPTER 4

To extend Schafer’s metaphor of “not flying blind” (p. 146), the

strategy resembles navigating an airplane; the pilot steers the plane by
consulting instrument panels, his co-pilot, and his navigator, who in turn
rely on data and feedback from a control tower or other devices. More
to the point, the strategy resembles a patient in psychotherapy respond­
ing to an interpretation by recalling a memory, having a dream, or
producing an association that further amplifies or corrects the interpretation
to steer it in a more precise direction.
How does this criterion appear specifically when performing diagnos­
tic testing? An image or verbalization, presented in a nonspecific man­
ner, may strike a hypothesis-generating chord in an exam iner’s
associative process but still not yield a decisively formed interpretation.
(What I referred to as striking a chord is the psychodiagnostic testing
equivalent of empathic understanding in treatment, as Kohut would
probably have noted.) A response may be unusual in the sense of being
statistically infrequent, or it may be unusual in the sense of being
suggestive of something more than it appears. It may also be unusual in
the way that the response is perceived or described, regardless of whether
it is familiar or idiosyncratic.
For example, on Rorschach Card I, a patient might report the familiar
and popular bat or an airplane, a rare but not necessarily odd, idiosyncratic,
or striking image by itself. Alternatively, the patient might report a tree in
the same area, an infrequent response although it still falls in a range of
normal tolerance. The patient might also note that the bat is falling, faltering,
or injured, the airplane is heading for a fall, or the tree’s leaves are falling.
Fortunately, most scoring systems capture the irregularity of the elaboration
of these percepts, and the irregularity appears as a distinctive pattern or
elevation of scores of special concern. A number of such irregularities rather
than one response in isolation are necessary for the formal scores to
accurately reflect appreciable departure from normative values. Alterna­
tively, the distinctive anomaly flags the response for the examiner’s atten­
tion, such as an M- code, a moderately notable or serious special score, a
color-shading blend, or a determinant of special significance combined with
an FQu or FQ- form quality rating.
Precision of formal scores is well and good as far as it goes, but it
probably does not go far enough to fully capture the dynamic significance
of percepts like a falling airplane, a tree with its leaves falling, or an injured
bat. The diffuse quality of some anomaly (such as a special score of morbid)
might be detected for several of these responses, but the phenomenologic
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 81

significance of responses such as these could be overlooked or mini­

mized as idiosyncratic. How responses are noted, recorded, or captured
in the form of a score or code, or by inferring some meaning in addition
to a formal score, is an issue directly related to Schafer’s criterion of the
nature of the evidence.
The critical test centers on how distinctive or psychologically evocative
a particular response appears, in terms of statistical frequency of occurrence
or unusualness, to substantiate an inference of deterioration or diminished
vitality. The persistence of the theme in other responses or tests needs to be
considered as well. Thus, other percepts of trees without leaves, a similar
manifestation of trees in an unhealthy state, or percepts of other images with
similar evocative meaning can be examined to determine whether these, too,
provide evidence consistent with the working hypothesis. This approach also
extends to higher order interpretive inferences such as concern about intact­
ness or experiencing oneself as firmed up and securely anchored.
It can be difficult to determine the precise meaning of the evocative
qualities in the way that a patient voices a projective test response or in the
nuances of a response. For example, Schafer (1954) described the different
shades of interpreting aggressive imagery ranging from explosive to hostile,
or engulfing to piercing. He alerted examiners to the caution required when
judging the affective connotations provoked by such adjectives. He also
called attention to the importance of remaining alert to shifts in intensity of
affects both in and across stimulus cards. This type of variability can be a
potentially rich source for revealing subtle vulnerabilities undermining the
adequacy of defenses, for example.
Another example of a problem in making interpretive inferences con­
cerns genetic reconstructions based on test responses. This type of infer­
ence is even more speculative and uncertain than is estimating the intensity
of an affect state such as the difference between an angry and a vicious
animal percept. With a genetic reconstruction, great caution is needed. An
examiner should be circumspect before extrapolating from a response such
as a towering monster figure to a statement about the patient’s perception
of the father. This line of speculation is not necessarily incorrect and should
not be dismissed entirely, however. It should be considered, albeit at a
lower degree of certainty or confidence relative to other lines of evidence.
Schafer (1954) allowed for another type of genetic reconstruction about
which clinicians can be potentially more assured. This type concerns
specifying the character pathology derived from a conceptual under­
standing of regression to a particular level of psychological development.
82 CHAPTER 4

If there is evidence indicating that the personality structure is predomi­

nantly paranoid or compulsive, for example, an examiner can presume or
infer the kinds of defenses and conflicts to be expected. This approach can
enable an understanding of the resulting central conflict as well as the type
and maturity (that is, developmental level) of defenses. It also permits a
reconstruction of the family constellation and the way that this sets in
motion the conflicts associated with particular stages of development.
Although it sounds like a fairly straightforward formulation specific to
classical drive or ego psychological theory, this form of genetic reconstruc­
tion can easily be extended to other theoretical systems, such as object
relations theory or self psychology. It need not be limited to a conceptuali­
zation based on the classical developmental trajectory of psychosexual
stages. In any case, Schafer (1954) regarded this level of genetic under­
standing as more reliable than that based on preconceived ideas about
particular responses (such as the towering monster example) in relation to
the family constellation and personality dynamics.
The process of listening to projective test responses requires examiners
to keep the range of clinical inferences broad rather than narrow. To prevent
a hypothesis-generation process from becoming prematurely closed off,
preconceived ideas based on a theoretical framework should guide the
workup but should not too quickly or narrowly foreclose the direction of
inferential thinking. Nevertheless, early tentative hunches are not neces­
sarily undisciplined. The clinical attitude is analogous to Freud’s concept
of evenly suspended attention (Freud, 1923/1961). Examiners listen to the
material, entertain pertinent associations, and screen them for their clinical
relevance. This process is one of empathic understanding as Kohut meant
it to be. While letting the imagination roam over possible meanings, the
examiner simultaneously operates at another level of ego functioning by
informally attaching a marker of inferential certainty to the various possi­
bilities under consideration.
Although making a different point, Goldberg (1990) posed a related
question about how many hairs make a beard or how frayed must a fabric
be to appear threadbare. His answer in both cases was when it is seen as
such. Scores and ratios, like hair counts, help determine an interpretation,
but disciplined impressions about content add something useful. Just as the
perception of a beard is more than the sum of a number of facial hairs,
projective test inferences are more than scores alone, but only when these
inferences are logically and cautiously considered.
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 83

Holt (Rapaport et al., 1968) wrote about Rapaport’s attempts to under­

stand test responses empathically and analytically. This process was not
unlike that of psychotherapeutic listening. In treatment, although clinicians
often do not know the specific meaning of a verbalization, they have more
opportunities for clarifying associations over time than does a diagnostic
testing examiner. In projective testing, by contrast, opportunities for clari­
fication may mean little more than the number of Rorschach responses or
TAT stories remaining to evaluate. Thus, the therapeutic and diagnostic
situations are not equivalent in this respect.
Some Rorschach images are symbolic in that universal meanings or
compelling connotations can often be agreed on. Schafer (1954) considered
symbolic referents to have an independent confirmatory basis, for which he
relied on evidence obtained from dreams, parapraxes, free associations in
psychoanalytic treatment, and certain types of symptoms to provide neces­
sary confirmatory support. He regarded the symbolic references in thematic
material from projective tests to be sufficiently persuasive to indicate that
“we are not flying blind” (Schafer, 1954, p. 146), and his examples included
imagery pertaining to churches, guns, madonna figures, devils, lambs,
puppets, and the like.
Not flying blind does not mean that there is a one-to-one correspondence
or absolute connection between imagery and meaning. The same idea
extends to omitting mention of images with common symbolic connota­
tions, such as the rifle on TAT Card 8BM. The problems associated with
the mechanistic application of rules of symbol interpretation are well
known. Especially with genetic reconstructions, inferences based on sym­
bolic connotations must be conveyed with full recognition of the limitations
of their credibility, unless there is good corroborating evidence. Otherwise,
inferences of this type should be foregone entirely. As Schafer (1954) said:
“The Rorschach record can neither support nor refute the interpretation. The
interpretation in effect does no more than remind the therapist to whom the
report is submitted what Freud, Fenichel et al. have said about overwhelm­
ing father-figures” (p. 144).
Dreams provide a good example of how to think about this problem. The
usual ego psychological approach is to elicit associations to understand
precipitants, rather than to build interpretations that rely heavily on the
meanings of symbolic imagery. There is a difference between interpreting
primary process content such as a dream about a menacing snake as a
symbolic phallus and interpreting a broad psychodynamic pattern. For
example, the snake might be interpreted as an indication that something
84 CHAPTER 4

dangerous or disturbing is being experienced, not necessarily as a symbol

with phallic-sexual content. The same way of approaching dreams also
occurs in self psychology. Thus, Kohut (1996) stated in a lecture:

I think that you probably have a reasonably good batting average in some
very clearcut instances when the symptomatology is of chronic depression
and the parental personalities are described in a way to indicate there was
no responsiveness, or where there was the withdrawal of the father, a
depressive mother, something on that order. If long periods of loneliness
are already beginning to be described in the diagnostic interview, if there
is dream material about abandonment, if there are lonely landscapes or
snowy landscapes, that kind of thing—I mean there are certain things that
make the diagnosis iron clad. (p. 121)

Kohut (1996) added:

Dreams of machines and of disturbed machinery are quite frequent, and

they usually give you a pretty good idea that the patient is experiencing
himself as not human, as not alive, but as a set of functions that are being
disturbed. In that sense, the dream shows you something quite specific
about particular propensities that he already had as a child, when he felt
unsupported and unresponded to, and began to feel less than alive and
less than human about himself, (p. 164)

In this framework, dreams as well as Rorschach responses can be viewed

as indications of a general state of disequilibrium. Whether this state is
represented by dysfunctional machinery, snowy landscapes, or wilting
leaves on a Rorschach blot, the connotation is not that of a specific conflict
or feature of the personality as much as of a disruption taking place. The
disturbance is viewed in different ways according to various theories. As
with dreams, examiners are of different temperaments about how specific
an interpretation should be.
The test of sufficient evidence also implies that the most salient person­
ality dynamics should appear broadly on projective tests. Genuine motiva­
tional states characteristically reappear across tests, although each test may
show selective sensitivity to various psychodynamic features. For instance,
defense-conflict mechanisms may be expected to emerge more clearly on
the Rorschach, interpersonal dynamics and object relations may be more
apparent on the TAT, and self-image or self-esteem can sometimes be
ascertained from figure drawing procedures. Integrating these components
or aspects of psychological patterns becomes an examiner’s synthetic ego
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 85

function. There is perhaps no better example of the faltering appreciation

of the test battery than this very situation, and Schafer (1954) made the
point: “Of course, other tests are indispensable in the search for secure
interpretations that are at the same time specific and penetrating. Also,
there are larger order convergences and complementary emphases to estab­
lish among tests” (p. 143).
It is frequently difficult to know whether Rorschach images such as
injured animals or destroyed objects are intended to represent patients’
experiences of themselves as damaged or of their hostile or malevolent
impulses. A similar dilemma can occur with TAT or human figure drawing
responses. The matter is not always clarified sufficiently, even with mul­
tiple percepts or responses of a similar nature. When there are many similar
percepts, not that rare an event, an examiner has little recourse but to
indicate what the psychological dynamic appears to be, although certain
crucial aspects of the response may remain of uncertain clinical signifi­
cance. This tactic is one way of indicating that certain forms of evidence
are inconclusive or insufficient. A definitive result invariably requires a
search for confirmatory evidence, usually across tests, in the psychodiag­
nostic protocol.

Depth of Interpretation and Manifest Content

The question of how deeply clinical inferences should extend is complex.
Schafer regarded it as legitimate to understand a percept of a mouth as
an indication of orality if the overall Rorschach protocol contained other
frequent percepts of food, teeth, or devouring creatures. An example
such as a mouth percept as an indication of orality is of limited value in
isolation from a broader base of related confirmatory responses. Schafer
added the important but frequently overlooked proviso that examiners
must also consider major regulatory functions, such as intensity of the
drive and the defensive operations associated with its expression or
inhibition. The mere mention of a response, like the example of a mouth,
is far less important than how it is seen (for instance, opened in antici­
pation of being fed, closed, or drooping).
Schafer also discussed different levels of confidence about clinical
inferences. The Rorschach percept of a mouth is probably a relatively clear
manifestation of oral wishes, at least from the standpoint of drive theory,
but responses such as Santa Claus or hands raised in prayer may not be as
compelling as indications of passivity or a receptive position. Although
86 CHAPTER 4

responses like these could be considered suggestive, Schafer still viewed

them as nonspecific. Such responses are intermediate between a clearly
direct indication suggested by the mouth of the previous example and other
percepts that are even less specific. Examples of nonspecific inferences are
interpreting oral-dependent wishes derived from responses such as waiting
for something or resting while listening to music, in the absence of addi­
tional substantive elaboration. In such cases, Schafer advised caution about
interpretations that reach too far.
He argued that examiners should state that a defense is operating and
reserve inferences about the intensity or the underlying conflict only for
clear indications of its presence, if only the defense is “seen,” not the archaic
impulse or drive. Schafer recommended a conservative approach to inter­
preting vague responses with weak or uncertain specification about under­
lying psychodynam ic features. For example, com menting about
constriction as a general defensive posture is preferable to denoting a
specific defense operation, unless it is clearly indicated. Schafer’s general
point is that it is advisable to be conservative about depth of interpretations
that might overextend their reach.
I have already noted Schafer’s cautionary recommendation about avoid­
ing too specific genetic reconstructions particularly when these are derived
from fixed symbolic meanings. Most interpretations of this type are gratui­
tous and thus “arbitrary, presumptuous efforts to deepen interpretation in
spite o f the patient” (1954, p. 150). This caveat applies to projective tests
such as the TAT, sentence completions, and figure drawings and to the
Rorschach. I restate the point here because none of these other projective
instruments has a clearly accepted formal scoring system with built-in
safeguards and normative reference points like the Rorschach. Tests other
than the Rorschach present even greater problems in generating interpre­
tive findings on the basis of the depth or level of understanding of
content-based material.
A formal scoring system with norm-based “protective” features still
does not entirely eliminate the problem of depth of interpretation because
overreliance on scores and ratios runs the risk of closing off examination
of indications of greater depth. The problem of depth still arises, al­
though in a different way when considering test scores such as those
derived from the Rorschach. These scores are typically based on the
formal aspects of responses, such as quality of thinking, perceptual
accuracy, and organization.
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 87

For example, on Rorschach Card III, a patient might report two people
circling each other, but omit the area conventionally representing the legs
from the location. The scores reflect the inaccuracy of goodness of fit of
the specific area indicated for a human percept, but the movement score
does not capture the specific quality of circling each other as distinct from
an activity such as looking at each other. It is also not considered to represent
an activity meriting a separate code for aggressive movement, at least when
stated this way.
Similarly, to a Sentence Completion Test stem “A mother ... ,” a patient
might respond “is sometimes there when you need her.” A story might be
given to TAT Card 1 in which the violin is misidentified as a guitar or on
Card 8BM the story might ignore the rifle. The defensive aspect of these
features might be considered for its interpretive value, but just as often the
interpretation does not proceed beyond noting the perceptual inaccuracy.
This case is no different from using only the formal scores on the Rorschach
example and not assigning interpretive significance to the people circling
one another.
The problem that Schafer described as depth or level of interpretation is
no greater in the analysis of projective tests without formal scoring systems
than of tests with reliable scoring systems. The crux of the issue concerns
how to interpret responses such as people circling each other or a failure to
incorporate the large figure of the rifle into a TAT story. A scoring system
does not alleviate the problem by itself. Should circling each other, for
example, be confined to the incongruity between this response and the failure
to specify the leg area, or should it be taken to represent hostile or predatory
impulses? Should the addition of the word “sometimes” in the Sentence
Completion Test example cited be left uninterpreted, or should an inference
be entertained about a complaint of maternal neglect or indifference?
Schafer’s discussion of the depth or level of interpretation applied to just
these situations. As with the criterion for adequate evidence, he favored the
view that “the interpretation should not push below the level of defense”
(1954, p. 150). Many of Schafer’s clinical examples clearly indicated his
willingness to attempt interpretations of drives or conflict when sufficient
evidence appeared to substantiate that level of analysis. In this respect, the
criteria of depth and adequacy of evidence are closely linked. The level of
an interpretation is influenced by the sufficiency and quality of the evidence
permitting an interpretation to extend beyond the level of defense analysis.
Schafer did not leave the issue here; his next criterion for judging the
adequacy of an interpretation, the use of manifest content, continued from
88 CHAPTER 4

the point that defense analysis left off. I have combined the two criteria in
this discussion because they are interrelated. When one identifies the
conflict that underlies defenses, one deepens the level of the interpretation.
The manifest content is now considered as a basis to speculate about its
meaning. With appropriate cautions, Schafer argued that there are more than
enough times when the evidence supports at least some consideration of an
interpretation of the manifest content. He wrote: “There are in fact good
reasons to support the inclusion of this criterion, particularly if we modify
it so: ‘Whenever possible, the manifest form of the interpreted tendency
should be specified’” (Schafer, 1954, p. 151).
Schafer acknowledged that it is generally easier to understand defensive
and adaptive manifestations than drive manifestations (manifest content).
Examiners can more easily attempt interpretations about drives or conflicts,
however, when they consider the analysis of manifest content. To be sure,
the argument is strengthened when formal scores, clinical validation by
history, repetitive patterns of scores or responses, and a battery of tests can
also be relied on to buttress an interpretation under consideration. Initially,
it is preferable to consider interpretations that are based on content. The
decision to proceed beyond the level of a defense interpretation depends on
other evidence that either supports or renders uncertain a deeper level of
clinical interpretation.

Intensity and Hierarchic Position of Specific Features in

the Overall Personality Structure

In this section, I discuss Schafer’s criterion about interpreting the intensity

of personality dynamics such as conflicts and defenses. I combine this topic
with his view that intensity should determine the relative importance of
each dynamic in the total personality structure. Although distinct, these two
points, intensity and hierarchic position, are so conceptually linked that it
makes good sense to combine them for the purpose of discussing their
individual importance as well as their interdependence.
Providing an indication of the intensity of a feature from the clinical
protocol means denoting its strength or persistence in projective test re­
sponse content. Therefore, to say that a patient has hostile wishes is not so
remarkable by itself; no one is without hostile wishes. To single out this
feature among other clinical characteristics, or to refer to a strongly evident
or even overwhelming hostile wish, however, calls attention to a trait’s
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 89

special prominence in the overall personality structure. Personality is

composed of trait-like characteristics, defenses, and conflicts, as well as
degrees of self-cohesion or vulnerability to self-esteem failure. What is
important is the relative balance of drives, the wishes opposing these drives,
and the degree to which various defensive operations are deployed.
As for the criterion of intensity, Schafer emphasized that personality
features should be specified in respect to their relative importance for a
patient’s central problem. For some people, defenses and their failure may
be critical to overall psychopathology; for others, the pressing or salient
problem may center on drive regulation, guilt, or self-cohesion. From the
standpoint of psychoanalytic self psychology, clinicians should try, when
possible, to specify the differential prominence of selfobject functions or
transferences, such as mirroring, idealization, and twinship, in the manage­
ment of self-esteem regulation. With regard to the question of how to
specify intensity, Schafer acknowledged that quantitative delimiters such
as marked, extreme, or strongly evident are not precise and convey no
greater accuracy than do their counterparts based on the clinical interview
(such as mild, moderate, and severe).
Schafer (1954) realized that the links between intensity or pervasiveness
demand a thorough understanding of a cohesive body of personality theory.
This level of theoretical conceptualization goes beyond grasping terms or
concepts in isolation; it requires a clear understanding of the relations
among concepts. Thus, he wrote: “The point is to avoid chain-like interpre­
tation in which each trend is simply juxtaposed to other trends, and no
hierarchy of importance, generality, stimulus and response, push and re­
straint is established” (Schafer, 1954, p. 154).
Schafer’s reasoning presumed that the working theory in which the
projective test findings are anchored provides a basis for hierarchical
ordering of psychodynamic processes. He also stated a strong case for
requiring understanding of the hierarchical possibilities inherent in certain
aspects of psychoanalytic theory. This approach requires disciplined under­
standing of theory to avoid the “psychological nonsense” sometimes ap­
pearing in reports of psychological testing. For example, in structural
theory, conflict precedes defenses, and failure of defenses leads to symptom
formation. It makes no sense to speak of symptoms producing defenses or
defenses producing conflicts. As Schafer (1954) noted, hierarchic integra­
tion should proceed from a systematic theoretical system that specifies
hierarchical links or cause-effect relations “and not on ad hoc, test-centered
and sign-centered improvising” (p. 157). Exner (1993) advocated a similar
90 CHAPTER 4

preference for following a systematic chain of dimensional links, the

cluster strategy, which is based on key variables for interpreting Ror­
schach findings.
Finally, Schafer recognized that it is rare for any single test to produce
an accurate hierarchical position and that examiners must use a test battery.
Otherwise, the understanding of the workings of the personality as a whole
becomes simplistic and is compromised. Schafer observed: “A battery of
tests is invaluable in organizing hierarchic test pictures; on the basis of the
Rorschach test alone one cannot do a thorough job in this respect” (Schafer,
1954, p. 154).

Specifying Adaptive and Pathological Tendencies

Schafer’s (1954) thinking was influenced by the prevailing ego psychologi­
cal viewpoint when he proposed his criteria for diagnostic testing evidence.
Thus, it should come as little surprise that one of these criteria concerned
the adaptive aspects of personality dimensions. Although symptomatic
complaints reflect the relative success or failure of defenses for containing
anxiety, personality traits (some of which may stem from ingrained char­
acterologic formations) can nevertheless have adaptive aspects. Rigid re­
action formation against hostility may dispose people to helpfulness or
generosity toward others, or schizoid withdrawal may lead to an overdevel­
oped cultivation of people’s artistic interests, despite the constricting or
otherwise debilitating consequences of these defenses. Many people with
chronic dysthymic disorders or characterological depressions (Akiskal,
1980) may be masochistically selfless, duty bound, and all too willing to
sacrifice personal needs for the good of others. Although sometimes seen
as the pillars of the community despite their profound sense of despair,
self-depreciation, and guilt, such people characteristically confine their
experiences of distress to quiet, selfless suffering.
Kohut (1971, 1977), in his contributions to self psychology, noted that
well-developed transformations of normal narcissism lead to mature goals
and ambitions as well as to expanded capacities for humor and wisdom. He
also showed that some pathological manifestations of mirroring and ideali­
zation may have adaptive consequences, for example, the sense of loyalty
and devotion to causes stemming primarily from an idealizing selfobject
need. Similarly, many patients with a self disorder display an exquisite
sensitivity to nuances of others’ reactions or comments, a sensitivity arising
from hyperalertness to the possibility of injury or of being slighted when
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 91

mirroring selfobject functions are undermined. They may appear to have a

heightened capacity for empathy, for sensitive understanding of others.
(This use of the term empathy does not necessarily correspond to Kohut’s
use of the term in its technical sense.)
Adaptive aspects of projective test material are usually the last elements
that students appreciate, and sometimes even seasoned practitioners need
to be reminded of their possible presence. Adaptive aspects are among the
least likely aspects of projective test analysis to be taught, and students
readily overlook these characteristics in their often single-minded pursuit
of pathological features. Not infrequently, in an effort to impress their
teachers and supervisors with their capacities for probing the depths of
human personality, students may miss adaptive signs, unless their own
defenses interfere with appreciating true psychopathology.
Psychodiagnostic examinations are first and foremost a method for
identifying psychopathology. Overt disturbance or aberrant personality
emerges most clearly and forcefully and detecting this may sometimes
overshadow an examiner’s balanced attention to test indicators of adapta­
tion. Although psychotherapists sometimes have difficulty recognizing
adaptive or relatively healthy aspects of thinking or behavior, diagnosticians
can have still more difficulty grasping these features because their contact
with patients is usually limited. Despite efforts to minimize the tendency to
view patients as specimens, the brief and pointed clinical contacts of
examiners direct their attention to narrow and focused areas because of the
nature of this clinical activity.
Schafer was most concerned about the topographic and structural points
of view of psychoanalytic metapsychology, but he also considered Erik-
son’s (1950) concept of ego identity to be one of promise for the psychodi­
agnostic assessment of adaptive characteristics. Schafer did not discuss
diagnostic testing indicators in this area as thoroughly as he did his other
criteria, perhaps because the Eriksonian view was still too new and not yet
sufficiently understood. His main recommendation was to consider the
opposing wishes of drives. Also relevant for recognizing the potential for
adaptation were expressions of ambivalence, wishes and counterwishes,
and alternating ego-dystonic or ego-syntonic aspects of the same basic
instinctual urge.
Incorporating Erikson’s contributions, Schafer wrote of alternating iden­
tity states, such as good or wished-for imagery coming forward or receding
in prominence against bad or rejected aspects of a patient’s sense of identity.
Nevertheless, he still observed: “It is a major weak point in the interpretation
92 CHAPTER 4

of test results that we are often so much better at identifying pathological

potentialities and weighing pathological trends than we are at identifying and
weighing healthy, self-integrative ‘normal’ trends” (Schafer, 1954, p. 159).
Over 40 years later, this statement is still true. Although Erikson’s work
was an early attempt to understand the self, his emphasis on identity
formation arose from a different theoretical position than that of Kohut about
2 decades later. Although Kohut’s ideas about maturational or adaptive
aspects of personality do not clearly offer greater potential than does Erik­
son’s understanding of identity, Kohut’s theories offer another viewoint of
healthy aspects of psychological life. Kohut’s self psychology also enables
diagnostic testing examiners to derive insights about self states and the self’s
strivings for vitality and cohesion through analysis of projective test im­
agery. Several clinical examples in the following chapters demonstrate
these points, particularly the self psychologically informed reinterpretations
(suggested in chaps. 5 and 6) of many of Schafer’s clinical examples.

THEMATIC CONTENT ANALYSIS: OTHER VIEWS

Aronow, Reznikoff, and Moreland

Users of the Rorschach test have often emphasized quantitative scores.
Indeed, most of the disputatious history of diagnostic psychological testing
has centered on debates about the relative merits of particular measures or
ways of computing scores. Diagnosticians have used the content of Ror­
schach responses far less as a primary basis for interpretation, although one
hallmark of the Rapaport-Schafer tradition was its attempt to combine the
scoring and content analysis methods. Nevertheless, there is a small litera­
ture on content analysis, some of which is thought provoking and sensible
but largely unsubstantiated. A thorough familiarity with content analysis
rarely extends beyond the experience or opinions of a diminishing number
of senior clinicians.
Aside from the sometimes ad hominem history of scientific debate on
the issue of quantitative and content analysis approaches, most psychodi­
agnostic clinicians consider both forms of evidence and favor one or the
other because of temperament or the requirements of a given case. Clini­
cians have characteristically understood content as they understood inter­
view material. As a result, clinical historical facts may sometimes be less
crucial than are fantasy and related introspective material, such as dreams,
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 93

early memories, associations about parents, and selective distorted recol­

lections of childhood events and motivations of the people in patients’ lives.
This approach is similar to using projective content as a type of interview,
much as Zubin, Eron, and Schumer (1965) recommended, although they
were dismissive of the scientific credibility or merit in attempting to use
projective tests in any other way.
The work of Aronow and Reznikoff (1983), and their revision (Aronow
et al., 1994), represents a clearly presented, balanced view of how content
analysis may augment clinical interpretation, although only for the Ror­
schach. Aronow et al. (1994) arrived at their principles for clinical interpre­
tation, partially influenced by the approach of the Menninger school, in the
spirit of combining content analysis and formal scoring. They described their
work as a content-idiographic approach and stated their case as follows:

We view it as a fundamental mistake to try to “regiment” this clinically

sensitive procedure into some sort of inkblot version of an MMPI. Too
much is lost in the process, and too little gained as a result. Psychological
assessment of personality should include both nomothetic and idiog-
raphic—objective and projective—approaches in combination. This
brings the unique strengths of each to bear. If one wants an objective test,
there are many more suitable instruments available, with time demands
on the psychologist far more modest. Why sacrifice the clinically sensitive
and versatile Rorschach technique in such a quest? (p. 16)

Although the specific context for this statement is a discussion of their

view of certain limitations of the Comprehensive System (Exner, 1993), the
broad context is not obscured by singling out any particular system or
scoring approach. The historical animosity sometimes generated by con­
ceptual debates has no place in a clinical-scientific argument about guiding
principles in clinical interpretation. Thus, Smith’s (1992, p. 5) comment that
“the Americans were frequently dismissed as obsessed with numbers and
conceptually bankrupt” is best seen as overpersonalized.
Aronow et al. (1994) described three types or levels of inference, the first
of which they designated as informational, consisting of declarative state­
ments or remarks of a low level of inferential depth. More important, their
second level of understanding thematic information is concerned with
symbolic associations that are amenable to psychodynamic understanding,
similar to Schafer’s criteria for judging clinical indications of response
content. Aronow et al. (1994) proposed a third type, complex idiographic
images, resulting from specific probes for idiographic associations. This
94 CHAPTER 4

level is represented by questions designed to elicit how a patient feels

about a Rorschach percept or what the percept evokes or suggests.
Although this form of inquiry is anathema in several Rorschach admini­
stration systems, it is necessary for Aronow et al.’s (1994) third level of
idiographic imagery. Should this administration style be adopted, inquiry
must be conducted judiciously and in a nonleading fashion to minimize bias
that can potentially influence subsequent inquiry. This type of inquiry may
be nearly impossible if the necessary safeguards are severely or rigidly
enforced, so that the resolution of the issue rests with balancing the potential
richness of the clinical yield against the problem of contaminating the
response process.
A probing if not leading inquiry of this sort is frequently employed on
the TAT, where the rules for inquiry are less constrained and the influence
on the response process is also more poorly understood. Some diagnosti­
cians have utilized a form of inquiry for figure drawings designed to elicit
fantasy material, self representations, and other internal states suggested by
the drawing of human figures of both sexes. Such inquiries can be specific,
pointed, and geared toward eliciting simplistic trait-like descriptions, or
provocative in the sense of probing for depth or complexity of motivations
and phenomenologic experience. The depth of a patient’s psychological
experiences that an examiner wishes to understand undoubtedly influences
the degree of probing inquiry. A knowledgeable and well-trained clinician
carefully observes the boundary between accurate (but still in-depth, prob­
ing) and forced motivations.
My point in emphasizing the nature of the probing inquiry process of
Aronow et al.’s (1994) third level of clinical interpretation is twofold. First,
a probing or provocative inquiry is crucial to detect fantasy material needed
for this type of content analysis. Second, in relation to the central focus of
this book, an intensive, in-depth inquiry is essential to derive the psychodi­
agnostic information necessary for understanding selfobject functions.
Aronow et al. (1994) recognized that their typology based on idiographic
or content analysis falls far short of customary requirements for rigor. They
argued that speeding the process of psychotherapy might be a sufficient
justification for idiographic analysis, but their emphasis on speed of treat­
ment rarely produced deepening of treatment. They discussed several
guidelines for judging the validity of a clinical interpretation of content,
such as cautious inferential thinking, especially for responses of doubtful
significance and uncertain referents. Like Schafer, they eschewed the use
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 95

of fixed meanings or mechanical application of symbolic associations and

stressed vigilant attention to examiners’ “blind spots.”
Aronow et al. (1994) also emphasized the caution necessary to differen­
tiate true projections from commonly reported responses and alerted clini­
cians to be aware of how far an interpretation should be taken. In the
analysis of sequence, they emphasized directing attention to select re­
sponses as further associations to, or expanded elaborations of, central
aspects of patients’ experiences of their internal world. Aronow et al. (1994)
regarded sequence analysis as important but advised against an uncritical
misapplication of this approach.

Schachtel
The culmination of Ernest Schachtel’s work on and thinking about the
Rorschach is represented by his 1966 book. In this work, he presented his
views about the major determinants and scores, particularly from the
standpoint of their experiential basis and the nature of the test situation.
Schachtel’s approach has its roots in the writings of Rorschach and the
Rapaport-Schafer, Beck, and Klopfer traditions. These approaches influ­
enced his synthesis of some of the finest traditions in the history of
psychodiagnostic testing.
Schachtel’s unique contributions centered on his emphasis on the expe­
riential nature of the Rorschach technique. His viewpoint stemmed from
the ego psychology tradition, and he was concerned with the perceptual and
cognitive features of the Rorschach in relation to affects and motivational
states. In this respect, Schachtel’s thinking about the relationship between
personality dynamics and perception was influenced by Hartmann’s (1939)
concept of ego apparatuses of primary and secondary autonomy and Ra-
paport’s (1951) approach to the subject. His ideas about experiential proc­
esses should not be confused with contemporary uses of the term, such as
those in philosophical phenomenology, the Rogerian or Gestalt psychother­
apy schools, or for that matter, empathic understanding as in psychoanalytic
self psychology.
Schachtel (1966) distinguished between allocentric and autocentric
modes of perception and the influences of each on Rorschach responses. In
allocentric perception, the emphasis is on objectification of the perceptual
process. An object such as a Rorschach percept is described in terms of what
it resembles: a person “figuratively or literally, takes hold of it, tries to
‘grasp’ it” (p. 79). In contrast, the subject-centered autocentric perceptual
96 CHAPTER 4

mode stresses attending to how the feeling tone of a projective test stimulus
impinges on a person. The response creates a fusion between a sensory
quality and an affect state, a fusion that Schachtel characterized as essen­
tially pleasure or displeasure.
From this view, which unites perception and affect or motivational state,
Schachtel (1966) considered major Rorschach determinants and noted that
the scoring features may be either allocentric or autocentric, even in the
same person at different times. He addressed the cognitive-perceptual
process of forming a Rorschach response to show how a percept can be
understood (i.e., how form is perceived influences the decision to produce
or withhold a particular response). Thus, Schachtel described a process in
which patients initially apprehended an ink blot in some fashion by taking
its contours and other form elements into account. The allocentric mode
leads to a tentative association with objects that resemble the ink blot. A
goodness of fit test, determined largely by an active or critical evaluation
of the likeness, is attempted, and finally the patient decides to accept or
reject the comparison. Any given response is either produced or leads to a
search for a better alternative, in keeping with a patient’s reality orientation
and capacities for critical analysis and judgment.
Schachtel (1966) noted that the autocentric mode influences the experi­
ential aspect of this form-generating process. For example, affect states like
depression and boredom may interfere with perceptual processing of form.
Diminished interest constrains the vividness of the range of form like­
nesses, although the accuracy of perception is usually unaltered.
To this point, Schachtel’s (1966) approach to the Rorschach response
process provided a conceptual basis for understanding how responses are
formulated and how affect or motivational states influence determinants.
The final interpretation of the full protocol, however, is another matter. In
this area, Schachtel used content analysis as a supplement to formal Ror­
schach scoring. His thoughts on the subject revealed a use of content-based
material narrower than that of Rapaport and Schafer and not unlike Exner’s
(1991) view. Schachtel’s approach to content analysis was based on formal
response characteristics such as the use of particular determinants, in
contrast with the broad, albeit judicious, use of content in Schafer’s and
Lerner’s approaches. Schachtel’s approach is certainly more restrictive than
are the “dictionary” approaches that he criticized, as did Schafer (1954)
before him.
Schachtel (1966) argued that content based on verbalizations and asso­
ciations is not suitable for understanding drive states, defenses, and adap­
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 97

tive efforts. He thought it was difficult and “most of the time impossi­
ble” (p. 259) to distinguish among these characteristics of the personality
by using content. He singled out the tendency to attribute specific
meaning to card details for special criticism and advised against inter­
preting references to parental figures on Cards IV and VII, a caution
generally accepted by most Rorschach clinicians. Thus, stripped of
unsupportable inferences and associative comments about particular
percepts, the essence of Schachtel’s (1966) strategy for interpretation is
best captured in the following statement:

The data we study in Rorschach’s test are what the testee saw in the blots
and how he saw it, in the full concreteness of the percept and with all the
emotional overtones and undercurrents that color what he saw, and all
the intellectual and emotional effort, its quality, its process, its smoothness,
or conflicts which entered into the work of perceiving, associating, and
judging the fitness of the percept. From his words we try to reconstruct his
experience. The score is merely an abstraction of this experience, and the
verbal content of the responses is also an abstraction, (p. 261)

Lerner
R M. Lemer (1991) and H. D. Lemer and R M. Lemer (1988), together with
Schafer (1954) and Aronow et al. (1994), also emphasized the usefulness
of content analysis and the cautionary approach that this form of interpre­
tation requires. The Lemers emphasized the importance of tracing the
inference back to the primary response data that are its source by including
each step in the process giving rise to an interpretation. R M. Lerner (1991)
emphasized searching carefully for confirmatory evidence from other test
findings and considering the internal consistency of a content-based inter­
pretation in the framework of the total personality. The Lemers are cham­
pions of an approach to diagnostic testing informed by contemporary
theories in psychoanalysis, including Kohut’s view of self psychology
(Lemer, 1988). In this respect, they considered internalized object relations
at least as important as drive-conflict-defense analysis.
R M. Lerner (1991) also regarded sequence analysis as a crucial aspect
of content analysis. He agreed with Schachtel’s (1966) phenomenologic
view in which sequence contains major clues to understanding a patient’s
experience or feeling state about the projective test process. Lemer (1991)
expanded on Schachtel’s (1966) and Klopfer’s (Klopfer & Kelley, 1942)
emphasis on formal Rorschach scores in sequence analysis with a broad
98 CHAPTER 4

approach compatible with that of Aronow et al. (1994). Lerner (1991)

discussed using sequence analysis to identify regressive shifts conceptual­
ized in both the conflict and deficit models in psychoanalysis. He relied
especially on the sequence of form level and thought disorder scores in
understanding regression and its impact on reality testing.
P. M. Lerner (1991) reaffirmed Schafer’s guidelines for valid content
analysis, to which he contributed additional clarifications, and stressed
remaining close to patients’ experience as expressed in the testing situ­
ation. Lerner (1991) therefore highlighted the increased clinical validity
that results from a sustained focus on features unique to each patient.

Comprehensive System
In the 75-year history of Rorschach psychology, no attempt to bring this
instrument to a scientifically and clinically respectable level exceeded that
of Exner’s (1993) Comprehensive System. Exner’s work is anchored in
contemporary psychometric theory and benefits from concurrent advances
in diagnostic nosology, reliable measurement, and test validation. Not only
has the Rorschach achieved a needed revitalization, but the Comprehen­
sive System also serves as a standard of psychological and psychometric
sophistication for other projective tests of personality. My discussion
centers on the role of content, which Exner referred to as Verbalizations and
Sequence o f Scores in his terminology.
Exner did not reject content analysis approaches to interpretation. He
considered content analysis to be potentially useful when applied judi­
ciously as a secondary approach following the sequence of Comprehen­
sive System scores and the clusters arising from combinations of major
scores. On this subject, Exner (1991) commented:

Although it is reasonable to expect the structural data to offer the greatest

utility in forming interpretive hypotheses, some of those hypotheses can
be too general, too narrow, or even misleading. Therefore, it is critically
important to review the other data groups intelligently in the context of
findings from the structural data. The Sequence of Scores often provides
information that clarifies or expands postulates developed from the struc­
tural data, and sometimes unusual sequencing effects give rise to new
hypotheses. Similarly, although new hypotheses developed from the Ver­
balizations must be regarded with the utmost caution, the astute inter­
preter should be able to cull considerable information from the verbal
material that can relate to other data in the test. (p. 141)
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 99

Exner’s Comprehensive System approach did not advocate ignoring

content analysis, but argued for its inclusion in a carefully considered
manner. Most advocates of content interpretation have made the same
argument, namely that analysis of content follows formal scoring and that
its cautious application should be based on clear guidelines. Thus, Exner
(1991) was not alone when he wrote: “The picture is drawn together by
merging nomothetic and idiographic information in a manner that high­
lights the uniqueness of the subject” (p. 127), and “Postulates generated
from verbal material are likely to have the greatest validity when derived
from a composite of responses that are homogeneous for content or
verbiage” (p. 141).
Clearly, however, the Comprehensive System relies prominently on the
formal scores and ratios from the Structural Summary. The main strategy
for interpretation starts with and departs rarely from selecting the most
appropriate psychometrically derived cluster-search routine suggested by
the key variables that represent the starting point in the interpretive workup.
The main approach is twofold: It begins with a systematic examination
of findings from each cluster and progresses by weaving together the
findings across all clusters to evaluate the total personality. Previously, a
data-driven examination began with the evaluation of the core cluster,
assessed stressors and adaptive resources, and focused on how these are
mediated in consequence of the basic introversive-extratensive configura­
tion. Exner’s preference now begins with the cluster-search options that
offer a starting point superior to the previous approach that began with the
core operational cluster. He identified 10 key variables that determine a
priority for searching through various clusters of personality and cognitive
variables. This strategy has become predominant for arriving at the even­
tual clinical interpretation of the protocol.
Like Schachtel, Exner (1993) subscribed to Rorschach’s disinclination
to view the task of responding to the ink blot series as a test of imagination.
He eschewed embellishments to the basic task of producing percepts. Exner
thought that the technique essentially requires subjects to “misidentify” the
stimulus. The resultant problem-solving exercise requires some violation
of reality. This process of misidentification provokes a series of cognitive
processing operations, which are influenced by current mental status and
level of psychological equilibrium. There are three phases: visual input and
preliminary rank ordering of acceptable possibilities, a decision-making
process involving discarding and censoring low priority response options,
100 CHAPTER 4

and a final selection of suitable responses reflecting an individual’s person­

ality traits or styles.
Exner (1991, 1993) regarded projection as “only a possibility in the
Rorschach” (Exner, 1991, p. 109) and as having a minimal role in the
primary perceptual-cognitive processing approach. Projection, in this view,
emerged typically as a state variable that may color the richness of the
verbalization, not as a fundamental feature of the main response process.
Virtually all prominent figures in Rorschach psychology have also ob­
served that projection was one of several psychological processes involved
in the formulation of responses. Its importance as a primary mechanism
varied among the developers of the Rorschach, despite the fact that all of
these leading figures acknowledged that projection was induced by the
instrument itself.

THEMATIC APPERCEPTION TEST

AND OTHER PROJECTIVE METHODS
As noted earlier, most psychodiagnostic literature on interpretive strategies
has been devoted to the Rorschach, probably because formal scoring
systems have been developed for its use. The popularity of the Rorschach
continues, despite some persisting questions about the merits of particular
codes and their meanings. This state of affairs is healthy; heuristic ques­
tions that can lead to empirical answers are important for a clinical science
such as personality assessment. A reliable Rorschach scoring system makes
it possible to continue discovering optimal strategies for combining scores
to generate accurate psychological inferences. The matter of content and
sequence analysis also continues to stimulate considerable interest, but the
lack of an empirical approach to this form of analysis is the same problem
that confounds much psychodynamic clinical practice and theory. The
question of combining thematic analysis with formal scoring remains
another major unsettled area in projective test psychology.
The lack of widely accepted scoring systems is no small part of the
reason that projective tests besides the Rorschach are ambivalently
valued. Because other projective tests can easily be overlooked or
minimized, it is surprising that they continue to be used as much as they
are by many clinicians, often in combination with the Rorschach. Cer­
tainly, tests like the TAT and figure drawings are considered important
and valuable, notwithstanding clinicians’ reservations about these in­
struments’ empirical value.
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 101

Although several such instruments continue to be used as part of many

test batteries, the TAT remains perhaps the most frequently used among this
group of tests, and more has been written about its clinical applications
despite the absence of an accepted scoring system. Leopold Beliak has for
many years been one of the chief advocates of its study. To provide a
balanced view on strategies for using diagnostic testing in this chapter, I
include Beliak’s main views on the TAT (Beliak & Abrams, 1997), together
with other approaches to understanding this instrument.
Beliak assumed that patients respond to the figures in the pictures not as
real people in real situations, but as determined by inner feelings and need
states. Like most psychodiagnostic clinicians who have written about
clinical interpretation, Beliak advised that TAT interpretation should be
built up from repetitive patterns across several data sources. He regarded
the principal elements of TAT analysis to be those denoting the main theme
or conflict and identifying the figure with whom a patient appears most
closely allied. By examining how feelings, wishes, and conflicts are asso­
ciated with the various TAT figures, Beliak reconstructed a patient’s psy­
chological world, including the important people in the patient’s
psychological environment. These people may be seen as exploitative,
hostile, benevolent, and so forth. Beliak attempted to arrive at a structural
description of anxiety, including how it produces defenses and adaptation
as these are revealed in the TAT imagery.
Other psychodiagnostic clinicians have also suggested interpretive ap­
proaches to the TAT, several of which overlap in many ways. Murray’s
(1943) traditional categorization of TAT responses stressed internal need
states or press (to use Murray’s preferred term) as these impinge on the
patient. Henry (1956) emphasized the distinction between form charac­
teristics of responses (e.g., organizational features, language structure) and
content characteristics (affective tone and positive or negative contents).
Rotter (1947) emphasized several key principles in TAT analysis, prominent
among which are frequency of occurrence or persistence of a theme, degree
of unusualness of important aspects of the story (such as atypical plot or
misidentification of a figure or object), and delineation of the central
identification figure. Rotter proposed interpretive hypotheses emphasizing
familial attitudes, social and sexual attitudes, academic-vocational atti­
tudes, personality characteristics, and etiological considerations.
Rapaport et al. (1945,1968) differentiated formal characteristics of TAT
story structure from content in their discussion of this instrument. Story
structure represents compliance with the task instructions and includes
102 CHAPTER 4

omissions and distortions, excessive emphasis on the concrete picture rather

than the situation it depicts, and introducing figures not present in the
picture. The story structure is also evaluated for consistency with the
patient’s total production. This consistency may be seen in deviations from
common themes and variations in these themes across the entire TAT set.
Finally, the analysis of story structure also includes noting any idiosyncratic
features of verbalizations. For Rapaport et al. (1945, 1968), like Beliak
(Beliak & Abrams, 1997), the story content analysis took into account
affective tone, identification with story figures, obstacles that may appear
in the stories, and strivings represented by the story content.
Most of this literature appeared during the 1940s and 1950s, and there
has been relatively little renewed clinical interest in the TAT since that
time. There has been little revision or clinical reconceptualization of the
TAT since Rapaport et al. (1945, 1968). Many aspects of their approach to
the analysis of the TAT can be applied to figure drawings as well. The fact
that empirically based interpretive principles for the TAT, figure drawings,
and Rorschach content and sequence analysis have not kept pace with the
major developments of instruments like the Rorschach and MMPI does not
mean that these tests have no value. Their potential usefulness has always
needed to be examined better than has been the case to date. Without a
refined empirical foundation for the use of these instruments, there exists
little more than the traditionally loosely applied approaches.
One can apply Schafer’s (1954) sufficient evidence criterion forjudging
interpretive adequacy of Rorschach responses to interpreting the TAT
(Schafer, 1967) and figure drawings. The same characteristic of unusual­
ness or idiosyncracy applies to TAT stories and drawings as it does to
Rorschach percepts. A story about a boy who prefers to play with his friends
rather than practice the violin is one thing; the familiar story to the same
card about a boy compelled to practice under threat of punishment by his
parents is another matter. Still another psychological state is suggested
when the story takes the form of the boy’s parents being unaware of or
unconcerned with his wish to play the violin well or to be accepted by his
friends. Thus, a departure from the normative story or a related variant may
provide clues to a person’s psychologically salient concerns.
Projective test content, such as TAT stories like those just cited, may be
understood in different ways, under the influence of various theoretical
frameworks. Thus, material may be “heard” or listened to by an examiner
on the basis of his or her conceptual viewpoint. Indeed, examiners may
select questions for inquiry under the influence of theoretical preferences.
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 103

This situation becomes a bias only when a response is either ignored or

attended to according to the meaning that an examiner hopes to find. It
is not a bias when a theoretical orientation influences the way that
examiners seek evidence to support or refute a clinical hypothesis, if they
conduct the inquiry in a disciplined way and dispassionately consider
alternative connotations.
For example, in the response of the boy made to practice the violin, a
classically trained diagnostician may choose to elicit more associations
about the outcome of not practicing from the standpoint of punitive action,
guilt, or outwitting the parents. An object relations theoretical focus may
lead an examiner to be particularly curious about punitive action or affects
about rage at being ordered about or having initiative stifled. A self psycho­
logical orientation may dispose an examiner to inquire about the boy’s
concerns about not living up to his or his parents’ expectations.
The TAT is more likely than the Rorschach to be subject to potential bias
of this sort. Ideally, examiners should elicit patients’ entire available range
of associations without directing attention to any particular aspect of the
story. Examiners would then decide which inference comes closest to a
patient’s phenomenologic experience of the situation represented by the
TAT card. Although this approach may sound objective and fair-minded,
clinicians do not work in this fashion. Fairness or impartiality, defined in
this way, has little to do with clinical thinking. Being impartial or attempt­
ing to be unbiased does not necessarily lead to more accurate interpreta­
tions than those obtained in the customary way. The main reason that an
apparently objective inquiry of this type fails is that theoretical orientations
are not decided on the basis of the winner of a race or contest. Examiners
cannot help being other than who they are, and their framework for
understanding others and their experiences is who they are. Consequently,
it is not a question of an examiners being more or less correct but of the
recognition that they view the clinical material from the vantage point of
their preferred conceptual approach.
As in psychotherapy, a patient seeking a cognitive-behavioral treatment
is not advised to consult with a psychoanalyst. Analysts and behavior
therapists evaluate patients in different ways, as a patient with jaw pain
might be evaluated differently by an otolaryngologist and a dentist. Thus,
a different theoretical view or method is not synonymous with bias. In
regard to understanding personality dynamics from content analysis, such
as the above TAT example, all that can reasonably be asked of examiners
is that they keep open other theoretical possibilities besides their own. It is
104 CHAPTER 4

not a bias to hold a theoretical preference; a bias arises when a preference

excludes other viewpoints.
As for Schafer’s interpretive criteria of sufficient evidence, a distinctive
feature of a TAT story should persist as a continuing theme across cards.
Thus, a recurring theme, conflict, or defensive preference should be detect­
able on several cards (and probably on other tests as well), although it need
not be present to the same degree on each card. This requirement of
continuity reflects a convergence of evidence to build a persuasive case for
the consistency of salient personality features. Some unique or test-specific
interpretive evidence varies in its intensity across tests. Nevertheless, it is
crucial that clinicians should examine evidence across tests to bolster their
confidence in the accuracy of the final interpretation.
The interpretation of the boy on TAT Card 1 as one who is forced to
practice does not necessarily mean that the patient perceives his or her
parents as dogmatic or authoritarian. Nor does it mean that the girl on Card
2 who remains on the farm instead of pursuing a career in the city is
unequivocally bound to her parents. An examiner can consider the possi­
bility that the boy on Card 1 feels psychologically abandoned rather than
oppressed by his parents and that the girl on Card 2 feels unable to separate
from her parents by pathologically idealizing their values rather than by
experiencing guilt about leaving them. Interpretations like these assume,
naturally, that there is sufficient evidence to support such inferences
throughout the test protocol. The same reservation about assigning specific
meanings to particular images on the Rorschach applies just as com-
pellingly to the TAT and figure drawings.
Examiners should propose interpretations as tentative or exploratory
impressions, which gain credibility when the distinctive quality of the
content compels the conclusion. There are no fixed or universal symbolic
referents in projective test material. The imagery and associative threads of
test responses can remain open to expanded interpretations as theoretical
knowledge advances. Thus, the drive theory or ego psychological frame­
work available to Rapaport and Schafer need not foreclose other positions
about the meaning of test responses, whether these be informed by psycho­
analytic self psychology, object relations theories, or other theories.
Similarly, inferential material from figure drawings need not routinely
be bound up in symbolic statements such as the equivalence between hands
drawn behind a figure’s back and aggressive urges. Although such an
interpretation is a possibility, the universality of this and many other types
of equivalence has never been firmly established, despite the useful contri­
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 105

butions of Machover (1949) and Harrower (1965). The possibility that

hands drawn behind the back reflects other dynamic conflicts should not be
discounted; an examiner can consider unassertiveness, shame, or even
brittle self-esteem, with appropriately converging support from other pro­
jective content, for their potential interpretive merit.

A SELF PSYCHOLOGICAL APPROACH

TO PROJECTIVE TEST INTERPRETATION

Schafer’s criteria follow straightforwardly from an ego psychology view­

point. Thus, the analysis of defenses, together with their intensity, perva­
siveness, and resilience, is the key factor to consider. A traditional drive
theory approach, although not in any fundamental way at odds with the ego
psychological approach, is more concerned with the type of intrapsychic
conflict and its specific dynamics, in addition to the analysis of defense
operations and their vicissitudes.
A shift in emphasis is expected in an object relations conceptualization.
One example is a focus on primitive or archaic devouring-aggressive urges
as described by Melanie Klein (1935/1975), who referred to them as the
paranoid and depressive positions. Another approach is the schizoid with-
drawal-avoidance adaptation as described by Guntrip (1969). P. M. Lerner
(1991) and several contributors to H. D. Lerner & P. M. Lerner’s (1988)
book have provided rich illustrations of Winnicott’s (1953) concepts of the
transitional object and the false self for understanding projective test
content. In a similar fashion, therefore, the regulation of self-esteem or
self-cohesion and the nature of selfobject functions become the central
focus of a self psychological point of view.
When Rapaport’s and Schafer’s seminal works on diagnostic psychologi­
cal testing appeared, psychoanalytic self psychology was unknown. The
predominant theoretical view in psychoanalysis was that of ego psychology,
influenced appreciably by the work of Hartmann, Kris, Loewald, and
Loewenstein. Melanie Klein’s work was also actively in progress at the
time. There were other formulations of preoedipal (deficit) pathology by
well-known precursors of contemporary object relations theorists, such as
Edith Jacobsen and Margaret Mahler. As Freud’s structural theory led
naturally to a renewed emphasis on the psychology of the ego, the evolving
views of psychoanalysis inevitably placed emphasis on elucidating the
defenses, character pathology, and adaptive-synthetic ego functions.
106 CHAPTER 4

Anna Freud’s (1936) pivotal study of defenses served as an important

bridge in this effort. The prevailing views of this period of psychoanalytic
thinking provided a compatible theoretical focus for Rapaport and his
colleagues’ effort to discover the complimentarities between clinical psy­
chopathology and cognitive-perceptual functions studied in the experimen­
tal psychology laboratory. One result of this effort was the battery of
personality and perceptual-cognitive tests that became the foundation of
personality assessment, or in Rapaport’s term, diagnostic psychological
testing (Rapaport et al., 1945, 1968).
How, then, can one attempt to incorporate Kohut’s theories into projec­
tive testing? There is no reason to believe that the same criteria that Schafer
proposed for inferences derived from drive theory cannot be applied in just
as logically systematic a way for a self psychological formulation. Because
empirically based test scores or markers do not exist, the conclusions about
self-esteem regulation or self-cohesion must rely almost entirely on content
and sequence analysis. Schafer’s criteria can be readily extended to inves­
tigate self states and self disorders because the method of analysis of the
response pattern is not affected. Instead, the theoretical viewpoint guiding
the clinical interpretation of test findings has changed or expanded.
For example, consider Schafer’s point about commenting inter-
pretively on the unusualness or provocativeness of a response. This point
becomes apparent when an incidental feature or an infrequent (and
perhaps idiosyncratic) elaboration is mentioned. Thus, a Rorschach
response of an airplane that is spontaneously described as falling or
leaves that are seen as hanging limply from a tree illustrates the point.
Additional recurrences of responses like these add to the interpretive
salience of images about falling or not being in good shape, such as a
TAT story of faltering health or a deteriorating object. To this point,
calling attention to a response or a class of responses for its psychologi­
cal meaning is not specific to any particular theory.
Thus, in a drive theory interpretation of these examples, a falling object
or wilting leaf reflects a relatively mature level of psychosexual develop­
ment, representing phallic defeat, oedipal failure, or loss of object love. If
the developmental level and maturity of defenses based on the total record
were judged to indicate a more regressed level, the same imagery could be
conceptualized as representing oral or anal stage manifestations of fear of
loss of the object itself. Object relations theorists could consider imagery
of falling or wilting as a reflection of dissolution of the self or object world,
in this sense representing a deficit view of psychopathology rather than one
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 107

anchored in conflict. From a related but not identical perspective, a self

psychological view might also regard a percept of falling or wilting as one
that is not rooted in conflict. Such responses indicate a self state conveying
the sense that the self is unable to experience itself as sustained or buoyant.
It is customary to attribute specific meaning to an image from a determi­
nation of the level of psychological organization and not from the associative
content proper, which includes structural conflict or defect, quality and
maturity of defenses, and the resulting pathological syndrome or clinical
picture. Although formal scoring and empirical decision rules are typically
a decisive influence on this clinical determination, content should be consis­
tent with the syndromal or characterologic diagnosis, and the specific
meaning of the content should follow from the clinical developmental
diagnosis. Thus, a falling object or wilting image follows from a phallic-
oedipal interpretation if the diagnosis principally involves structural neu­
rotic conflict. The same response could indicate fear of fragmentation in a
transient psychosis or decompensated borderline state, and it would be
viewed as a reflection of an enfeebled self if the central disturbance is
conceptualized as a self disorder.
In general, Rorschach percepts with imagery having to do with deterio­
ration states are noteworthy, whether these refer to objects (peeling off,
coming apart, wilting, faltering, leaking, crumbling, breaking into pieces,
decaying, rotting) or to people or animals (faltering, aging, withering,
injured, ailing). Related indications of a self disorder or of vulnerable
self-cohesion may be expressed in TAT stories having to do with failure,
degeneration of varying degrees, or illness. Similarly, figure drawings may
denote faltering body parts, clothing in disarray, or details connoting weak
supports, such as a broken umbrella, a button or zipper needing repair, or a
worn-out purse. A tree with drooping leaves, worn bark eroded by the
weather, or a house with a leaking roof or in need of painting also contain
related indications of vulnerable self-cohesion.
Probably even more than in the specific images, such as deteriorated
body parts or objects, the most distinctive indications of self pathology are
revealed in patients’ narrative descriptions, on inquiry, about how a figure
or TAT story is seen. The self psychological significance contained in these
narratives may be particularly pertinent for identifying selfobject func­
tions or needs. Thus, a man standing with a broken umbrella may be
described as having resources to seek another means of protection, as being
able to repair the umbrella on his own, as becoming helplessly drenched,
108 CHAPTER 4

or as seeking a strong, protective figure to assist him with a function he

cannot otherwise perform.
As an illustration of the self psychological approach, a TAT story to Card
1, for example, may refer to the boy as trying to figure out how to play the
violin with no mention of parents or teachers in the background to help
him. The story might be accompanied by an affect state of despair or
helplessness, or it might simply describe finding a solution but with neutral
affect. The key, then, is the meaning of the affect state and its expression.
Thus, the story denoting the feeling of despair might characterize a self that
is devastated to the point of giving up hope of rescue; there is, in effect, no
potential selfobject on the horizon. In contrast, a patient who emphasizes
feeling helpless may be expressing inability or weakness of the self to
sustain itself hardily; therefore, a state of feeling underpowered or vulner­
able is suggested. This response also provides an indication of a need for
selfobject responsiveness, although the specific type of selfobject function
requires additional evidence. A description with no particular affect state
other than thoughtful contemplation related to problem solving may rep­
resent a sufficiently viable self that does not falter in helplessness or
crumble with despair.
In this last example, it might be an error to view the absence of a strong
expression of affect as a defensive reaction formation such as isolation or
repression. For example, the neutrality of the expressed affect may reflect
a patient’s joyful pride in relying on his or her own talents. Although Kohut
believed that the self is not entirely devoid of any selfobjects, the experi­
ence of isolation or solitude as defensive or healthy must be determined
from other test indications.
Inquiry about affective qualities is crucial for arriving at these clinical
distinctions, particularly for TAT stories and figure drawing images. Ob­
taining such information, therefore, should not be neglected or minimized;
a sensitive but astute examiner can obtain it without sacrificing clinical
objectivity or leading the patient off course. Examiners must remember that
the purpose of diagnostic testing is to expose and reveal the depth of
personality rather than to support or abet a defensive posture. Psychodiag­
nostic testing is not the lollipop after a feared injection; it is the injection
itself! The psychodiagnostic examination should be undertaken with prob­
ing incisiveness; it is not a mechanical repetition of routinized administra­
tion procedures. The examination usually does not perturb patients; if they
are perturbed, this reaction can be used to good advantage, and the patient
will recover.
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 109

As for the self psychological analysis for interpreting TAT Card 1, a

common outcome of this story is that the boy becomes a famous violinist.
This outcome is sometimes misunderstood as an indication of grandiosity.
Actually, an inference closer to the real spirit of Kohut’s view is that the
outcome is a statement of pride in one’s abilities or accomplishments. In
development, it parallels toddlers exploring their world with abandon and
pleasure. Although derived from the sector of the self that Kohut called the
grandiose-exhibitionistic pole, an interpretation of grandiosity may be
incorrect and it may exaggerate the pathology—healthy pride and ambitious
assertion may be all that is indicated. To quickly assume that pathological
grandiosity is indicated fails to grasp this aspect of a vibrant self; thus, it
may miss the boat. Further exploration about this story outcome is best
directed toward eliciting how a patient imagines the successful outcome is
responded to or mirrored.
The story for Card 1 more typically describes a parent or teacher
compelling the boy to practice; through understanding the give and take
between the boy and the parent, the nature of the selfobject function can
best be understood. Can the parent not see the boy’s need? Does the parent
fail to size up what the child needs? Is the parent truly absent, in reality or
psychologically, so that the boy is left too much on his own? Does the boy
seek some degree of responsiveness from the parent, in the form of control,
discipline, attention, or affection? Can the parent or teacher manage to
fulfill the authority function while still leaving room for the boy to feel
that he is listened to or that he has some recourse? These are important
questions to try to answer on inquiry; they are crucial to understanding the
boy’s (that is, the patient’s) experience of the self-selfobject milieu.
From this vantage point, the selfobject function as represented in what
the parent means to the child is a critical feature that the examiner should
be able to empathically understand. Analysts and psychotherapists listen in
the same way, but to different material. An examiner can understand what
selfobject function is missing or has interfered with a patient’s develop­
ment by attending as much to what the patient fantasizes about the self state
of the boy of Card 1 as to what the patient sees. It may also be important to
attend to the psychological characteristics of those figures that are unseen
but are still important parts of the patient’s description of the boy’s experi­
ence of himself and his need for selfobject responsiveness. Simply reduc­
ing the typical story to a relatively brief adjectival description by staying
close to the surface of the picture itself does not “cut the mustard,” whether
110 CHAPTER 4

one adopts a self psychological approach or any other psychodynamic point

of view.
It is possible to infer useful information about a patient’s self state from
the three examples provided earlier. In the story of the virtually absent or
unavailable parent, the lack of empathic understanding hinted at by the
feeling of despair describes a parent who sees nothing of the boy’s dilemma.
The story foreshadows the patient’s expectation that he or she is not heard
and is the helpless pawn of others’ needs. Mirroring and idealization
selfobject needs are likely to be unacknowledged. The example of the
unaware or absent parent unavailable to attend to the boy’s selfobject need
is similar to the first in that selfobject functions are probably deficient. But
the reason in this second example is different, and there is the hope of
restoring a needed selfobject response. The reason is that the boy experi­
ences helplessness rather than despair; the injury to the self might poten­
tially be repaired with adequate empathic responsiveness. The example of
thoughtful contemplation conveys a situation in which selfobject func­
tions are likely to be operating relatively normally. There is no implied
injury to, or devitalization of, self-cohesion; it might describe an optimally
responsive parent who works with the child to allow him what he wants
while still insisting on what the parent wants or believes is good for the boy.
Although this third story does not specifically describe mirroring or ideali­
zation functions, it can be assumed that neither is deficient or unavailable.
These examples demonstrate that self states may be inferred from TAT
stories, but they are neutral with respect to specific selfobject functions.
How can mirroring and idealization needs be seen on TAT stories? To
answer this question, I again describe several directions that various stories
for Card 1 can take. One possibility is a story in which the parents insist
that the boy practice with no realization or concern for what he wants.
Inquiry directed specifically to elicit the parents’ motivations or needs
reveals that they do not listen to the boy and do not let him do something
else, such as play with his friends. This version points to an experience in
which the boy’s complaint is dominated by feeling unheard or unresponded
to. It is an indication of deficient mirroring, seen frequently in stories in
which the boy’s wish to make his own needs known is ignored. He is left
feeling unaffirmed, insignificant, or unable to hold his own or to feel
buoyed up. The case would be strengthened were the patient to comment
that the boy’s efforts to get through to the parents go unheeded and so he
feels ineffectual, sad, or undermined.
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 111

Indications of faulty idealization characterize a story in which the boy

wants to look up to an admired figure but his wish is unnoticed or rejected,
so that the boy feels unworthy or ashamed of his wish. The boy may lack
enthusiasm to practice because he worries that he cannot live up to a
teacher’s or parent’s expectation or expects that the teacher will reject his
admiring overtures. Still another indication of an unresponded-to idealizing
need is a reference to the boy’s feelings about not having an adequate
model for how to play the violin. The boy may be described as too bored
or understimulated to sustain the work of practicing in the absence of a
parent who listens, eggs him on, or provides some other encouragement or
reason to emulate the authority figure. In these instances, one can infer that
the idealizing selfobject function is undermined, particularly if accompa­
nied by evidence of an earlier attempt at mirroring needs that were unmet.
Finally, a patient can describe the boy as searching for someone like
himself, a twin, to whom he can feel attached, who shares his plight of
failed empathic understanding. The story may express predominant feelings
of shared misery or hopelessness. Alternatively, the twinship selfobject
function can provide just enough vitalization to the self to allow the boy of
Card 1 to rise to the occasion. It is important to ascertain whether this self
state of vigor and accomplishment requires the continued presence of the
selfobject to sustain itself in a sufficiently robust manner.
It usually requires an inquiry more vigorous than is often the case,
together with a patient capable of indicating this affect, to be certain about
the nature of the selfobject function stimulated by this TAT card or by any
projective test stimulus. Patients may fail to elaborate on many TAT stories
in sufficient detail, a response suggesting only that a selfobject experience
has not been elicited. The inquiry elaboration does not indicate often enough
the specific selfobject function that is mobilized. The absence of an em­
pathic response does not necessarily imply deficient empathic under­
standing, but chronic and ongoing lack of responsivity to need states, seen
over and again on several TAT card stories, does suggest some disturbance
of selfobject function.
Although Card 1 usually contains material that typically concerns a
patient’s relationship to authority figures who place demands on the
patient, it may not be the most suitable card for eliciting content that best
characterizes selfobject functions. These examples suggest that the custom­
ary stories provide a general indication of self states. A deeper nature of
selfobject needs is usually revealed when accompanied by a richly detailed
description, offered either spontaneously or, more typically, only on vigor­
112 CHAPTER 4

ous inquiry. Other TAT cards can yield better examples of selfobject
functions on the basis of their natural or evocative “pull,” such as cards that
depict more than one figure so that some type of relationship, such as a
struggle or intense emotional encounter, is powerfully evoked.
For example, Card 2 frequently contains a story line revealing how
the patient has managed the developmental step of separation from the
family of origin. The nature of the relationship between daughter and
mother may also be captured in the story. In particular, the mother who
cannot let go of the daughter raises the specter of a mother who is lonely
or fragile if left alone. This response offers useful albeit presumptive
information about the daughter’s selfobject needs from a mother who is
unable to tolerate loss or separation. The mother may be described as
though she would lose an important part of her own self, and the daughter
may be experienced as a narcissistic extension of the mother. This
description provides a hint about what the child of such a mother may
be re-exposed to on Card 2. The mother can also feel as if her maternal
function is no longer needed and she is therefore unmirrored and empty
or depleted. The mother can derive pride and sustenance from the
daughter who turns to this mother as an object of idealization. The bond
between them can be experienced as so tightly knit, from the point of
view of the mother, that the potential interruption of a possible twinship
selfobject function represents a specific threat or vulnerability.
A related if not identical pattern can also appear on TAT Card 6BM. The
fullest understanding of the psychodynamic meaning of the relationship
requires a level of inquiry that proceeds beyond simply eliciting that a
separation or rupture has occurred. The fantasied meaning of the separation
should be ascertained to understand what it represents for both characters.
A close inspection of Card 7GF, frequently seen as an interaction between
a girl and her mother, also yields an understanding of the selfobject
functions surrounding the intimate nature of this mother-child relation­
ship. At one level of analysis, the girl may be described as looking away or
as absorbed in internal fantasy as the mother reads to her. At a more deeply
revealing level, the patient may note that the girl who looks away has
withdrawn or decathected from the mother. This response is quite different
from feeling content in the company of the mother. Only when a patient is
pressed does the typical story reveal whether a breach between mother and
child has exposed an empathic failure or disruption and how it is remedied.
Does the mother realize that the girl is not paying attention and attempt to
enter her world to re-engage her, or does the mother persist in reading to
CONTENT ANALYSIS OF PSYCHODIAGNOSTIC TESTING 113

the child apparently unaware if not unconcerned that the girl is not psycho­
logically present? Examiners need to determine how patients perceive the
affective attunement of the mother, and by inference, the intimate figures
in their lives. Even a story indicating maternal involvement does not by
itself imply empathically attuned responsiveness. A level of responsiveness
in which the mother insists that the child listen to her or in which the child
listens obediently misses the boat if taken to mean that an optimal self-sel­
fobject environment is indicated.
A telling feature of these responses is the child’s concern about securing
a needed selfobject function. This feature is typically one of seeking
admiration or affirmation from a parent who is often unaware of what the
child looks for. The story about obedience implies that the patient complies
with almost anything to win the mother’s responsive mirroring, even if the
story outcome suggests that the girl feels subdued or that she quietly
tolerates sadness or disappointment over a deficient self-selfobject milieu.
Some outcomes to this story convey similar reactions to a self-selfobject
unit that is not working optimally. The girl may be left psychologically
immobilized with no choice but to listen passively until the mother’s
“lecture” is over, or the girl’s depression may lead her to fantasize that she
will be a different kind of mother to the doll she is holding, or the girl may
become angry.
The same TAT card may also emphasize the girl’s relationship to the doll
on her lap. This feature is particularly distinctive for denoting an idealizing
or twinship selfobject function. Some common stories take the form of the
child’s imagining that she becomes as good a mother as her own, that the
mother in the picture teaches the girl how to care for her “dolly,” or that the
girl asks the mother to show her in fantasy how to minister to the doll as an
imagined baby. When such story lines do not contain veiled references to
maternal disinterest or resentment on the part of the girl, a normal or
healthy revival of the idealizing selfobject function may be indicated.
Aspects of twinship may also be present, a not unreasonable assumption if
the girl emphasizes her role as an exact replica of the mother’s attunement
or ministration, which the girl then extends by imitation to her doll.
In its most unsatisfying form, and from the standpoint of psychopathol­
ogy a serious indication of a potentially untreatable self disorder, the story
may describe the mother as unresponsive to the girl’s needs, and the girl
may not manage to reinvolve the mother or, in fantasy, to work through
some way with the doll to achieve a sense of restored self-cohesion. Here,
neither mirroring nor idealization is operating properly. This response
114 CHAPTER 4

suggests not only a defective primary structure but the absence of

acquiring compensatory structure as another route to attempt to restore
an injured self. A repetitive series of outcomes to TAT stories permeated
by pessimism or depression is sometimes the expression of hopelessness
resulting from a seriously undermined or devitalized sense of self with
limited selfobject resources to assist with its repair.
 Clinical Indications

5 of Selfobject Functions:
Mirroring

In this chapter, I consider the mirroring selfobject function as it appears on

projective tests. I focus here on mirroring as a selfobject function that results
in the sense of vitalization or buoyancy of the self. Mirroring is a way that
people experience feeling affirmed or admired, a view that comes close to
Kohut’s (1977, 1984) final thinking about mirroring. Although mirroring
originates in the grandiose-exhibitionistic pole of the self, to use Kohut’s
(1966,1971) earlier description, his later writings emphasized affirmation
rather than surface grandiosity as the more fundamental self state. I first
discuss psychodiagnostic testing indicators of grandiosity, but I emphasize
that grandiosity as seen on projective tests should be reconsidered in terms
of an expanded view of disturbed or insufficient mirroring.
The remainder of this chapter consists of a large number of clinical
examples of mirroring. I illustrate admiration as a normal mirroring selfob-
ject need and disillusionment and devaluation as pathological forms of
mirroring selfobject failures. These examples include both Rorschach and
TAT responses from Schafer, Lemer, Holt, and Sugarman. In my discussion,
I attempt to demonstrate that the self psychological view of mirroring can
be applied to projective test responses to provide an alternative view beyond
drive theory or object relations frameworks for understanding personality
dynamics and psychopathology.
The clinical illustrations to be presented are vignettes of projective
testing responses rather than complete cases. (I present two cases in their
entirety as the focus of chaps. 7 & 8.) Although the in-depth material of
fully integrated cases does not appear until chapters 7 and 8, I am not
advocating basing completed clinical interpretations on isolated examples
such as those used throughout the present chapter. The following examples
are illustrative, but not necessarily decisive.
115
116 CHAPTER 5

GRANDIOSITY

A long tradition in diagnostic psychological testing has equated grandios­

ity with narcissism. Kohut expanded that tradition by reconceptualizing
grandiosity as not necessarily pathology (although it may, of course, repre­
sent that, too) but as the expression of a normal need for accurate, empathic
responsiveness or mirroring. Kohut (1966, 1971) first came to understand
the importance of the mirror transference as originating from the grandi­
ose-exhibitionistic pole of the self. Therefore, it is probably no accident that
his early clinical descriptions used the term narcissistic disturbances. Kohut
and his colleagues subsequently de-emphasized grandiosity and the term
grandiose-exhibitionistic pole o f the self. This de-emphasis of pathological
grandiosity came about as it became increasingly clear that its appearance
(as well as its other manifestations colloquially and too casually termed
narcissistic) is fundamentally a normal developmental need for empathi­
cally attuned recognition.
With self disorders considered in this way, grandiosity takes on a differ­
ent meaning in the psychodiagnostic examination. The easily recognizable
indications of grandiosity are readily detected on projective tests. Some
common examples include Rorschach percepts that denote exaggerated
power, such as “the greatest airplane ever known to man,” “the most
powerful force to destroy the planet,” “a king sitting on his throne and
looking over his kingdom,” and TAT story outcomes such as “he becomes
the best violinist of the century” or “the young man gets the best lawyer in
the country to get him off on the speeding ticket.” Such test indications
pertaining to grandiosity should not automatically be construed as narcis­
sism, but rather as defensive efforts to buoy up a faltering sense of self-co-
hesion. Examiners should look for those aspects of the protocol that suggest
deficient self-esteem rather than exaggerated elevations of self-esteem.
Such test indications are frequently subtle rather than immediately evident.
Many of the examples that follow denote the appearance of grandiosity.
Some are from records of patients with inflated self-worth or a sense of
entitlement diagnosable as narcissistic disorders by most criteria. The
majority of the examples, however, imply the diagnosis of a narcissistic
disturbance but are too infrequent or too transitory to convincingly sustain
this impression. My reason for selecting such examples is to demonstrate
that many responses that appear to suggest grandiosity are more usefully
considered as defensive bravado overlaying a self disorder. Several exam­
ples represent little beyond an essentially normal need for admiration.
CLINICAL INDICATIONS: MIRRORING 117

Characteristically, the desire for admiration either reveals a deficit of

mirroring or provides an indication that an injury to self-esteem has
occurred as a result of an empathic failure of mirroring selfobject
responsiveness.
Kohut came to view grandiosity as an exaggerated manifestation of
normal children’s joyful pride in their abilities. Grandiosity becomes patho­
logical as a self disorder only when an expectable response to a person’s
prideful achievements is chronically unresponded to or still worse, when a
person has been made to feel excessive shame about even normal “tooting
one’s horn.” In normal development, Kohut argued, the appropriate re­
sponse to children’s expressions of greatness and omnipotence is joyful
acceptance (“the gleam in the mother’s eye”), which forms the basis for the
internalization of feeling proud that gives rise to normal self-esteem. This
quality of self-esteem persists in an exaggerated form as grandiosity only
when its normal stirrings have been unrecognized, suppressed, or deval­
ued by others.
With maturation, young children’s unbounded omnipotence is less
prominent if, as a result of normal development, it becomes transformed
into the basis for ambitions and strivings. Maturation continues, despite
failures or disappointments and without a fall in self-esteem, but only if
selfobject responsiveness has been optimal enough to permit young chil­
dren, and later on, adults, to tolerate the idea that talents and abilities may
sometimes falter. Empathically attuned parents or similar figures convey
the feeling that they love the children or regard them with pleasure despite
their “warts.” Otherwise, children may re-experience the devitalization,
depression, or rage characterizing an undervalued or unmirrored self that
persists into adolescence and adulthood. Mirroring is thus the normal
response to a budding self in need of being recognized, admired, or
affirmed. It becomes the substrate from which emerges a stable, internal­
ized basis for feeling confident and energetic about pursuing the goals that
provide vigor to aspirations. Deficient mirroring produces the charac­
teristic disintegration products of self disorders, including depression,
anergia, and rage, as well as defensive grandiosity.
The examples such as the greatest airplane, the powerful force, or the
boy who strives to become the greatest violinist illustrate the excessiveness
of the grandiose wish. Beneath that surface excess or bravado is frequently
faltering self-esteem. Thus, for example, the greatest airplane may have an
association to a crash, or the powerful king is overthrown, or the boy fails
as a violinist. More typically, projective test content referring to vigor or
118 CHAPTER 5

power does not take the form of exaggerated grandiosity like the preceding
examples. Some examples are a Rorschach percept of a spaceship take-off
elaborated in a way that emphasizes that the sight is majestic, or the
abominable snowman described as impressive, or an imposing animal such
as a lion described as strong or with a grand mane. Responses such as these
emphasize the wish to be admired and sometimes have additional elabora­
tion about a patient’s feeling misunderstood or unheard or otherwise indi­
cating empathic failure.
Other examples are more subtle. Consider the following Rorschach
responses from a 37-year-old firefighter experiencing outbursts of anger.
The acute reaction followed his inability to prevent his father’s death in a
car accident that he witnessed. This patient produced “the stealth bomber”
as a response to Rorschach Card V. He elaborated this response on inquiry
as: “Broad wide wings, the sleekness of it, the principle that it’s an
undetectable surveillance.” Although not without connotations of secrecy,
aggression, and immunity from detection, this response can also be seen as
an image suggesting grandiose qualities such as being the best of its kind
and most powerful. The response conveys a desire to be admired for its
sleek looks. In terms of psychological development, it is not very different
from the little girl showing off her Sunday best or a little boy wanting praise
for the big fish he has caught or the proud owner of a new automobile
remarking: “Isn’t that a beauty!”
As an indication that fantasies of greatness can readily coexist with less
flattering self perceptions, this same patient gave several responses indicat­
ing weakness or vulnerability. Thus, following his percept of the stealth
bomber, on Card VI this man reported: “A microorganism. I can’t relate to
this thing. Like under a microscope, looks like it’s being squashed between
two sheets of glass.” On Card VIII, the patient delivered a response of “two
rodents climbing to something, a wall, just stuck to it, a foot’s coming out
and it kind of looks like he’s falling away but yet he’s still stuck there, like
a cartoon,” and on Card IV: “A beaver laying next to a roadway, looks like
a flattened animal, the lighter color makes it look more frail like a
crusted-up dried-up dead animal.”
The flattened-out beaver percept was followed by an attempt to restore
some resiliency to the weakened undermined self, but the effort was short
lived: “It also looks like a space shuttle, the one that blew up. The Chal­
lenger.” Thus, his attempt to invoke another strong, powerful image became
the vulnerable shuttle that failed to function and exploded in a well-known
disaster. In the psychopathology of self disorders, patients often give
CLINICAL INDICATIONS: MIRRORING 119

responses depicting prideful, buoyant imagery, such as this space shuttle

or the example of the stealth bomber, followed by indications of an
underlying devalued self.
This same patient previously reported a response on Card II as follows:
“Looks like I’ve been working on my car and I banged my fingers again,
and the dirt and grease and the blood,” which he elaborated on inquiry as:
“If someone’s bleeding like that why don’t you get up and do something
about that, but like if it’s me, I’d just as soon get the job done, it’s obviously
been bleeding a while and I’d just keep working right through it.”
Despite the fact that several pathological Comprehensive System codes
are apparent, notably, inflated morbid special scores, these alone do not fully
capture the vulnerability of self-cohesion strongly portrayed in these exam­
ples. Whether bravado, grandiosity, invulnerability, or sheer brute tenacity,
the responses of this man dramatically conveyed the price that he paid for
walling off the intensity of the affect surrounding threats to self-esteem.
Thus, prideful, vigorous imagery characteristically alternated with projec­
tive test responses suggestive of depletion.
On other projective tests, this patient continued to reveal aspects of
how demanding he was for himself. His stoic, singleminded pursuit of
fulfilling a responsibility served to sustain optimal self-esteem at any
cost. The patient related a conventional TAT story to Card 1 in which the
boy is told to practice the violin and he appears to obediently accept. The
concern behind the story was not whether the boy wants to do the job,
but rather what he must do to master the skills. Accordingly, “He studies
and practices and is happy to make music for himself and others.” The
wish to present oneself as competent is well and good; it is the substrate
for a self turning to the world for admiration. To this point, there was
nothing particularly remarkable about the patient’s response. When the
patient felt he came up short, an intropunitive side to his expectation of
accomplishment began to emerge.
Thus, on Card 3BM, the girl was “sent to her room for disciplinary
reasons; she failed to clean it,” and the girl felt like a “prisoner in her own
room, she feels cold and alone and mistreated.” As the outcome, he reported
that she buckled under, completed the job, and faced responsibility. Later,
describing his figure drawing of a person, the patient emphasized the
“grown, mature” side of the person. He expressed concern about unex­
pected situations in which he had no control, such as “seeing wrongs he’s
not able to correct” or “not being able to do enough.”
120 CHAPTER 5

Together with the Rorschach examples, a picture emerges of a man

with a strong need to be competent, responsible, and in command of
himself. These traits can be seen as manifestations of the grandiose-ex-
hibitionistic pole of the self, traits that emerged with every reasonable
anticipation that mirroring selfobject responsiveness in the form of
affirming his accomplishments would be forthcoming. Any perceived
weakness that undermined the sense of joyful pride in a vigorous,
accomplished self disposed him to feel affectively distanced from feel­
ings of depreciation. This quality is not one of guilt-driven intropuni-
tiveness characterized by wrongdoing; rather, this man’s turning in on
himself resulted from a predominant feeling of not measuring up. The
patient felt underpowered rather than guilty. His difficulty in sustaining
self-esteem was not essentially a problem of grandiosity. It was the
failure to live up to the excessive standards he came to view as prideful
accomplishment worthy of mirroring selfobject responsiveness. This
failure produced the disintegration products of rage outbursts that domi­
nated the clinical picture, perhaps mobilized by finding himself helpless
to save his father from a fatal car accident.
The following series of clinical examples also highlights the close
relation between the appearance of grandiosity and its underlying origins
in self-depreciation. Like the previous vignettes, these examples include
illustrations taken from the TAT and projective drawings in addition to
the Rorschach. They also consider the matter of differentiating mirroring
from idealization selfobject functions.
A patient, a 21-year-old woman hospitalized for an agitated psychotic
reaction, gave the following response to Card IV of the Rorschach:

A giant, like Jack and the Beanstalk, and this would be the beanstalk
he climbed to see if there’s a castle up there, and the giant came out
and Jack ran away and cut the beanstalk down and Jack fell from the
beanstalk; he saves the town and he’s a hero.

Heroic, yes; grandiose, perhaps; in either case, the risk was running away
from something threatening and falling down. The appearance of a noble
gesture, replete with all the greatness of being the conquering hero, is
close to an associated fantasy of falling. Later, the same patient produced
this percept: “It’s like Merlin, some sort of magician, or maybe a witch
talking out of something, it just looks like a witch, either bad or good,
helps people or doesn’t” (Card IX).
CLINICAL INDICATIONS: MIRRORING 121

Although possibly an attempt to grasp at an image of Merlin as a

mythic figure associated with great but benevolent powers, the image
was short lived and quickly gave way to disturbing content. These two
percepts were typical of much of the remainder of her Rorschach proto­
col, in which percepts of vulnerable self-esteem were common. Other
illustrative responses included flies eating garbage, a squashed cartoon
cat’s head, and “a little bear’s claw,” which immediately followed her
Merlin percept.
On Card 1 of the TAT, this patient told the story of a grandfather who
gave the boy the violin as a present that has been handed down, and the
story pertained to the boy’s solitary attempt to figure out how to play.
The boy appeared immobilized by his inability to play and felt “bored,”
perhaps a euphemism for depressed or, from the self psychological view,
devitalized. The patient continued her passive inactivity on Card 2,
where she was “waiting for a bus to take her to school to make something
of her life” because she “wants her parents to be proud of her.” As on
Card 1 the girl passively waited to be taken somewhere. She anticipated
that making something of her life to make her parents proud would just
happen to her. The self as actively pursuing or attaining goals was not
part of this patient’s experience of the self. Rather, as a passive recipient
of whatever came her way, she appeared to submit to what she was given.
This picture is not one of a vibrant, buoyant self that feels full of itself
or strengthened from within. The self psychological meaning of such
passivity or dependency suggests inability to take steps to invigorate
herself when necessary.
On Card 7GF, the patient described a nanny as reading to the passive
little girl. The girl was seemingly unmoved by the nanny’s ministrations.
The girl then “goes off and plays,” and although the nanny was described
as attentive, the girl was “just off in the blue.” When asked to elaborate
her drawing of a person, the patient also lacked a firmed-up sense of who
or what the person should be. Thus, she commented: “This is going to
be sloppy, I’m just going to draw it like a kid. She’s unhappy or happy,
maybe. I don’t know, she’s looking off somewhere, waiting for some­
thing, maybe a car or someone to pick her up.”
Her drawing of a male was described as “a character, not a real person,
a fairy tale character from a book. In England in olden days and he was
a prince and he’s just that. He rides a horse, helps other people, defends
them. If something goes wrong he saves the day.” The emptiness and
indecisiveness of the sense of self and the faulty mirroring of the
122 CHAPTER 5

vigorous strivings of the self for definition are particularly notable in this
young woman’s projective test responses. This picture is not that of a
cohesive, invigorated self, but rather a possibly depleted shell of a self.
On Card X of the Rorschach, the patient attempted to depict lions as
a figure of strength, but the percept became “lions on a crest, or a brooch,
like my grandmother’s brooch.” Before assuming, however, that the
attempted reach for a vigorous percept of lions cannot be sustained but
instead became a design on a piece of jewelry, one must consider the
possibility that the grandmother was a source of strength to be relied on
for idealization. This possibility may also apply to the patient’s previous
Rorschach response of Merlin the magician. Nevertheless, this interpre­
tation is unlikely; the patient failed to sustain an idealized wish for
strength in her tearfully delivered references to the witch-like qualities
of the percept as it was elaborated on inquiry. In addition, the previously
noted responses of a valiant prince who was not real or the heroic Jack
in the Beanstalk who was cut down are ominous. It is difficult to be
reassured that the lions on the grandmother’s brooch and the percept of
Merlin can do much to come to her aid. Rather, these responses repre­
sented futile attempts to repair undermined self-cohesion. Recall again
her passive anticipation of others to pick her up at a bus stop or take her
to a place where someone comes along to “make something o f ’ her.
Thus, the possibility of idealization as a compensatory structure is
weakened by the emphasis in this patient’s associations on failure or
unavailability of potentially strong, idealizable figures such as Merlin or
the heroic prince who becomes an unreal fairy tale character. Although
the powerful lions on the grandmother’s jewelry may suggest a possibil­
ity of a revivable, idealizable selfobject, the relative emphasis on help­
lessness rather than on potential sources of strength favors the view that
deficient mirroring is the predominant self state.
These examples indicate that the appearance of clear or suggestive
percepts of a grandiose nature, including descriptions of powerful fig­
ures, does not necessarily represent inflated self-worth. Indications of
vigor and invulnerability often give way to other percepts expressing
weakness, devaluation, or diminished self-esteem. Rather than attempt­
ing to portray psychological health, responses of a grandiose nature
frequently represent ill-fated attempts to preserve whatever vitality can
be managed. As these examples illustrate, the effort is often not well-
sustained, and the patient typically caves in before very long.
CLINICAL INDICATIONS: MIRRORING 123

ADMIRATION

My discussion of grandiosity examined the issue of how the surface

appearance of exaggerated self-worth may have more to do with defensive
concealment of an underlying self disorder. The defense is the way that
people protect themselves from re-exposure to injuries to self-esteem. This
response becomes particularly important when the injuries result from
selfobject failures to respond empathically to the need to feel invigorated,
appreciated, or understood. These needs are all manifestations of mirroring
selfobject functions.
Several of the following examples of mirroring selfobject failures come
from a re-examination of outstanding projective testing texts from other
periods in the development of diagnostic testing. These classic case discus­
sions are valuable in their own right and also demonstrate that the interpre­
tation of projective test content followed from the theoretical approach in
which it was originally framed. Some of these views can be reconceptualized
in light of subsequent developments in psychoanalysis, such as the psychol­
ogy of the self and various theories of object relations. I am including select
examples in this chapter to demonstrate how a clinician with a self psycho­
logically informed viewpoint might understand such material.
Schafer (1954) presented the Rorschach protocol of a woman who was
diagnosed with conversion hysteria (Repression, Case 1, pp. 197-203),
a diagnosis emphasizing the characterologic organization of the person­
ality as hysterical and narcissistic. In his ego psychology formulation of
the protocol, Schafer commented on the naive and egocentric themes,
accompanied by feelings of inadequacy and a need for protectors who
are depreciated but still admiring of the patient. This patient’s initial
response to Card I was an orchid, which Schafer regarded as an indica­
tion of the core narcissism and a symbol of a passively received tribute
to a woman’s attractiveness. The implication is that the patient’s presen­
tation of herself asking for adornment or praise represents a character
weakness. Consequently, her seeking attentiveness is a defensive reflec­
tion of narcissistic vanity.
Clinicians adopting a self psychological interpretation might view this
response as neutral with respect to psychopathology or even charac-
terological defect. The orchid would represent the patient’s normal need to
be valued, as when a child turns to an admiring parent for a display of
acceptance of the child’s effort. The initial response to Card I may be
compared to the beginning treatment sessions of a patient asked to associ­
124 CHAPTER 5

ate freely. If the early associations in treatment are thought of as asking the
question “How am I doing?” the central dynamic is a need to be seen
favorably or as competent. The comparable question about beginning the
unfamiliar Rorschach test can just as easily be “Is this orchid a good enough
response?” Thus, the interpretation of a narcissistic character structure is
not crucial for understanding the orchid response but may represent the
dynamic of healthy mirroring needs striving for recognition.
The patient’s next response of a woman’s dress need also not be inter­
preted as another narcissistic-decorative indication as Schafer regarded it.
Schafer considered that the dress as an adornment took precedence over the
human qualities of the person in the central detail of Card I. The focus on
the dress rather than on the person may show a continued need for recognition
or admiration originating with the orchid percept, as if the patient asked the
examiner to admire her dress or appearance as a symbol of herself. It is like
asking again “How am I doing?” without necessarily implying a deficiency
in failing to appreciate the inner qualities of the person.
By the time Card II was presented, this patient’s percept of dwarfs
attending Snow White signifies a failure of the patient’s wish to be admired
or noticed, at least from the standpoint of Kohut’s understanding of mirror­
ing needs. The image of dwarfs may indeed indicate a depreciating mockery
of men, as Schafer suggested. The same imagery can also reflect the
patient’s feeling of herself as weakened. This feeling is reflected in her state
of being attended by dwarfs, in the absence of a more suitable selfobject
presence to confirm that the patient as Snow White is, in effect, the fairest
of them all. (This association is mine, not the patient’s or Schafer’s.) This
line of thinking considers the patient’s desire to be the fairest of them all,
as I view it here, not as grandiosity, but rather as simply asking for
admiration or affirmation of herself as worthwhile. The characterization of
Snow White as standing for basically normal expectations of an optimal
level of selfobject responsiveness can represent just as plausible an alter­
native to the vain, hysteroid “Southern belle” of Schafer’s ego psychologi­
cal interpretation.
Much of the remainder of this patient’s protocol consisted of imagery
such as heavy boots, a stuffed animal skin worked on by a taxidermist, a
rat, beetles, and a dead tree branch. By the time the patient arrived at Card
IX and reported knights in armor, it is easy to imagine that she had described
again and again her experience of an injured self in need of mirroring
selfobject responsiveness, with the suit of armor representing her need to
protect her brittle sense of self. From this viewpoint, the knights in armor
CLINICAL INDICATIONS: MIRRORING 125

response need not be construed as another manifestation of the Snow

White and seven dwarfs image of Card II, which was Schafer’s beginning
to his commentary about Card IX, emphasizing “hysteric imagery, South-
ern-belle style” or his patient’s need to ward off hostility.
On Card X, Schafer considered the percept of a caterpillar that the patient
despises (and other percepts of bugs and beetles seen on Card X) as naive,
egocentric expressions of phobic defenses. A clinician of a self psychologi­
cal persuasion may consider these same responses as the patient’s failure to
sufficiently repair the injuries leaving her with feelings of self-loathing. The
patient’s other response to Card X was a flower bud, which Schafer
interpreted as part of her concern about loss of youthful charms. A psychol­
ogy of the self interpretation centers on this image of the flower bud as a
revivable kernel of self-esteem awaiting a responsively empathic selfobject
to help restore an enfeebled self. The difference between the clinical
interpretations of the previously cited responses contrasting drive theory
and the psychology of the self also illustrates the different viewpoints about
whether human needs are essentially in the service of enhancing faltering
self-esteem or are drives and their derivatives in search of discharge.
As just noted, Schafer’s patient concluded her Rorschach protocol with
the image of a budding flower emerging forward, much like the orchid she
began with. This imagery can be understood as a representation of narcis­
sistic-decorative needs, as Schafer recommended. It may also be under­
stood from the viewpoint of what the patient needs to sustain viable
self-esteem. The examiner’s empathic response to the Rorschach percept
is to the need it represents. The self psychological view of empathy is not
the same as the customary meaning of empathy as concern for a person’s
plight. With this type of empathic understanding, in Kohut’s conceptuali­
zation of the self, one then considers an image such as a flower to stand
for states of the self. More characteristically, it represents what the self
requires for its “flowering,” that is, cohesion or vigor. Thus, the imagery
depicts as much the idea of what the self needs for its buoyancy as it
reveals its state of health or disrepair.
The initial response of an orchid can also be seen as the response of the
self expecting to be valued, like the healthy child who turns to the mother
after successfully practicing some skill with the expectation of praise for
that accomplishment. This mechanism is precisely that of the mirroring
selfobject response. Schafer’s patient experienced disparagement as re­
vealed in many of her responses between the orchid and the flower bud.
Feelings of disparagement reflect empathic failures to the self’s more or
126 CHAPTER 5

less normal expectation of accurate mirroring to the assertive display of

its vigor, like the orchid response. The knight’s armor may represent the
self’s attempt to protect itself from further injury, and the flower bud of
the following inkblot can be construed as a revivable attempt to obtain an
empathically responsive mirroring response. The prognostically favor­
able indication implied by this dynamic does not reflect the relatively
inflexible characterologic or defensive position that Schafer described as
narcissistic-decorative in type.
A similar example is supplied by a sequence of Rorschach responses
reported by P. M. Lerner (1988, p. 81) in which a patient reported on Card
V: “A b a t... beautiful, billowing, and showing its splendor ... yet there is
pain in the wings, they look racked and crumbled.” The next response, also
to Card V, was “dancing girls you see in Las Vegas with costumes on, head
gear and little feet.”
Although Lemer regarded these examples as illustrations of Winnicott’s
concept of the false self, he noted that the patient initially emphasized the
exhibitionistic aspect of the self “showing its splendor” to be admired. This
reaction quickly led to the anticipation of not being responded to (or
selfobject failure, in Kohut’s view) and resulted in the “crumbling” depres­
sion of diminished self-esteem. Lemer viewed the dancing girls percept as
a defensive manifestation of the false self on the basis of the reference to
being in costume. An examiner with a self psychological approach based
on Kohut’s work might note that the percept of dancing girls in costume
represents an attempt to repair a devitalized self that had “crumbled” and
failed to sustain its greatness (“showing its splendor”). Therefore, the
percept need not necessarily be seen as defensive, but rather as the healthy
attempt of a self seeking what it needs to be reinvigorated and thus to
forestall further depression.
It is instructive to examine another patient’s response to Card X, similar
in some ways to the previous patient’s response of the dancing girls in
costume or Schafer’s patient’s percept of the flower bud. The response is
described much more expansively in the following example, also taken
from Schafer (1954; Projection, pp. 305-306). This patient reported:
“Springtime with budding and flowers ... a certain sort of exuberance to it
... a feeling of newness in it, beginning a new thing.” In the Menninger
scoring system, this response was considered to be a confabulation, with a
CF score, although Schafer noted that it contains “elements of pure C,
absurd F- and autistic handling of size relationships” (p. 306). Although
there is some question that this response unambiguously satisfies Compre­
CLINICAL INDICATIONS: MIRRORING 127

hensive System criteria for confabulation, there can be little doubt that
an integration failure has nevertheless taken place. This interpretation
casts a different light on the matter of whether references to budding and
newness represent rejuvenated self states in the same way as in the
previous examples.
The poor quality of the response, in its utilization of affect (C or CF),
form demand, and cognitive organization, may compromise this view
about the self state. The response should at least cause examiners to
consider comorbid psychopathology. Schafer pointed out that the re­
sponse comes as a surprise because of the emptiness and depression
suggested by the rest of the Rorschach protocol. Thus, examiners must
take into account the possibility of hypomanic denial in evaluating this
response, which provides a useful reminder that the total record, includ­
ing the assignment of major scores for form quality, affect regulation,
and cognitive organization, cannot be ignored in the analysis of content.
This point is crucial to guard against the danger of unrestrained interpre­
tations considered in isolation of the total record.
In contrast, another response with exuberant affect, but without a
cognitive-affective integration failure, and also to Card X, was reported
by Athey (1986, p. 36):
Martian creatures ... overall, it’s very colorful and conveys to me a feeling
of celebration, even jubilance or flight.... I guess I’m thinking of fireworks
like on the Fourth of July ... like the burst of color and light of fireworks,
and there is an overall feel of lightness and airiness to it as well.

Unlike Schafer’s patient, Athey noted that this potential pure C response
did not inappropriately combine with form-based components, and the
associative process remained task focused. There were no thought dis­
order or cognitive integration scores. Thus, there was no apparent per­
ceptual-cognitive failure in this response, which permitted an analysis
of the joyful affect unspoiled by a response of poor form quality. This
response is more similar to that of the flower bud of Schafer’s first
patient, but not to the response of the flower bud from the hypomanic
patient just noted.
The contrast between these examples also serves as a useful reminder
that the content analytic approach I am emphasizing throughout this book
follows after formal scoring. It is not my intention to argue that content
analysis should represent the sole or even the primary basis for clinical
interpretation.
128 CHAPTER 5

DISILLUSIONMENT AND SELF-DEPRECIATION

The previous examples illustrated that deficient responses to normal

selfobject needs for mirroring undermine healthy, robust self-esteem.
Mirroring provides the foundation for sustaining self-esteem; if it is off
the mark, poorly timed, or insufficient, the result is the symptomatic
picture of narcissistic personality and behavior disorders, or more gen­
erally, of disorders of the self. One of the chief manifestations of self
disorders is depression with its associated problems of emptiness,
chronic boredom, or disillusionment with life. These problems are fre­
quently expressed in the form of self-depreciation, although they may
be defensively transformed into devaluation of others as well. The
examples that follow indicate how disillusionment and self-depreciation
may appear clinically in projective test content.
The following Rorschach responses are by a patient who is more self-
depreciating than were Schafer’s and Lemer’s patients cited previously.
Nevertheless, there remains an attempt to repair a self state that appears
pervasively devalued. The patient is a 35-year-old man, hospitalized for a
major depressive episode after several job rejections following a checkered
work history in his professional field. He produced the following response
to Card VI: “Two bison, small horns and a head, irregularly shaped legs.”
He followed this response with a percept of “two bear rugs with just one
arm,” to which he added on inquiry: “They could be sewn together to make
one rug. (Q) two pieces trying to come together to make a whole.”
Ego psychologists would naturally be attracted to the conflict-defense
configuration and would perhaps consider the bison percept to be a mani­
festation of aggressive wishes (suggested by the powerful figure of the
bison) that are threatened by the counterwish of retaliation (the diminished
horns and irregular leg of the bison; the missing [castrated or amputated]
arm from the bear rug). This interpretation very likely regards the punitive
superego as influential in the patient’s depression.
Alternatively, this patient’s responses suggest a desire to present an
appearance of strength represented by the image of a bison, but this image
is immediately undermined by the reference to small horns and poorly
shaped legs. The sewn-together bear rug response reveals a self state in
which the patient cannot stand on his own. The response captures failing to
sustain self-cohesion particularly well by indicating that the patient, in his
defective state, feels malformed or incomplete.
CLINICAL INDICATIONS: MIRRORING 129

Another example comes from Holt’s (1978, pp. 312-317) discussion of

the TAT obtained from a young male college student. One TAT story reads:
“He is a broken man ... He tries to find research in a pulp mill but by now
he has become an automaton. He has no initiative and no spark, and his
mind is warped.”
Holt interpreted this response as an indication of stereotyped conform­
ity. The same patient went on to produce another story in which: “She is
completely disillusioned with what she thought there was in life other than
what she had so she comes home and marries ... and settles into a life style
exactly like that her mother had ... she resigns herself to it.” Holt’s
interpretation emphasized disillusioned resignation. He characterized this
young man’s passivity as defensive reactions to threats to self-esteem.
Although this view is evident, it may not go far enough. With the benefit of
Kohut’s understanding about the fall in self-esteem experienced when the
self is unresponded to, the hopeless giving up reflected in these TAT
responses suggests more than defensive passivity. These responses capture
not only how the patient undoubtedly feels, but also what he urgently needs.
Specifically, the need is for the responsiveness of an alive, invigorating
selfobject that can provide the necessary mirroring for this man to recover
his assertive ambitions.
Further evidence that self-cohesion has been undermined in the ab­
sence of optimal selfobject responsiveness may be seen in another TAT
story from this young man:

This fellow has been working in the lab trying to find a new form of
gasoline that will revolutionize the market. After 165 trials he finds it; an
oil company buys it, but the new gas is shelved, and the man realizes ...
that he will have to start over again. He is disillusioned with science which
has no more to offer him. He has given up the idea of benefiting man.
He is a broken man.

Holt did not indicate TAT card numbers, so it is unclear whether this story
precedes the previous story. It is not crucial, however, insofar as the main
point remains unchanged: After much effort, the product of the man’s work
is “shelved,” as are all his hopes for sustaining self-esteem. Unmirrored and
unresponded to with the vitalization he needs to support a buoyant, alive
sense of the self, his ambitions (of science and benefiting mankind) and
self-cohesion (the reference to a broken man) fail to take root. Although not
inconsistent with Holt’s characterization of this TAT story as a lowering of
the ego ideal, Kohut’s enhanced description of a healthy, viable self as a
130 CHAPTER 5

precondition for ego ideals adds a further level of understanding to the

relation between selfobject functions buttressing self-esteem in striving to
accomplish life goals.
Two other TAT stories from this same patient illustrate the devaluation
that has developed to protect him from the self-esteem injuries he appar­
ently experienced repeatedly: “He’s against everything ... and against
what everybody else is doing in general because he can never be satisfied
with the world as it is. He always has a chip on his shoulder and a grudge
to bear,” and “the sounds that came out just were not music to him; so little
by little he began to hate music lessons ... practicing just became a bore
and a burden ... He began to hate his teacher. He began to dislike his
mother for making him take lessons.”
Holt’s descriptions associated with these stories highlighted negativism
and resentment. A reactive (defensive) pattern of abasement serves the
purpose of protecting the patient by letting him retreat to an unreal world in
which matters are set right. Kohut would very likely call attention to the
experience of feeling bored and listless, of mechanically going about the
business of life in a joyless manner. This self state of devitalization is bereft
of the needed mirroring selfobject experiences that provide energy or pleas­
ure. The patient’s incentive to pursue goals and to enjoy life is replaced with
angry, resentful emptiness.
The need for mirroring has not disappeared entirely and may still be
revivable, as can be detected in TAT stories in which the patient “gradually
worked up until he owned ... a corporation ... so he was rather successful in
spite of the fact that he didn’t have his father’s help,” and “he was a great
daydreamer and often thought of himself as a Galahad riding off on a white
horse or a kind doctor who helps all his patients.” In addition, the patient tells
a story in which “the farm isn’t yielding anything any more, but still they
keep on ... their future is just n il... but they’ll try again, year after year.” Holt’s
description of these responses emphasized the patient’s fantasies of achieve­
ment, but it is not clear whether these form the basis for his interpretation of a
“retreat into an unreal world where matters are set right” (p. 317). The Galahad
story is no more an indication of a retreat than any normal striving of an
injured self attempting to find whatever resources may still remain to keep
afloat. To regard it otherwise is clinically misguided, from the self psychologi­
cal viewpoint. Nor is it correct to view owning his own corporation as magical
thinking or a grandiose fantasy. The joyless struggle to keep trying despite
repeated disappointments can not be overlooked in this patient’s ongoing
experience of his struggles to repair injured self-esteem.
CLINICAL INDICATIONS: MIRRORING 131

ARROGANCE AND DEVALUATION

One typical way in which mirroring needs may appear is in the form of
criticism, faultfinding, or arrogant superiority. These represent aspects of
grandiosity and appear sometimes with only a superficial defensive veneer
that barely conceals an underlying aggrandized sense of self. In fact, on
closer analysis, the arrogance appears to mask feelings of diminished
importance. The haughtiness or sense of entitlement is often the surface
manifestation disguising that patients with self disorders can feel deval­
ued, sometimes painfully so.
Although Kemberg (1975) and the Diagnostic and Statistical Manual o f
Mental Disorders (DSM-IV)-fourth edition criteria for narcissistic person­
ality disorder accorded entitlement a prominent place among symptomatic
features, Kohut did not emphasize this quality in the self disorders. Kohut’s
preference for directing attention to cold aloofness or arrogance rather than
feelings of entitlement did not minimize the importance of entitlement in
his thinking on the subject, however. Arrogant faultfinding is not seen as
originating from envy, as does the British object relations theoretical
preference or Kemberg’s position on devaluation. Rather, the self psycho­
logical emphasis is on vulnerability or self-denigration. Thus, consider a
response such as “two pigs dancing snout to sno ut... or Middle European
peasants dancing in a folk dance—women probably, peasants” as produced
on Card II by a Hispanic man (R M. Lemer, 1988, p. 286) or similar
examples such as content involving “talking down to” or giving “dictation”
to the examiner as in several examples provided by Schafer (1954) and R
M. Lemer (1991). Responses such as these are understood in the self
psychological framework as revealing a patient’s vulnerable, undermined
self-esteem rather than as arising from a primarily aggressive impulse or
from a sadistic or envious introject.
Following an object relations interpretation of psychological dynamics,
R M. Lemer (1991) also considered devaluation as a major clinical phe­
nomenon seen on projective tests. Devaluation, from this viewpoint, may
represent envy. Some of Lerner’s examples included distortions of the
human form, such as a sinister-looking figure, a headless figure, evil
witches, or figures from outer space. These examples characterize a self-
image of incompleteness, distortion, or failure. These aspects of the expe­
rience of the self are not the same as Kohut’s concept of devaluation. In
Kohut’s view, devaluation appeared as a defensive means of protecting the
132 CHAPTER 5

self from further injury by concealing how the patient experiences compro­
mised self-esteem.
The following vignettes are from a 53-year-old depressed woman
executive currently in her third lifetime hospitalization for a suicide
attempt. The patient had a history of flight of ideas and decreased need for
sleep, although there were no clearly documented manic or hypomanic
episodes. Her initial Rorschach response was “a butterfly” (Card I), and
on inquiry she stated:
The dominant thing is the wings, not a perfect rendition of wings. This
thing is not interesting, but calling it a butterfly gives it more validity even
though it’s not perfect, so I gave it its best name. Looking at it now I see
these hands like maybe it’s drowning, but at first I didn’t see that.
Her next response to the same card is a frog, subsequently elaborated on
inquiry by the comment: “Frogs seem like ugly witless things to me,”
which is then followed by a bat, to which she notes, on inquiry, that “it
looks blind, no intelligence there.” This same patient reported two butlers
as her first of five responses to Card III; however her fifth response was
“creatures talking to the butlers, they seem to know what they’re doing,
though, not like that woman we just drew, sort of a dumb ox” [the human
figure drawings preceded the Rorschach]. She began her inquiry to this
response by commenting: “It’s like you’d just better do it right, you fellows
[referring to the creatures talking to the butlers], this is a very important
affair so don’t screw up.”
Responses characterized by haughty arrogance frequently coexist with
other percepts denoting self-depreciation and finding oneself lacking. Thus,
this woman produced percepts such as “antennae of a bat, something very
sensitive, the vital center of the bat, the nerve center. If you destroy that you
destroy the whole thing” (Card V), and “like an animal, perched, balancing”
(Card VII), to which she elaborated on inquiry: “like all this kinetic stuff. I
must be very lacking in fantasy. There must be this big void in me that I’m
not that fanciful.”
Even on Card III (between the butlers and the creatures talking to the
butlers), the patient reported percepts of gnomes and “a decoration to fill in
the picture. I could say it looks like a tie but that’s not very interesting ...
it’s not doing anything, just hanging there.” One final example from this
same patient’s record is a response to Card IV of “dry leaves, very thin and
curled” to which she added in the inquiry: “I see a burst of glory, very
dramatic, wondrous and warm, while everyone else sees it as everything
dying.” This response may provide a good illustration of hypomanic denial.
CLINICAL INDICATIONS: MIRRORING 133

It is at the same time a good representation of the lengths to which she may
need to go to preserve a vibrant, buoyant self in the face of a self state more
accurately experienced as diminished.
This patient’s combination of bravado and devaluation extends beyond
the Rorschach. Several instructive illustrations from her TAT and figure
drawings continued the same themes noted on her Rorschach. Thus, elabo­
rating on her drawing of a person, this patient stated:

It’s devoid of a projector who could project it well. This poor person is not
attractive and not very interesting and she certainly has no style. That’s a
feminine line there but I don’t know how to make her pretty, she’s sort of
stuck with this funny body. Sort of a stupid expression, a flat, featureless
face: the cortisone look.

By her critical, mocking tone, this patient attempted to distance herself from
this projection of her depreciated self. Her response was consistent with the
previously noted Rorschach percepts in which the patient attempted to stand
above her percepts, such as an uninteresting tie or an imperfect butterfly.
Her effort was not entirely successful, as in her remarks about a void in
herself so that she was not “fanciful” in her imagination. In the projective
drawing, she tried to avoid identifying with the person who was unattrac­
tive, but her only recourse was to fault the projector who is not able to project
the figure well. On Card 1 of the TAT, the patient told the story of a boy
who is told to play the violin but “he couldn’t care less, so he pulls out the
violin in both boredom and exasperation, he puzzles how he can be expected
to get anything out of this contraption.” Her outcome was that the boy breaks
the violin “with his hands in his pocket and a shrug of defeat ... although
the mother is disappointed.”
After inquiring about the mother’s disappointment, the patient changed
her tune: She concluded her story with the boy “dejected” rather than the
previous defensive shrug of defeat. Once again, and by now on three
different projective tests, this patient showed that a defensive bravado,
critical arrogance, or distancing herself from shortcomings readily evoked
feelings of shame or disparagement. Her vulnerable self-esteem was repeat­
edly seen through images of diminished intellect, attractiveness, or talent.
Schafer (1954) reported the Rorschach records of two patients in which
a similar dynamic appears to be evident. One patient’s (Repression, Case
3, p. 213) response to Card III is that of two little men, about which Schafer
noted the condescension, but which he also conceptualized from the drive
theory position of oedipal rivalry or masculine strivings. Similarly, another
134 CHAPTER 5

patient’s (Denial, Case 1, pp. 255-268) response to Card I was the sinister-
looking image of a figure with a small head, big body, and “short hands
lifted up like this, as though he needed elongation for strength ... with no
mentality: that’s why you could go back almost to prehistoric ages with it.”
On Card III, the same patient reported dead limbs of trees, “an old hobo ...
gives the impression of rags and tatters,” and a monkey hanging from a tree.
Commenting on these responses, Schafer considered the reference to
the male figure seeking strength on Card I as the patient’s unstable
conception about masculinity and devaluation of the male figure. He noted:
“She may be unsure whether masculinity implies strength or weakness, i.e.,
whether to be awed by it or to sneer at it” (Schafer, 1954, p. 256). He
continued in this vein by interpreting the hobo-caricature figure as an
indication that men are ineffectual failures. Schafer included the dead limb
response as a further representation of masculine deterioration and the
inadequacy of men as providers. Clearly, although devaluation by no means
went unnoticed in Schafer’s interpretive remarks, these themes are cast
squarely in a drive theory framework. From this perspective, oedipal
rivalry is superimposed on oral hostility in the patient’s complaints about
the inadequacy of men as nurturant providers.
Schafer’s patient continued to deliver responses of a similar nature, with
percepts such as “little gnomes” and a “horrible old man” (Card V), a “weird
figure” and “the Old Man of the Mountains carved out in the rock, not by a
good sculptor” (Card VI), “the face of a baboon” (Card IX), and “a child’s
drawing ... but the house is too small” and “an old telegraph pole that was
partly cut down and grayed with age; not painted the way modem ones are”
(Card X). The devaluative content and tone of many of these responses
revealed this patient’s preoccupation with underpowered figures. In this re­
gard, the projected aspects of her feeling concerned her own ineffectualness.
This same patient displayed indications of idealizing selfobject functions
alongside her responses with a devaluing tone. I return later to the clinical
significance of mirroring and idealizing selfobject functions coexisting in the
same person. For the moment, it is sufficient to note that these selfobject
functions need not be mutually exclusive. Indeed, the relative balance between
them and the capacity for one selfobject function to achieve self-esteem
regulation more successfully than another are further important considerations
in the interpretation of projective test findings.
In regard to Schafer’s patient, Kohut’s view would not ignore the possibility
that men are seen as incompetent, although the dead tree limb, the hobo in rags
and tatters, and the figure with the small head in need of elongation need not
CLINICAL INDICATIONS: MIRRORING 135

refer exclusively to men. Schafer’s patient’s faultfinding is well-noted and

is seen as her attempt to defensively protect herself from being re-exposed
to feeling inadequate. The same dynamic also applies to the patient with
grandiose-sounding criticisms delivered repeatedly.
Thus, grandiose bravado or complaining on projective test responses
may be understood as externalizations of what is at root a prominent self
state of feeling defective. Theoretically, the exaggerated grandiosity and
devaluation seen in Schafer’s patients’ responses cited previously may be
understood as originating from an unmirrored self. The empathic respon­
siveness of a selfobject environment capable of understanding the self’s
requirement for vitality and cohesion has chronically been absent, has left
patients vulnerable, and has caused them to defensively fall back on
haughty arrogance to protect the devitalized self.
Schafer (1967, p. 116) also reported a sequence of TAT stories from a
52-year-old male patient with a chronic alcohol problem. The stories
represented admixtures of bravado and devaluation alternating with self­
depreciation. The patient began on Card 1 with a story about a boy
practicing the violin who “hadn’t brought off, what will we say, the Scarlatti
exercise to his satisfaction. He is a sensitive, thoughtful child who, like
myself, needs a haircut. ... Okay, that takes care of Buster. Oh, you put
everything down” [noticing the examiner’s verbatim recording].
Schafer’s clinical interpretation took full account of the theme of failure
but emphasized the defensive tone in which the patient presented himself as
cultured while flippantly remarking about the haircut. The nonchalant de­
tachment about the examiner’s work barely concealed the patient’s devalu­
ation. This devaluation extended to the condescending reference to the boy
of his story (with whom he identified) and continued throughout successive
TAT responses. Schafer commented: “From a characterological point of
view his style of defense—facetiousness, condescension, transient identifi­
cation, status seeking, nonchalance—is steadily narcissistic” (p. 122). The
self psychological view would focus on the injury and the patient’s image of
himself as small and insignificant. From this viewpoint, unattuned selfobject
responsiveness to the self-esteem loss is the central dynamic feature.
The issue of compromised self-esteem runs throughout the rest of this
man’s TAT protocol. Thus, for example, the story for Card 7BM showed
the degree to which the patient alienated himself from the needed soothing
responsiveness in the selfobject milieu, as the patient told of being in trouble
with the law and “his patient, understanding father is appearing with him
in court and trying to offer a bit of paternal advice. The boy, both remorseful
136 CHAPTER 5

and defiant, is listening to papa but it is too late. He is sent to a prison term ...
for further details, see page three.” Schafer certainly noted the “sarcasm and
detachment concerning human involvement and morality” (p. 125). It is clear,
however, that the central interpretive points were “intense fear of destructive,
authoritarian punishment for the aggressive, sexual, and oral aspects of oedipal
strivings, and fear of being cut off from maternal supplies, of which he feels
very much in need” (p. 127).
The focus of a self psychological interpretation is rather different. The
grandiose bravado is a thinly disguised smokescreen attempting to conceal the
injury from an unavailable, unresponsive, or unattuned selfobject milieu. The
story’s description of an understanding father whose advice arrives too late to
help the boy betrayed the absence of a selfobject environment in which
normal exhibitionistic strivings were tolerated and affirmed. Injuries resulting
from momentary failures might have been eased by timely, empathically
responsive calming, which might have forestalled the patient’s need to develop
such hypermetabolized grandiosity and sarcasm. The patient’s need to depre­
ciate much of what he came in contact with preserved his faltering self-esteem.
It should be apparent from all these illustrations that grandiose images are
closely related to depreciation. On suitably vigorous inquiry, these grandiose
responses readily expose the self injury that undermines a cohesive, firmed-
up mental structure. The inferential strategy assumes that a reference to the
condition of an object seen in a Rorschach percept alters the nature of the
response itself in a psychologically important way.
The same observation is true of descriptions of the mental or physical state
of a character in a TAT story or of a human figure, house, or tree drawn on
command. The description does not refer only to an object with good or poor
fit to the form demand of the inkblot, and the perceptual function is not seen
as the primary task. The elaboration about the condition of the object or person
is taken as a projection of some aspect of the patient’s internal state. In
particular, the experience of the self is crucial insofar as it is felt to be
cohesive, vigorous, or able to withstand threat. The predominant selfobject
need is typically one in search of a potentially available or responsive
selfobject to repair defective mirroring.

CONTENT ANALYSIS AND SELF STATES:

FORMULATING INFERENCES
To this point, I have sketched several principal clinical features charac­
terizing the mirroring selfobject function. I have attempted to show that
CLINICAL INDICATIONS: MIRRORING 137

mirroring selfobject responsiveness is fundamentally a normal rather than

a pathological need. It is both necessary and expectable that accurately
timed empathic mirroring leads to healthy self-cohesion in normal devel­
opment. Only when normal mirroring needs are derailed, through defi­
ciency, inappropriate timeliness, or inaccurate responsiveness, is
self-esteem undermined. Mirroring selfobject failures prevent the feeling
of admiration that promotes healthy pride, buoyancy, and a feeling of
being valued. The results of defective mirroring are self-depreciation,
haughty grandiosity, or devaluation previously described in addition to the
more pronounced disintegration products that Kohut described.
I proceed now with further examples, which were obtained by pursuing
a more vigorous inquiry than is often the case. Some of these examples
represent subtle features of mirroring selfobject functions. These illustra­
tions are all the more notable because the subtle manifestations of defective
mirroring emerged from the detailed inquiry that becomes necessary when
considering content. The inquiry that I illustrate here probes in depth to
reveal selfobject failures that often result from empathically unattuned
mirroring. People who feel devalued attempt to hide this self state in life,
on interview (particularly when they feel unsafe with a therapist or inter­
viewer), and also on projective testing. Patients with resilient defenses
conceal their depreciated self states more effectively; they often drop hints
rather than expose their problems like an open wound. These hints may not
be detected sufficiently with formal scoring. It requires a probing inquiry,
conducted sensitively and judiciously, to reveal the self state in depth.
The strategy of vigorously pursuing elaborations and associations on
inquiry comes as no surprise to seasoned clinicians, including those whose
preference is to favor empirically supported inferences. The purpose of
provocative inquiry is to bring to the foreground the internal experiences
mobilized by projective stimuli. Provocation in this sense does not mean
that thoughts or affective states are suggested or induced. A clinician’s
judgment determines where to draw the line between unearthing what is
there and planting the seed of what an examiner wants to see emerge.
The first example presents a series of TAT responses and figure drawing
elaborations that suggest important aspects of the self state. The patient
was a 21-year-old unmarried woman hospitalized for a depressive episode
after an unsuccessful job search following her college graduation. Her
drawing of a woman was described as happy, autonomous, and joyful, but
her drawing of a man shifted to an image of someone indifferent and
unattainable. Her earlier verbalization about the autonomous and confident
138 CHAPTER 5

woman changed when she was queried about what she meant by the man
whom she drew as unattainable. She commented: “Girls would have to feel
like you have to get someone, something I always felt I’d never attain. He’s
looking away, not interested in what I’m doing.” It is of more than passing
interest that her devalued self-esteem came forward in her elaboration of
the male drawing. This response casts doubt on her original statements
about the female drawing. This skepticism about the healthy self-image
based on the female drawing would not have arisen in the absence of the
additional comment that emerged after a thorough inquiry about the male
drawing. This patient reported a number of other responses that revealed
the same self state so that the interpretation is not tied to a single response.
The patients who can conceal deep internal states are precisely the patients
who require special efforts to provocatively reveal what an examiner needs
to understand about this level of the personality.
The TAT continued these concerns about failure, measuring up, and
attempting to assert her own wishes: The boy of Card 1 “failed to do as
well as he should have,” the girl of Card 2 “feels left out because she’s
obviously not part of the more simple farm life,” and the character of
Card 3BM is “like a puppet who fell. All her strings got cut. In the end,
she stands up again.” The predominant imagery of failure and isolation
is also associated with the feeling that “her mother is not into what the
daughter is doing” (Card 2) and “the girl wants to do something but the
mother is hovering over her being overclawing” (Card 7GF). These
responses suggest deficient mirroring of the patient’s autonomous
wishes. The mother’s selfobject failures, lacking in empathic responsive­
ness as these appear to be, contributed to the patient’s concern about
measuring up. Although a few of these elaborations were supplied
spontaneously by the patient, just as many appeared only after a follow-
up question. It is well worth repeating that it takes time to conduct a
thoughtful, careful inquiry.
The following examples are taken from the Rorschach of a 16-year-old
girl whose parents were divorced; she had been hospitalized following a
suicide attempt precipitated by her father’s recent remarriage. In each
instance, the patient was asked for an association by way of testing the limits
after the scoreable response features were obtained in the standard manner
of administration. On Card I, the patient reported “a dog, a Brittany spaniel,
a puppy,” to which she added upon prompting after the formal inquiry for
determinants: “Looks dead or sick or unhappy, just kind of there, no
emotion.” On Card II, she responded with “a big diamond in the middle,
CLINICAL INDICATIONS: MIRRORING 139

like an engagement ring,” which was elaborated on inquiry as being “sur­

rounded by junk, it can’t shine because no one could see it because there’s
so much other stuff surrounding it that it’s just buried. It’s sad because no
one can see the beauty of the ring unless they dig through all that stuff.” On
Card III, the patient reported “a bloody frog,” which she explained in the
inquiry as: “blood smeared all around it and it just runs, like someone stepped
on him.” The patient produced “a dragon” on Card IV and elaborated further
on inquiry : “Funny-looking like his front feet are bent over and the back feet
are up here, a flexible dragon. (Q) looks sad to me, like he can’t blow out a
fire any more. He’s old and he’s rotting away.”
Some of these percepts are notable because of the juxtaposition of striking
contrasts, such as an engagement ring surrounded by junk or a dragon (even
a “flexible” dragon) who is old and rotting away. The psychological meaning
of a powerful but impotent dragon or junk obscuring the glitter of the
diamond is relevant for understanding the patient’s self state.
The image of junk alongside a shining ring points to a condition in which
the self is very likely experienced as devalued. It also contains some degree
of preserved self-esteem, because a valuable object is still viable however
demeaned it is. This response also provides a good example on projective
testing of Kohut’s belief that the injured self is invariably experienced
alongside the selfobject function that it needs for its recovery. In this
instance, the devalued self as expressed through the reference to junk is
potentially revivable in the form of the diamond, which represents,
therefore, a vigorous self wanting to be seen, admired, or valued. The
reference to the engagement ring might also connote disparagement of
marriage or intimacy as the ring is described as surrounded by junk.
The percept of the dragon may be understood as a symbol of strength
to be taken seriously, regardless of the hostile or menacing connotations
it also has. The play of children, especially boys, is replete with fantasies
of overcoming powerful and frightening figures, fantasies that have more
to do with affirming vigor than with aggression. This patient’s dragon
may also represent a self wishing to be admired for strutting its stuff as
if to say “Look at what I can do.” The self is represented as weak,
however, regardless of how face saving the defense of a “flexible”
dragon may seem. This attempt to buttress a self state shows more
vulnerability than vigor. Similarly, the stepped-on frog and the sickly
dog are also indications of an injured, depreciated self. At least three of
the four responses would not have yielded the self state interpretation
denoted here without the testing of limits after a standard inquiry.
140 CHAPTER 5

This patient’s TAT stories take on a significance that is not only

consistent with the just-mentioned self psychological interpretation, but
that also casts a different light on how conventional interpretations of
common TAT themes might be construed. On Card 2, the patient de­
scribed a situation in which the man plowing the field, who is married
to the woman in the background, has an affair with the woman in the
foreground. He leaves the woman because he prefers his wife, and the
woman “feels she’s been used and hates the guy, but eventually it doesn’t
bother her.” To Card 3BM, the patient’s story is that of a girl crying
because her mother, who had promised to sew a new dress for her, “gets
caught up in other things so she has to do it herself, and like cutting the
dress she gets it uneven and ruins the dress. She wears something else
and lets it go by.” The patient relates the following story to Card 4: “She’s
in love with this man but she moved away and just came back after a
long time and finds him married to someone else. She tries to make him
come back to her but he won’t. Then she finds someone else.”
All three stories have a theme of rejection, either by a man in favor of
another woman or by the mother who appears to forget about the patient.
All three stories end with an apparently flippant disregard for the affec­
tive reaction of being rejected or ignored. It is not difficult to infer
oedipal rivalry and defeat interpretations from these stories. The patient
seems inclined to favor defensive operations that allow her to wall off
or minimize the emotional impact of rejection.
From a self psychological standpoint, however, the themes in these three
stories indicate a normal-enough seeking of admiration, appearing in a way
that suggests that she should be valued for her qualities. She asked for a
mirroring responsiveness that would enable her to feel vibrant. The stories
are a TAT analog of the diamond to be admired or the vigorous dragon
demonstrating its strength as these were seen on this patient’s Rorschach.
Moreover, the TAT stories are a clearer statement of the wish for mirroring
selfobject responsiveness. The spurning of the female figures in the stories,
together with the mother who became distracted and forgot about her, points
to the patient’s experiences of devaluation associated with the thwarted
mirroring selfobject need. These experiences are echoed on her Rorschach,
in which the diamond cannot shine because it is surrounded by junk and
the dragon is no longer powerful because it cannot blow out a fire and is in
danger of rotting away.
Thus, the wish to be treasured or seen as desirable, vibrant, and
valuable emerges in these projective test responses. This wish can be
CLINICAL INDICATIONS: MIRRORING 141

viewed as representing the normal manifestation of the grandiose-exhibi-

tionistic self that presents itself to the world, like the normal toddler
asking to be admired and affirmed. That the patient experiences mirroring
selfobject functions as absent, inattentive, or unresponsive to her can be
seen in the diminished feeling of buoyancy of the self, producing feelings
of inadequacy. This feeling is also evident in the patient’s story about
making a dress that is ruined because the mother was too uninvolved to help
her and in her stories of men seeking other women as love objects. These
responses recapitulate the percept of junk obscuring a diamond and the
response of a dragon rotting away. The defensive walling off of painful
affects associated with the mother’s neglect or the men turning away from
the women of the TAT stories also appears. This imagery reveals the
distance that this patient attempted to create to minimize experiencing
narcissistic injury to her vulnerable self-esteem.
Even the example of the bloodied frog suggests something more about
the experience of self-depreciation because the patient reported that the
frog was stepped on. This comment is as compelling as the strong associa­
tion between the red color and blood; it reaches beyond the aggressive
connotation of stepping on a living thing as expressed in this response.
Probably hostile in intent, although not necessarily always, being stepped
on is also a prominent metaphor for how people feel when belittled or
criticized insensitively. The consequent injury to self-esteem is a dimension
of personality that should be considered in addition to the propensity for
rage. Finally, the examples of falling in the water and the sick or unhappy
dog without emotion also suggest self states associated with injury. These
less striking images are consistent with the psychological meaning of the
patient’s responses of a stepped-on frog that is bleeding or a diamond ring
that is degraded by junk that hides its brilliant sheen.
These two cases illustrate the importance of considering richly elabo­
rated verbalizations. Examiners must conduct a cautiously provocative
inquiry when necessary to expose a patient’s inner life as much as possible.
Usually all that is needed to provoke or unearth an association is simply
singling out a word or phrase and asking for elaboration, such as “An
engagement ring?” or “A flexible dragon?” Often, provocative inquiry is
not even necessary: A patient may freely provide useful associations, such
as the TAT responses or the bloody frog Rorschach percept cited previously.
Examiners must permit verbalizations to come forward beyond what is
needed for formal scoring to hear the deep psychological meaning.
142 CHAPTER 5

CONTENT ANALYSIS AND SELF STATES:

IDENTIFYING MIRRORING AND DRIVE
DERIVATIVES

This section addresses the matter of drawing inferences about self states,
particularly those arising out of defective mirroring. I discuss differentiating
between interpretations derived from self psychology and ego psychology
by using projective test content and begin with a discussion of some
problems about how mirroring may be accurately identified.

Mirroring
The first example illustrates how a self psychological explanation of a
Rorschach response may be misapplied. This vignette is taken from one of
the few reports in the published literature about a self psychological
approach to projective testing. It provides a particularly good illustration of
the need to exercise care in clinical interpretation. At the same time, this
report by Amow and Cooper (1988, p. 58) contributes several excellent
examples of a self psychologically informed interpretive approach.
Amow and Cooper (1988) provided the following Rorschach response
from Card VII: “Two statues facing each other but without much expression
on their faces.” Their interpretation of this response centered on the formality
and coldness of the statues. They emphasized the patient’s experience of the
mother’s difficulty in providing sufficiently enthusiastic mirroring. Amow
and Cooper suggested that the patient hid behind a controlled exterior. They
also suggested that this response characterized one of Kohut and Wolf’s
(1978) typologies, referred to as the contact-shunning personality.
Amow and Cooper’s (1988) interpretation of this response should be
seen as tentative. Although the interpretation is appealing, the response of
statues without expression does not unambiguously characterize mirroring.
The affectively removed statue figures may well refer to an important aspect
of the patient’s experience of his selfobject environment, however a more
compelling case could have been made if the patient’s verbalization in­
volved turning to the statue percept for affirmation that was rebuffed. A
percept of a statue may sometimes connote unavailability when the statue
is specifically referred to as expressionless as in this example. Unavailabil­
ity is not, however, the same thing as deficient mirroring, particularly in the
absence of an indication that a need is frustrated. Furthermore, the clinical
CLINICAL INDICATIONS: MIRRORING 143

validity and conceptual utility of Kohut and Wolf’s (1978) subtypes have
not been uniformly acknowledged.
This fact does not necessarily weaken the basis for assuming that a
mirroring selfobject need for empathic responsiveness is present. The
percept as it stands, however, is too ambiguous for one to conclude that a
mirroring need is mobilized for the patient at this time. In treatment, the
selfobject need is less certain when it is inferred from its absence. Selfobject
functions are most clear when seen through rage reactions and depression
or depletion anxiety arising from frustration of the selfobject need. These
functions are perhaps best illustrated by Kohut’s (1971) case of Miss F.,
summarized in chapter 1.
The same consideration about inferring selfobject functions through the
absence of a reaction or evidence for disintegration products is applicable
in psychodiagnostic testing situations. The most reliable indications of
faulty mirroring are references to a rebuff of the need for mirroring selfob­
ject responsiveness. The response to that rejection (such as somebody or
something’s being depleted, in ruins, or rotting away) becomes crucial for
identifying the selfobject need. Responses based on absence of a reaction,
even stiffness or coldness, are less reliable because they are nonspecific to
mirroring. They may still be accurate, but other substantive evidence is
needed to make a compelling case.
The problem with Amow and Cooper’s example is compounded by
attributing the mirroring deficiency specifically to a maternal figure. Per­
haps their reason was that the response occurs on Card VII, but this
gratuitous interpretive link is a well-established error in clinical inference.
Their attribution may be applicable to the patient on the basis of the total
protocol, but as a clinical vignette considered out of context, this example
is ill advised. It is also unclear whether Amow and Cooper regarded the
statue, with its associations of reserve, as an indication of an unresponsive
mother, the patient’s defensive coldness, or both. Finally, Arnow and
Cooper’s (1988, p. 59) view about the patient’s defensive reserve may not
be well-supported by the available evidence. Kohut did not inevitably
imply that a surface veneer of coldness or a controlling manner represents
a defensive transformation of defective mirroring.
In contrast, Amow and Cooper (1988) provided a better reasoned exam­
ple of a Rorschach percept of a chandelier coming close to the mark: “Very,
very warm, of the past. Grandmother’s house. To bask in the warm light of
a radiant smile.” This response sustained their interpretive hypothesis of a
mirroring need, represented by the chandelier as something to be admired.
144 CHAPTER 5

The chandelier as a representation of the grandiose-exhibitionistic self is

thus a more understandable interpretive suggestion, in contrast with the
statue-mother-Card VII link of the previous example. With this interpre­
tation built around the association between warmth and the grandmother,
the longing for the grandmother in connection with a mirroring selfobject
function can more readily be appreciated.
As with grandiosity, responses with references to mirror images or
reflections do not automatically connote mirroring selfobject functions.
For example, P. M. Lerner (1991) cited a Rorschach response of two men
“mirroring each other ... a man fixing himself up in front of a mirror”
(p. 216). This response was intended to illustrate narcissistic mirroring,
as an illustration of Kwawer’s (1980) scale of borderline interpersonal
relations. This mirroring is not, however, the same as that described by
Kohut. Similarly, Sugarman (1986, p. 67) reported the following re­
sponse to Rorschach Card VIII: “This looks like some sort of a jungle
animal looking at its reflection in a pond.” Neither example indicates
that the patient felt devalued or experienced a need for empathic respon­
siveness. The examples highlight the caution necessary when extrapo­
lating concepts from one theoretical system to another to avoid
introducing unintended implications. Although it is true that mirroring
is a central concept in Kohut’s psychology of the self, it is equally true
that casual indications of reflections in a mirror do not by themselves
connote Kohut’s specific meaning.
The following response, from P. M. Lerner (1988), contains an image
of mirrors that is consistent with mirroring selfobject needs. Lerner’s
patient reported a clown making a face in a mirror so that there seemed
to be two people when there was just one person (Card II). Lerner
commented about the patient’s difficulty in differentiating her own
internal states from those that the patient attributed to others. From this
point of reference, her preoccupation with mirror images represented her
way of seeing herself in others. The patient thus attempted to know who
she was and what she felt. Her imagery also represented the need-grati-
fying quality of her relationships.
This interpretation may illustrate a theoretical difference between
Lerner’s conceptualization of the patient’s diffused sense of self and
Kohut’s interpretation of mirror imagery as the patient’s need to sustain
a clear experience of the self as cohesive. Nevertheless, the need for
mirroring selfobject experience seems to be well-sustained in this Ror­
schach response. This percept and other examples that Lerner reported,
CLINICAL INDICATIONS: MIRRORING 145

contain more than the mere mention of mirrors and mirror images. There
are sufficient elements of an experience in depth with regard to the sense
of the self and its requirement for a mirroring selfobject function to sustain
feeling firmed up.

Mirroring and Drive Derivatives

To this point, I have described the circumstances in which Rorschach
response imagery may represent mirroring. The examples that follow are
concerned with a different matter: whether a Rorschach percept best lends
itself to a classical drive theory interpretation or to one from an alternative
framework, that of psychoanalytic self psychology. I illustrate self psycho­
logical interpretations alongside those derived from ego psychology. Mul­
tiple examples from the same patients offer the possibility of sequence
analysis for examining consecutive responses.
The examples in this section are all taken from Schafer (1954, 1967),
who has provided some of the richest and most complete protocols in the
existing literature. Schafer’s interpretations are valuable because they are
conceptualized solidly in the ego psychological tradition.
The first patient (Schafer, 1954) began Card I with a bat, followed by
“the continent of Australia after an atom bomb hit it,” and concluded with
“a map of Shangri-la.” It is understandable that Schafer stressed the
aggressive content of the bomb; so, too, does a self psychological frame
of reference. The difference, however, is that in the self psychological
interpretation, this response is a disintegration product announcing that
the patient’s self-cohesion is undermined so seriously that it is in danger
of being devastated.
In a drive theory interpretation, the destructive rage is a manifestation of
the patient’s aggressive drive. In contrast, the self psychological position
regards the response as the patient’s saying “I have been destroyed or
shattered” rather than “I am angry or enraged.” The patient does not reveal
his hostility so much as he reveals his vulnerability. In addition, as consid­
ered in this context, the percept of Shangri-la is not thought of as a denial
of aggression in the form of passive-regressive wishes as Schafer advised.
Rather, it is an attempt to repair the devastation by achieving some sem­
blance of restorative calmness.
Self psychology has been criticized for minimizing aggressive urges,
but this criticism is often misplaced. Aggression is not ignored but has
a different clinical meaning. Instead of being seen as a fundamental
146 CHAPTER 5

drive, anger is more typically understood as a disintegration product that

indicates the presence of a self that is either vulnerable or endangered. The
self seeks a means to restore cohesion. The response of Schafer’s patient
illustrates the dilemma well. Shangri-la is not the patient’s attempt to
escape from destructive rage; instead, it represents the hope to find a source
of soothing calmness in which the patient can recover from the injury to
which the self has been exposed.
Subsequently, this same patient gave the response on Card IV of “a
bearskin rug charred in a fire.” Although Schafer’s interpretation in­
cluded the patient’s destructive impulses, he also commented on the
overriding sense of devastation that the patient experienced. He noted
that it is of “more immediate significance” when he stated: “The patient
appears to feel in ruins.” This feeling is close to the self psychological
viewpoint.
Before the response of destruction in a fire, the patient reported birds
with boxing gloves and ballet dancers, then Scottie dogs chasing a
butterfly (Card V), and, still later, cherub figures and an island that
suggested a safe harbor (Card VII). The patient concluded Card VII,
however, with a decomposed pelvic structure. He became appreciably
flustered in his initial inability to deliver a response to Card IX, an
inability accompanied by bravado and defensive arrogance. The patient
at last admitted failure when he stated that “it doesn’t bring to life a single
thing, so we might as well say so.”
His feeling of being incapable of bringing a response “to life” may be
a plausible metaphor for this man’s core experience of the self state as
devitalized and his fear that it cannot be revived. He did succeed,
however, in delivering responses of South Sea island natives kissing and
wearing fluffy ostrich feathers and a Mardi Gras scene that he named
“I’m forever blowing bubbles.” In a similar fashion, after an initial response
to Card X of “My God! They finally blew one apart here!” he concluded the
protocol with sea animals and another Mardi Gras scene.
Thus, Schafer’s patient alternated between a self state of devastation and
attempts to repair injured self-cohesion. He attempted to ease his way out by
either defensively amusing himself or searching for some source of calm amid
the inner storms he experienced so powerfully. This man attempted to repair
an injured self by seeking calming selfobject responses, although this attempt
was sometimes concealed behind a frivolous off-putting surface presentation.
This case is included here, in a discussion of mirroring, because soothing
images are frequently a manifestation of mirroring selfobject functions. In
CLINICAL INDICATIONS: MIRRORING 147

this sense, ministration or nurturing is sought not as an expression of

dependency, but as an attempt to repair injuries to an undermined self.
Thus, responses such as those cited, representing oral needs in the frame­
work of drive theory, may alternatively be viewed from a self psychological
viewpoint as indications of mirroring needs.
Another example, from a later work by Schafer (1967, p. 129), may make
the point more clearly. A depressed patient reported the following TAT story
on Card 5:
This woman is taking a last look at her living room. She has invited her
husband’s boss for dinner and she is not ready ... she is worried that the
room isn’t neat enough because her husband always says she is messy ...
she does have time to go upstairs and change and it is a very successful
party.

Schafer’s (1967) interpretation centered on oral needs, yet the protagonist

of this story may have been primarily concerned with how she appears and
how she is judged. Her self-esteem seemed to depend on the affirmation
resulting from performing successfully. From the vantage point of self psy­
chology, concerns with oral needs surrounding food and a dinner are consid­
ered less crucial features. Although not commented on by Schafer, anal
preoccupations derived from criticism around messiness are also of minor
interpretive importance. At most, the dynamics of such oral or anal conflicts
are secondary to the central need to preserve self-esteem.
Pathological or pronounced oral needs or anal preoccupations are therefore
disintegration products rather than drive states. The need is for the self to be
experienced as robust and cohesive. This experience is sought by securing
selfobject responsiveness based on acknowledging the need to be judged as
competent. In this sense, the specific selfobject need is that of mirroring. Like
the Rorschach examples quoted previously, calming, soothing, and reassuring
responses are usually considered to represent central aspects of Kohut’s
broad interpretation of mirroring.

FURTHER PROJECTIVE TEST INDICATIONS

OF A DEVITALIZED SELF
These examples provide illustrations of defective mirroring needs that are
subtle. In other manifestations of faulty mirroring seen frequently in mod­
erately well-compensated patients, self-esteem appears less overtly patho­
logical. The essential characteristic of this category of self-esteem
148 CHAPTER 5

dysregulation concerns a person’s experiences of him or herself as small,

insignificant, or unresponded to along with feelings of tentativeness about
facing the world with confidence.
In everyday life, patients may describe transient states such as shyness,
timidity, generosity to the point of selflessness, unfailing availability to
others’ needs, and admirable humility. Sometimes viewed as virtues to
others, these subtle manifestations of an often asymptomatic self disorder
are best thought of as characterologically ingrained features, at times
associated with subclinical dysphoric mood, or with chronic but intermittent
states of dysthymic moods that fall short of full criteria for a major mood
disorder syndrome.
Although less frequent, striking, or provocative, the projective test
features of these subclinical states are similar to those of patients with more
overt self disorders. A diagnostic testing examiner may either fail to notice
such responses or may be uncertain of their significance and dismiss them
as a momentary anomaly, particularly if such responses do not recur.
Responses like these are more difficult to interpret because they can be
fleeting and barely noticeable, as if, on an airplane, turbulence passed so
quickly that there was not time for the captain to request that passengers
fasten their seat belts. As with the airplane turbulence, a problem arises
when there are more than just a few such isolated moments or responses.
The customary criteria for judging adequacy of inferences can lead to a
decision to minimize the validity of subtle signs of self state disruptions. I
am hesitant to argue strongly for paying great heed to fleeting responses of
this nature; the criteria for taking them into account are usually impression­
istic and therefore difficult to defend convincingly. My main recommenda­
tion, therefore, is for clinicians to note their presence and potential
significance as a tentative indication.
Some examples of the types of responses that I refer to describe dimin­
ished or underpowered figures, such as “two men facing each other; cartoon
faces, old crusty types with a cigarette dangling out of the side of the mouth,
playing patty-cake” (Card II) or “a hint of a couple of faces, humanoid,
child-like, almost a cherub. The smallness and delicacy to the features”
(Card VII).
These two responses are from the protocol of a 34-year-old male physi­
cian who was receiving disability benefits while claiming that he was
unable to return to the practice of medicine. The percepts were not notably
unusual for these card areas, and the form quality and determinants were
also unremarkable. The percept of men playing a child’s game is likely to
CLINICAL INDICATIONS: MIRRORING 149

be seen as an indication of impotence or insignificance, a regression

originating perhaps from oedipal defeat. This cartoon image may also be a
thinly disguised self-devaluation deflecting attention from the self state of
one feeling infantilized, as the cartoon image of adult men reduced to
child’s play suggests. The percept of a cherub is also not particularly
unusual, although the tendency to emphasize the oedipal theme of small­
ness can obscure the fact that the delicacy of a child-like figure suggests
fragility of the self.
In contrast, neither of these responses is as unambiguous as, for example,
another patient’s percept of “some kind of flower, the leaves are dying,
they’re wilting over” (Card IV). Here, the devitalized self state emerges in
a clear and undisguised manner.
This same patient began the figure drawings with the comment: “You’re
attacking my weakest skill,” a remark conveying his fear of being re-ex­
posed to a vulnerability in which he might appear deficient. His drawing of
a man, in which he “drew his hair like my own,” was immediately criticized
in statements about a receding hairline, too-long arms, and being young
“but not real young.” Much of his elaboration referred to fears that the
person in the drawing “[is] found out to be not good enough,” “trip[s] and
fall[s] and the roof falls in,” and is “walking but not really going anywhere.”
On TAT Card 7BM, the patient described an interaction between a father
and son in which the father was a successful attorney who wanted the son
to follow in his footsteps. The son attended the same college and law school
as his father, who was “reasonably pleased, but the son is not. He does what
his dad wanted him to do. Now he’s into it and it feels pretty hollow.” This
might be looked at as an unsatisfying resolution of an oedipal conflict by
accommodating to the powerful father’s wishes. The response also can be
interpreted as in keeping with Kohut’s (1977,1984) preference to favor the
self-esteem component of oedipal dynamics as crucial. That is, the patient
may have acquiesced to the oedipal parent, but if the boy was not responded
to with joyful pride, as a “chip off the old block” to use Kohut’s metaphor,
the self was driven underground. Consequently, the patient was re-exposed
to feeling devitalized, and, as the patient said, “It feels pretty hollow.”
The self state that results from devitalization, a state that Kohut had termed
depletion depression, may be inferred from projective test responses such as
those just described, in which the experience of depletion is subtle rather
than unequivocal. As with cases of more pronounced selfobject failure, the
most telling characteristic is the persistent absence across responses of some
sense that a vitalizing selfobject is sought. The issue here is not primarily
150 CHAPTER 5

one of diagnosis, centered on differentiating, for example, among a self

disorder, borderline personality disorder, or another characterologic condi­
tion. Instead, the question is how the patient finds himself or herself alone
with the experience of the devitalized self, with no hold on the possibility
that an appropriate selfobject is available to revive the depleted self.
Sometimes, there is a tentative hint of a potential selfobject available for
mirroring, as in the following example: “A flower, dropping two petals”
(Card VIII), which is elaborated on inquiry as: “It’s getting rid of petals that
are dying, it’ll give out new ones soon.” Although initially sounding like a
percept representing deterioration, perhaps as a result of defective mirror­
ing, this inquiry elaboration also suggests the potential for repair of an
injury to the self.
At other times, however, the person representing the selfobject function
may be seen as flawed and thus is not approached with hope to revive an
underpowered self. This situation recalls that of a small child who does
not turn to the mother with animation and expect her to pick the child up,
fuss over him or her, or somehow respond in an empathically attuned way.
It is rather the look of mild surprise, distanced curiosity, or even disinterest
that a child shows to occasional, unpredictable displays of a mother’s
empathic responsiveness. Most of the time, however, there is little expec­
tation that the mother can provide the mirroring selfobject responsivity to
stimulate a feeling of joyful liveliness in an ongoing or sustained way.
The phenomenon I am describing here does not occur in an isolated way
on an occasional Rorschach or TAT card but is a persistent, repetitive theme
appearing regularly across TAT stories and sometimes in the narrative
inquiry accompanying human figure drawings. It is sometimes captured in
the ebb and flow of brief spurts of hopeful anticipation alternating with
disappointment or dashed hopes. Because it resembles depression or
dysphoria, it is often mistaken for the subjective mood feature of a major
depressive disorder. To regard this as a depressive sign, however, contrib­
utes little more to understanding the clinical state in depth than the diag­
nostic interview already provides.
Some good examples of this phenomenon may be seen on the TAT
stories obtained from a 25-year-old man with a psychotic disorder, reported
by Holt (1978, pp. 164-174). On Card 1, this young man described a child,
sick in bed, who has been given music to study; the boy preferred an
adventure story “that interests him more than the music.” The boy was
described as studious, regretting missing school, and “He is not too happy,
CLINICAL INDICATIONS: MIRRORING 151

though not too sad. His eyes are somewhat blank ... reading a book without
any eyes or knowing what is in the book without reading it.”
The boy disregarded the music and fell asleep reading the book. Holt
noted the theme of passive-resistant counteraggression in the boy’s not
studying what the parents wanted him to. He also introduced the theme of
castration based on failure to refer to the violin in the picture. Holt com­
mented on the boy’s difficulty in sustaining interest in the adventure story
that he chose to read and felt that his parents would not mind. Holt also
noted that the story concludes in withdrawal, as the boy fell asleep.
Apart from the conflict-defense interpretive framework favored by Holt,
it is also possible to approach this story from the standpoint of self
psychology. In this view, the boy’s seeking an adventure story represents
his attempt to revive an uninvigorated self, in view of the predominant affect
state of being sick, alone in bed, missing school, and assigned an uninter­
esting task to study. The absence of the parents in an empathically involved
way cannot go unnoticed. The boy is thus left to his own devices to provide
the needed stimulation to an uninvigorated self in this context of parental
selfobject failure. In the end, the boy’s efforts to revitalize himself ulti­
mately fail, he cannot sustain the interest any longer, and he withdraws into
sleep. The deficiency in selfobject mirroring responsiveness can presum­
ably account for the boy’s ennui or inner emptiness.
Later, this patient told a story to Card 7BM in which the young man,
depressed by poor health and feeling hopeless, was told by his father to
find the will to cure himself because otherwise the father and mother must
care for the young man’s wife and children. The outcome was that the
young man moved to a healthier climate with his family, but still failed to
recover. His children were old enough to support their mother, and the
young man had no further contact with his father. Holt emphasized the
moralistic position of the father in addition to his guilt and lack of
nurturance. This situation accounted for the son’s feeling that he can resort
to passive rejection and aggression only by discontinuing any further
contact with the father.
From the viewpoint of the psychology of the self, there is hardly a clearer
illustration of empathic unresponsiveness. Not only does the father fail to
notice the son’s distress, but he lectures him about his responsibilities and
further ignores the son’s need by making sure that the son realizes the burden
that the father himself might have to bear. This interpretation about failed
empathic mirroring is not based on whichever aspect of the moral position
152 CHAPTER 5

one addresses, but rather on the father’s responding to the son without any
apparent awareness of the son’s precarious state.
Even more telling, in the present context of diminished expectation of
selfobject availability, there is no indication that the son attempts to per­
suade the father to attend to his injured self. The son’s passivity is not so
much a rejection of the father as a reflection of the son’s inability to stand
on his own. He fails to recover from his illness and does not thrive. The
illness of the young man represents the devitalizing self disorder from which
he suffers and reveals compellingly how he has come to expect continuing
and ongoing selfobject failure. Like the previous story in which the boy
withdrew into sleep, the young man of this story withdraws from his
unempathic father who fails to provide the encouragement or mirroring to
revitalize the young man’s faltering self-esteem.
Holt’s patient continued with another TAT story. On Card 13B, he related
a story set in “a very poor farmhouse in an isolated part of the country” in
which the boy’s mother is about to deliver a baby and the boy “has been
told to stay out of the way.” He turned to the father but “since he cannot get
much affection from his father who is too busy working in the fields to
even be kind to him, the boy, in his small mind, comes to the conclusion
that it’s a hopeless case.” At this point, the mother needed the boy’s help,
“which makes him feel very elated and he decides he will never leave home.
He had really done more than his father.”
Holt used the term oedipal fulfillment to refer to the “elated” victory the
boy “in his small mind” ultimately achieved. Feeling needed after the initial
rejection by his parents counteracts the boy’s feeling that he is unloved.
From a self psychological position, however, the boy seems to tell the
examiner that he feels forgotten about and must keep out of his overbur­
dened mother’s way. Understandably, patients who feel themselves to be a
burden can hardly expect to experience the gleam in the mother’s eye, one
of Kohut’s favorite metaphors for the developmental origin of normal
mirroring. The fact that this boy recovers so dramatically, notwithstanding
the underlying meaning of his wish to never leave home, points to the level
of selfobject admiration that he craves.
It is of more than passing interest that in the face of deficient mirroring
from one parent, the person experiencing faulty empathic responsiveness
attempts to turn to another potential selfobject. Compensatory structures to
counteract mirroring selfobject failure may emerge in this way. In this
story, unlike the previous two stories from Holt’s patient, the young man
shows some indication of what he seeks in the way of selfobject respon­
CLINICAL INDICATIONS: MIRRORING 153

siveness. He also conveys how much he is at the mercy of what happens to

randomly come his way.
That the brief hope for empathic mirroring was too transitory to sustain
adequate self-esteem may be seen in the patient’s story to TAT Card 16 (the
blank card). A settlement’s inhabitants suffered in an environment in
which they could not survive:

Entirely reliant upon themselves and no one was reliant upon them.
Because of the reason that they were alone was also the reason that they
came to their doom. If they had had one line of contact... they could have
perhaps been saved.

From the standpoint of drive theory, Holt’s comments emphasized the

oral deprivation and cravings underlying this image. Holt also referred to
narcissistic withdrawal in the patient’s desire for human contact that he
found unattainable. The inner deadness and devastation of the self were
not overlooked in Holt’s remarks. Holt may have anticipated Kohut’s
emphasis on the special significance of a psychologically alive selfobject
environment to sustain the self through disillusionment or threats to self­
esteem. Accurate empathic attunement from selfobjects is regularly needed
for sustenance and “psychological oxygen” throughout life.
These examples show that a self state characterized by inner deadness
develops from marked selfobject unresponsiveness. There is a near-total
abandonment of hopeful expectation that mirroring selfobject responsive­
ness is even possible. The patient seems to have given up, which is not the
same as subjective depression. In Holt’s example, this entrenched charac-
terologic position is comorbid with a severe disorder, in this instance a
schizophrenia-like illness. No presumption about causality is intended.
These responses show that a profoundly injured unmirrored self may be
detected even in severe psychopathology. In chapter 7, I present the full
protocol of a case illustrating a similar degree of defective mirroring in a
nonpsychotic affective disorder syndrome.
For other indications of subtle self state manifestations of defective
mirroring, several examples pertain to patients’ finding fault. Often, the
patients’ criticism is confined to references about irregularities of the
image rather than to overt complaints about its inadequacy. Examples of
this dynamic may be seen in the following: “A large furry animal like a
badger, crawling along the ground. Its front paws aren’t quite right” (Card
IV); “these don’t go together down here, it’s made out of paint on one side
154 CHAPTER 5

of the paper and they took the paper and smashed it together because it’s
the same on both sides” (Card I).
Faultfinding responses such as these reflect patients’ complaints that the
world has “done them wrong” or mistreated them. These patients’ role in
life is to collect grievances that show how they have been slighted. At one
level, they are correct insofar as accurate empathic responsiveness has
been lacking, but correcting wrongs is hardly ever therapeutic, although
the patients’ understanding their feelings of being shortchanged may lead
to a salutary outcome. As for the psychodiagnostic use of projective test
responses of this type, faultfinding complaints are often best understood as
deriving from a history of mirroring selfobject failures.
Other subtle examples of faultfinding may be seen in responses such as
“the shadow of a tree, it has no leaves and no branches, because the color’s
fading here” (Card VIII); “an old bone, the bone is chipped and it’s got little
holes” (Card IX); “a daisy. I don’t like daisies, they look too plain, I like
more color” (Card III). Criticisms or complaints such as these nuances of
projective test content can provide indications about self states that are
otherwise difficult to discern in a clinical interview. Many patients manage
to conceal character pathology through a well-defended and compensated
clinical presentation, but projective test comments about irregularities
suggest the underlying devaluation or self-depreciation. The veiled criti­
cism conceals an inner feeling of diminished self-esteem, not unlike the
way that people feel after purchasing store models or “demos.” Although
these products are not necessarily damaged goods, many people still con­
sider them less than optimal. Patients with subclinical self disorders feel
this way internally, and this feeling arises from deficient mirroring selfob­
ject experiences.
Another subtle feature of projective test content related to mirroring
selfobject experience takes the form of creative, novel, or even playful
responses. Consider, for example, the following responses: “A turtle, looks
like it has little socks on. Maybe turtles get cold feet, too, but the rest of his
body’s kept warm by his shell. Needs to keep his feet warm, too” (Card II);
“a flower, but the stem’s not big enough for the flower. Either the flower
has to shrink or the stem has to get bigger” (Card II); “a butterfly. His wings
are down like he’s tired. He’s been through a lot” (Card V). In the absence
of hypomanic indications, responses of this nature may be only one step
removed from a deep concern for the integrity of the self.
Finally, a need for mirroring may be contained in responses in which an
amotivational state predominates. For example, Schafer (1967, p. 139)
CLINICAL INDICATIONS: MIRRORING 155

reported the following TAT story to Card 20: “Well, it looks like somebody
taking a walk in the park. Maybe he was sitting at home and got tired of
doing nothing and wanted some fresh air and went out for a walk.”
Schafer’s comment about this story centered on the motivational state
of feeling bored and inactive. From the vantage point of the psychology
of the self, the search for fresh air is an indication that the understimulated
self is seeking revitalization to enliven or invigorate itself. Although not
specifically denoting a self state in need of mirroring selfobject responsive­
ness, an unsatisfied mirroring need often turns out to be involved in many
patients’ amotivational states.
All these instances deserve note because they portray elements of impor­
tant self states, albeit understated and subtly expressed. The self states in
these responses may not often be the most prominent characteristics of
clinical psychopathology, but they are no less important because self-es-
teem regulation is of concern in a broad range of clinical conditions,
including psychotic reactions, mood disturbances, character disorders, and
even normality. Either a self disorder or a muted vulnerability to disturbed
self-cohesion may constitute the central psychopathology.
A disorder of the self can appear as a primary disturbance in narcissistic
personality or behavior disorders. It may also be secondary to other
psychological disorders with a self-esteem disturbance as one important
aspect. In both instances, subtle manifestations of self states can be readily
detected in projective test responses. Psychodiagnostic clinicians may find
utility in being alert to their presence in the content analysis of projective
test material.
 6 Clinical Indications
of Selfobject Functions:
Idealization and Twinship

In this chapter, I continue the discussion of projective testing indications of

selfobject functions. The previous chapter was devoted to the clinical
indications of mirroring. Here I consider the clinical findings indicating
idealizing and twinship selfobject functions on psychodiagnostic tests.

IDEALIZATION

Theoretical Considerations
The second major form of selfobject functions that Kohut (1971, 1977)
elaborated was idealization. I begin this section of projective testing illus­
trations of idealization with a summary of the principal conceptual and
clinical features of this selfobject function. The points I have selected to
restate are particularly salient for interpreting the vignettes from the psy­
chodiagnostic test material that follows.
Idealization appears clinically in a variety of forms, including admiring
or looking up to others, holding them in awe, or turning to others for
calming strength or to restore equilibrium. The center of greatness shifts
from oneself to an idealized other to whom a child or adult turns with the
hope of bolstering self-esteem. Idealization does not imply attributing
omnipotence or excessive greatness to the idealized selfobject. Thus Ror­
schach or TAT responses can describe an admired figure, like a parent or
favored teacher, without attributing exaggerated qualities of greatness to
the figure.
Idealization may ultimately strengthen ideals or values, although the
primary psychological function of idealization is restoring calm or giving
solace. Projective test content referring to soothing or protective figures is
likely to connote idealization, albeit subtly and sometimes silently. A
calming presence is probably more common or clinically relevant for
156
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 157

identifying the mobilization of an idealizing selfobject function than are

descriptions of more obvious indications, like religious or inspirational
figures. Often, an intensification of idealization selfobject needs follows an
experience of disappointment or injury resulting from deficient mirroring.
This response may be corrective or palliative for faltering self-esteem if the
insufficient mirroring has not been too traumatic, chronic, or premature.
Idealization represents a more or less normal maturation of a selfobject
need for someone to look up to and treasure. This experience fosters renewed
vigor of the self by transferring greatness from the self to a figure who can
be respected. Idealization thus strengthens or enhances self-esteem. Psy­
chodiagnostic test content can readily refer to admired figures, but it is more
important to note that the admired figures reinvigorate the self.
In the face of injury, idealization may revive a self in need of another
route to sustain its cohesion when it has been interrupted or disturbed.
Although not an inevitable consequence, idealization may be another
direction to repair the self, as a compensatory structure, if mirroring has
been insufficient but not seriously undermined. Thus, a projective test
protocol that contains responses alternating between depreciation and ad­
miration suggests the possibility that a compensatory structure is present.
The content also indicates the success of this mechanism. I previously cited
Bacal and Newman’s (1990, p. 232) metaphor of the self “walking in the
shadow of his admired object”; this image is useful for looking at projective
test content to reveal an idealizing selfobject function.
Silent idealizations may obscure the clinical identification of an idealiz­
ing selfobject transference for some time in treatment, although veiled
references suggestive of idealization may be discerned in the clinical
history. Projective testing may reveal muted idealizations more clearly than
does the diagnostic interview. In all clinical methods, however, idealization,
like mirroring, makes its presence known through selfobject failures that
predispose patients with self disorders to depletion depression or anxiety or
more serious disintegration products. These symptoms are well-known to
clinicians treating narcissistic personality or behavior disorders and should
also be familiar to psychodiagnostic examiners.
Responses whose content denotes disappointment or humiliation, such
as falling from grace, are important, subtle indications of an idealization
selfobject function. Disappointment at the hands of an idealized selfobject
seen either as faltering or defective characteristically thrusts a patient into
a vulnerable state of narcissistic injury. Still worse, rejecting or trivializing
a patient’s idealizing overtures only compounds the problem. The discovery
158 CHAPTER 6

that an idealized selfobject is ill, weak, or diminished may be sufficient to

re-expose a patient to the devastating injury to his or her own self-cohesion.
From psychodiagnostic testing material, precisely this sequence of de­
scribing the content of Rorschach percepts or TAT figures in an idealized
manner, followed by an elaboration of the image as devalued or depreciated,
defines the idealizing selfobject need most convincingly. The one without
the other is certainly possible, but the most definitive test indicators are
simultaneous evidence for the idealizing wish, the failure of the selfobject
function, and the patient’s ensuing reaction (such as rage, demoralization,
or sullen injured withdrawal).

Clinical Examples
Consider the following example from a 55-year-old photographer-writer
hospitalized for a depressive episode. This episode was precipitated by the
patient’s wife’s recent onset of illness. On figure drawings, his drawing of
a man was elaborated as follows:

I am a camera. This is a photographer and he sees the world as it is,

sometimes it’s pretty painful. Sometimes he sees that his wife has cancer
and he doesn’t know how to deal with that. Sometimes he’s not able to
have any control of things.

The next drawing, that of a woman, was described as the patient’s wife:

[She] tends to feel pretty good about herself, coping with cancer much
better than I am. She’s a professional woman, a speech therapist, she
enjoys her work and manages her job on a professional basis. Her
relationships with her students and fellow therapists are good. She’s
observant, extremely honest, affectionate, and complimentary.

I chose this example to open the clinical illustrations for this section on
idealization because it demonstrates a fundamental premise about what
people seek in an idealized selfobject function. This example, which
contrasts the description of the two figures, is deliberately not the clearest
or most self-evident I could have chosen, because it does not highlight an
exalted person or a quality of exaggerated greatness or importance. Rather,
it illustrates a subtle but crucial point about idealization.
The patient cast himself as floundering and his ill wife as managing
gracefully despite a life-threatening illness. He did not describe his wife
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 159

in glowingly idealized terms as god-like or as perfect or even powerful.

That is precisely the point: Idealization is not necessarily detected from
aggrandized images, such as all-powerful or bigger-than-life figures, roy­
alty, or gods. Idealized figures are often seen as having a quality or ability
that the patient lacks, a quality leaving the person feeling depleted or
underpowered in its absence. Idealization represents one way that a person
attempts to repair this aspect of diminished self-cohesion. The self becomes
strengthened through the calming reassurance felt in association with the
selfobject.
In a relatively undramatic way, the patient described himself as beside
himself, as feeling out of control in his distress. The contrasting image of
his competent, well-functioning wife provided the calmness or sustenance
that he cannot provide for himself. The idealized image appeared in the
context of this patient’s experience of himself as being overcome and
passively floundering. His fearful anticipation of loss suggested the need
for the idealized selfobject to sustain or bolster self-cohesion. The ideali­
zation occurred in the patient’s search for something that he himself
lacked, not in references about bigger-than-life images.
The example just cited also demonstrates that the primary diagnostic
indication of idealization is not a specific image, such as a Rorschach
percept of a giant, but the quality attributed to the percept, such as its
strength or power, poise or composure, or calming function. The crucial
consideration is the patient’s elaboration or association about what the
image connotes. Certain Rorschach images such as wizards, ballerinas, or
angels may frequently be construed as indications of idealization. These are
thought of as representing a wish for strength or vitality, as possessing
special or unique powers, or as simply being out of the ordinary compared
with other human figures. Such imagery may be considered to represent the
Rorschach counterparts to invoking thoughts of admired people such as
Albert Schweitzer, Jacqueline Kennedy Onassis, Arturo Toscanini, and to
bring it closer to home, Heinz Kohut or David Rapaport. Responses such
as wizards or angels may not necessarily reflect any of these qualities. Many
percepts like these may or may not be of acceptable form quality on
particular blot locations on the basis of normative frequency compilations
such as those of the Comprehensive System.
As I observed in chapter 5, another reason for the need to inquire
thoroughly but judiciously has to do with the frequent observation that
many responses are elaborated in ways indicating that an idealizable object,
admired for its beauty or greatness, may simultaneously be perceived as
160 CHAPTER 6

defective or wanting. Deidealizations of this type occur in responses such

as a ballerina with a broken leg or an angel with torn wings. Examiners need
to inquire for such deidealizations to emerge; merely eliciting a percept
suggestive of idealization, like a ballerina or an angel, does not adequately
convey what is truly being expressed.
For example, one woman with depression described, on inquiry, a wizard
like the Wizard of Oz (Card IX):

A phony, he staged the whole thing, he just seemed like a crook, he has
to be something other than what he is, a big facade, like my father. Now
he’s caught, everyone thought he was so great. He seemed like a real nice
man, some softness under the scary image he portrayed.

The patient also produced a Rorschach percept of “Arthur Fiedler from

behind, leading his orchestra” (Card III). The inquiry to the Arthur Fiedler
percept revealed that “he’s dead, he died an old man.” The patient later
produced this TAT story:

A girl who wishes she could be a ballerina, her mother reads her a story
about a ballerina, she fantasizes obsessionally about being a ballerina, she
tries on her first pair of shoes and dances as if she had magic shoes and
dreams about a beautiful ballerina she imagines. (Card 7GF)

The story concluded with the girl “sad now, she hates everything about
everything. She’s just depressed, stares a lot.”
As these examples indicate, idealized selfobject needs may appear
alongside expressions of failed responsiveness and sometimes unavailabil­
ity or loss. The idealization is frequently revealed to be transitory and
fragile. The selfobject need is clear, but the unavailability or inability of the
selfobject to provide the needed vigor has been transformed into disappoint­
ment, depreciation, or rage, as these responses suggest.
The previously discussed patient’s responses are not rare or uncommon,
particularly in those with severe conditions such as borderline personality
disorder. Idealizing selfobject needs frequently appear in the form of their
breakdown rather than in anticipation of being achieved. The failure or
interruption of the selfobject function indicates the presence of the need.
At other times, the idealization is sufficient to sustain the possibility
that the need may be responded to and the idealized figure remains
available. The need for carefully probing inquiry should not be minimized,
both when the idealization is self-evident and when a surface appearance
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 161

of idealization gives way to a deeper sense of devaluation or rejection of

the empathically unresponsive idealized selfobject.
It is of some interest that the previous patient, who used drugs, produced
a TAT story about Valium, a story conveying that the substance may have
sustaining or restorative properties. Consider her story to Card 3BM:
A woman who discovered the world of Valium, a doctor started her on it.
She just came back from a session, took too many Valiums, she’s ex­
hausted from the session. She just sat down to relax, hopes everything
would just go away. Eventually she just wakes up and goes on, she lives
from appointment to appointment and Valium to Valium. Eventually
through AA, someone helps her get her life together, then she helps
other people and is very good at it.

The craving may be thought of as an idealization of the drug as selfobject

for its calming properties. This example demonstrates that the critical
selfobject need for people or objects is the function that they serve for
people.
As I have been emphasizing at several points thus far, the evaluation and
assessment of idealization offer persuasive reasons for obtaining a detailed
Rorschach inquiry that goes beyond ascertaining determinants and location
scores. As with mirroring, but less consistently so, idealizing selfobject
needs can be expressed in a direct and straightforward manner. But ideal­
izing selfobject needs may initially appear as subtle and easy to overlook.
Paradoxically, idealization may also seem compelling as an interpretive
suggestion, when in fact it can conceal dissatisfaction with idealized sel­
fobjects. Thus, a reference to a figure such as an angel is by itself not
informative. Only through a judiciously curious and probing inquiry (I use
the term judicious to mean “nonleading”) does the quality of the selfobject
need become sufficiently clear to reveal its idealizing character.
For example, a 19-year-old depressed female college student began her
Rorschach with: “Two angels, some godlike power. Moses in the middle,
with his arms raised” (Card I). Following inquiry about location and
determinants, the examiner asked this patient about her reference to godlike
power, to which she responded: “I assume someone who would raise their
arms would be like an appeal to a god.” Initially, there could be some
uncertainty that the reference to godlike power referred to the grandiose-
exhibitionistic self or represented a desire for an idealizable figure to whom
she can turn to buttress a vulnerable sense of self. The added elaboration
on inquiry clarified that the reference to godlike power suggested a wish
for an idealizing selfobject.
162 CHAPTER 6

Besides thorough inquiry, the analysis of sequence is another important

means to understand idealization. A 14-year-old depressed suicidal girl
reported “an angel, very big wings” on Card I, and, on inquiry elaborated
by saying “someone in heaven. They die and become an angel, it represents
good.” This benevolent-enough response would not have been so remark­
able had it not been preceded by “a bat with a mean smile, laughing at
someone.” The angel response was followed by “the flying monkeys in the
Wizard of Oz, carrying Dorothy.” She described the reference to carrying
Dorothy in the inquiry as: “they’re what the wicked witch uses to get things
for her, she wants the ruby slippers because they’re magic. It’s the evil side
of the Wizard of Oz that kills people and steals things.”
I suggest that this adolescent girl sought a protective figure (the good or
benevolent angel) to shield her from what she saw as malevolent forces
(represented by the mean bat). The idealized good angel failed to function
for her, despite its enlarged (and possibly strong or safe) wings. Thus, she
was left unprotected, in the hands of the witch who stole Dorothy’s magic
shoes. She sought insulation of the self from harm, but this help did not
appear to be available for her.
This theme emerged again on Card VI in this patient’s report of “what
Jesus is, a crucifix” to which she added on inquiry: “People didn’t like him,
he said he could do miracles and they didn’t believe him and they killed
him, they didn’t think he was telling the truth.” This use of a probing
question, together with the sequence analysis of Card I, produced the
conclusion that the patient did not believe in a strong, benevolent figure
who can be counted on to provide an idealizable selfobject function. The
weakened Jesus, like the angel of Card I, lacked the vitality or resilience to
save himself. This image implied the girl’s concerns about being vulner­
able to malevolent figures.
Her disillusionment with potentially idealizable selfobjects also ap­
peared on the TAT. Here, she described figures to whom she might look up
to for sustenance as impotent. For example, on Card 13MF, she told the
story that “a doctor tried to save this patient but couldn’t and he’s very
ashamed” and on Card 18GF, “someone’s holding their lover who just
died.” Although idealizing selfobjects have not overtly abandoned her, there
is little depiction of effort or concern to show the girl that someone was
trying hard or putting forth effort on her behalf. Through her disappointment
that a responsive idealizing selfobject environment did not seem to exist for
her, it becomes possible to see that an unsupported, devitalized self might
well dispose this adolescent patient to the suicidal urges associated with her
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 163

depression. This notion of a disappointing idealized selfobject environment

is compounded by feeling neglected by parents she might wish to have
function in that way but who have, instead, forgotten about her. Thus, she
supplied a TAT story describing parents who: “would like him to learn the
violin but he doesn’t see that she [the mother] understands and he feels he’s
letting her down” (Card 1). In another story, the parents: “are out working
on the farm, the mom doesn’t care about her and all the dad cares about is
if the crops come out during the harvest ... the mom is self-centered and
only cares about herself and the dad doesn’t really understand her because
she’s a girl” (Card 2).
These examples represent evocative responses with richly productive
inquiries. A large number of patients, however, tenaciously guard their
vulnerable self-esteem in the form of terse verbalizations. It is important to
avoid misunderstanding these patients’ apparent withholding as defenses
against hostile impulses. For instance, the following example of idealization
comes from the projective testing of a 41-year-old unmarried woman. She
lived with her parents and was hospitalized after a suicide attempt following
arguments with the parents, related to the failure of her effort to start a
dressmaking business. This off-putting woman gave the impression of an
arrogant-sounding malcontent, and her projective protocols were generally
tightly guarded efforts in which requests for elaborations were responded
to as challenges or affronts. She attempted to conceal as much as she
clarified when asked about suggestive or provocative aspects of her re­
sponses. Nevertheless, her figure drawings unwittingly revealed a glimmer
of idealization of the sort often resisted or defended against by patients with
fiercely maintained fronts of self-assurance or arrogant pride. This patient’s
first drawing was that of a woman, which she elaborated as:

A woman meditating so she can deal with the world. She’s getting ready
to go to work, very happy with her job, it’s tedious work, she has a lot of
responsibility, but she gets paid very well. Life is beautiful, but there can
be trouble, it can be empty. Her motivation in life can be pleasant. She’s
not married, has no children, she could have an easy life. She donates her
money to charity to help others.

The inquiry following the drawing of a man began:

Did I put pants on that other drawing? He’s an aggressive business-type

of man, he’ll take care of his family and love his wife and do things to make
164 CHAPTER 6

her very happy and she could do whatever she wants. He’s dominant,
arrogant, self-centered. She’ll look up to him.

Although the female figure reflected at least some measure of ambiva­

lence in regard to her self-image, the assurance she wished to feel about
herself was more unambivalently experienced toward the male figure. The
wish for an idealizable selfobject who can provide the selfobject function
to invigorate a vulnerable self may be detected in her remark about looking
up to the man. The patient seemed to let this comment slip indifferently at
that vulnerable, revealing moment.
Patients like this woman are difficult to evaluate, and their style of
responding to inquiry requests characteristically leaves an examiner feeling
as if he or she is attempting to extract blood from a turnip. Although there
is no simple solution to this dilemma, attending carefully to passing com­
ments or slips that these patients produce is important. At the same time,
an examiner must be mindful of potential overinterpretation based on
limited content.

Conducting a Probing Inquiry

This example also underscores another difficulty often associated with
projective test administration. The problem is determining what constitutes
adequate inquiry or elaboration of a response, whether on the Rorschach,
TAT, or figure drawings. Examiners must obtain the data necessary to either
score a response or infer something about its meaning without conducting a
too leading or provocative inquiry or extending inquiry indiscrimately
beyond the customary, controlled conditions of test administration. They
must balance the merit of obtaining potentially useful and clinically inter­
esting information against implementing a procedural variation that can be
construed as “not part of the Rorschach” (Exner, 1995, p. 4).
This issue is admittedly controversial, particularly in Rorschach psychol­
ogy, and theorists have not reached agreement on this point. The extended
case report of Mr. L. in chapter 8 demonstrates one potential solution, based
in part on a second Rorschach inquiry devised to test the limits of verbali­
zations and associations. The other full case report in this book, Ms. T.
(chap. 7), is an example of a standard inquiry, one that is provocative but
does not require the testing of limits undertaken with Mr. L.’s protocol.
Some projective testing examiners are interested in identifying selfob­
ject functions and self states that are meaningfully (and not superficially)
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 165

in keeping with Kohut’s in-depth understanding of these phenomena. These

clinicians understand that a pure administration style deviating little if at
all from focusing the Rorschach inquiry on information necessary for
accurate coding is too limited. More problematic is carrying over the
tendency to conduct a conservative but limited inquiry on other projective
tests; such sparse inquiry can yield little more than stereotyped, hackneyed
psychological insights of limited depth or be overly influenced by percep­
tual detail rather than fantasy. This approach is probably inspired by the
need for pristine or uncontaminated inquiry that is now customary for the
Rorschach. Examiners struggle, therefore, between seeking results that
provide an understanding of personality in depth but which run the risk of
invalidity, and obtaining results that remain close to the behavior and
verbalizations but are too superficial in their validity. If clinicians who refer
their patients for psychodiagnostic testing, to clarify subtleties of diagnosis
or characterology, can expect little more than trite superficiality, they are
not likely to be consoled by the fact that the simplistic interpretations they
receive were the result of our best efforts to ensure reliable and valid
measurement. It has long been my impression that the low regard clinicians
in some quarters hold for psychological testing reports is well-deserved
when reports are filled with obvious and superficial findings that contain a
lack of thoughtful reflection beyond the narrow specifics of the basic data.
Although criteria for the extent of TAT and figure drawings inquiry
have never been formally established, the available literature on the issue
is quite limited. The lack of consensual criteria for inquiry on tests other
than the Rorschach, as well as for testing the limits as an expanded
method of Rorschach inquiry, becomes particularly problematic for a self
psychological approach to psychodiagnostic testing because projective
tests with limited inquiries reveal little more than speculative hints about
the self states that form the centerpiece of the psychology of the self. A
further discussion of this matter and one potential suggestion to remedy
the situation is illustrated in the extended case of Mr. L. presented in its
entirety in chapter 8. The results of this protocol demonstrate that aspects
of idealization or twinship could not have been detected in the absence
of a carefully conducted testing-of-limits inquiry.
In respect to the other side of the dilemma, vigorous or interested inquiry
need not be provocative, inappropriately leading, or culminating in spurious
findings bordering on wild analysis. I remain convinced that joining the
contrasting temperaments of in-depth inquiry and empirically-based scores
ultimately requires a disciplined, thoughtful clinical strategy based on a
166 CHAPTER 6

coherent theory of personality. Just as the optimal qualities that make for
good psychotherapists have yet to be described, the definitive charac­
teristics combining meaningfully sensitive and clearheaded thinking are yet
to be specified for clinicians engaged in psychodiagnostic evaluation.
For the moment and in the present context, I simply comment that the
clinical identification of idealization and twinship selfobject functions with
projective tests poses a particularly challenging test of this dilemma, one far
more difficult to resolve than is the case with the generally more transparent
or easily elicited projective test indications of mirroring selfobject needs.

Differentiating Idealization From Grandiosity

Grandiosity, in its conventional implication, connotes expansiveness and is
sometimes delusional in nature, as in the case of bipolar syndromes. Kohut,
however, did not think of grandiosity with that implication in mind; rather,
his intended meaning was that of a self putting itself forward to be affirmed
or acknowledged. Kohut’s use of the term grandiose-exhibitionistic self is
not what most clinicians understand the term grandiosity to mean.
Kohut, probably unfortunately, continued to use the term grandiose-ex­
hibitionistic self, which had been his term for narcissistic pathology, to
indicate (in his broadened view) turning in eager expectation to the world
to be admired or responded to with pleasure. He did not primarily regard
grandiosity as exaggerated self-worth, arrogant pride, or self-righteousness.
Kohut understood that these surface manifestations occurred, although he
regarded them as the narcissistic pathology resulting from a selfobject
environment that is chronically or traumatically unresponsive to a normal,
expectable need for admiration.
Schafer (1954) provided a basis for the customary interpretations of
Rorschach responses of grandiosity, such as coats of arms, emblems,
crests, and similar imagery. From a somewhat related viewpoint, it is not
difficult to consider that examiners familiar with Kemberg’s (1975) views
on narcissism are inclined to regard such percepts as manifestations of
entitlement or special position. From this position, a percept such as “some
screwy design: not quite a coat of arms but some water color monstrosity
of some nature” [Card IX] (Schafer, 1954, p. 297) could readily be inter­
preted as devaluation. The percept could also represent self-depreciation if
the coat of arms is thought of as self-aggrandizement. An interpretation of
hostile devaluation or rageful envy could also follow from drive theory or
object relations theory.
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 167

Another possible formulation comes from the psychology of the self.

This line of interpretation is unrelated to grandiosity, aggression, or devalu­
ation. It stems from people’s efforts to put themselves forward with pride
(but not necessarily with arrogance) in expectation of mirroring or in
wishing for a strong, idealizable selfobject. This suggestion does not resolve
the difficulty of distinguishing between these two selfobject needs, but it
does point to an interpretation that is not frequently considered when this
imagery is observed on projective tests. The “coat of arms monstrosity”
response cited previously may represent either the disappointment in the
idealized selfobject or the inadequacy of the self state.
The response provided by Schafer was preceded, on the same inkblot,
by “a stain of meat wrapped up in a piece of paper, like blood in a package
of meat comes spread out.” It is not difficult to see the aggressive connota­
tions of such an image, and the devaluation of the coat of arms can be viewed
as a continuation of the same psychological dynamic. It is also possible to
view the sequence of these two percepts as the patient’s attempt to recover
from the gory “bloodied-up” or defeated self state, represented by the
bloodstained meat. The coat of arms can represent this patient’s attempt to
turn to a strong, idealizable figure in the hope of repairing the injury to the
self. The attempt was unsuccessful, however, because the patient felt
disappointed and then critical of the idealized selfobject as capable enough
to restore the self-cohesion that the patient required.
Schafer (1954, p. 404) also interpreted a patient’s Rorschach responses,
both from Card VII, as grandiose images. These two percepts were a temple
or monument and domes such as that on the national capitol. In addition,
Schafer regarded another patient’s response of a crude monument resem­
bling a religious cross (Schafer, 1954, p. 385) on Card VI as consistent with
other indications in the patient’s protocol about rebellion against internal­
ized superego authority and values. These interpretations are quite under­
standable from the vantage point of the ego psychological framework.
Even though I present these three responses here in isolation, Schafer’s
interpretations are internally consistent with the full protocols from which
these vignettes were taken.
From a self psychological view, however, an image such as a monument,
as in these examples, can be seen as a manifestation of idealizing selfobject
needs. Responses such as monuments and temples or similar religious
imagery may also be present in patients with a self disorder, who hope that
previously thwarted attempts at mirroring are satisfied through idealiza­
tion. The examples cited from Schafer are instructive because idealization
168 CHAPTER 6

is suggested regardless of whether the imagery is primarily that of greatness

(such as the capitol monument percept) or of devaluation (such as the crude
religious cross monument).
Thus, in summarizing the self psychological clinical significance of
percepts such as a monument, coat of arms, crest, or emblem, one need not
automatically assume that such responses represent grandiosity. Sometimes,
larger-than-life images such as a giant or an angel may also be difficult to
distinguish from grandiosity. The possibility of idealization may be a viable
alternative; an appearance of devaluation of the idealized selfobject repre­
sents the failure of or disappointment in the idealized selfobject, particularly
when mirroring selfobjects have been chronically unresponsive. Aggression,
whether conceptualized in a drive theory or an object relations framework,
is also not a definitive or exclusive basis for a critical, hostile, or depreciating
tone expressed in projective test responses when it is considered from the
self psychological position.
Self psychology offers another viewpoint for understanding these re­
sponses. The previous sequence of responses, in isolation, does not enable
an examiner to decide whether the monument or coat of arms percept
represents grandiosity (either in the conventional sense or in Kohut’s view)
or idealization.

Differentiating References to Idealization From True

Idealized Selfobject Functions
In view of the type of imagery often reported on projective tests, it is not
surprising that images such as religious symbols, totem poles, crests and
badges, and similar percepts rich in symbolism suggest idealization. This
idea is based on the compelling associations surrounding omnipotence,
strong powers of a religious or quasireligious nature, or even symbolic
references to abstract ideas such as chaos, doom, and creation. From the
vantage point of drive theory, imagery of this nature might give rise to
interpretations of grandiosity, narcissism, or hostile impulses. Related
examples include less exaggerated images like statues, chandeliers, or alien
beings in protective suits, such as some of the examples that Arnow and
Cooper (1988) gave as indications of a self disorder.
Although fertile ground for generating propositions about idealization
selfobject functions, such interpretations require more than the customary
degree of caution. My main reason for recommending a particularly con­
servative approach to such material stems from the obvious, understandable
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 169

associations between images containing powerful symbolic content and

interpretations of omnipotence or power. The associations are often accurate,
but the associative link must rely on a greater burden of proof than simple
content or the connection stimulated by such imagery. In reference to self
psychology, the connection between powerful or exalted imagery and ide­
alization requires a further link specifying that the projective test imagery
provides or is needed for restoring vigor, calmness, or self-cohesion.
Thus, the restorative properties of the figure or object described in
projective test responses must be clear. This requirement of greater preci­
sion is illustrated here in several instances of false positives. The examples
implicate but do not sufficiently sustain a link between references to power,
greatness, or larger-than-life images and an idealizing selfobject function.
Consider, for example, the following two Rorschach responses: “Like a
church, a steeple, the cross. People going out the door to see if anybody’s
coming in” (Card VI), “a totem pole” (Card VI), to which the patient said
on inquiry: “They worship it and carve faces of people who died on the
totem pole, worshipping after the dead.” These responses, from the same
patient, occurred in a protocol with indications of devaluation and morbid
preoccupation such as “a reflection in the water” (Card II) subsequently
elaborated as “it’s a man, he looks like a monkey,” “a tombstone” (Card II),
and “a leaf drying up” (Card IV). Even the response: “Angels, like on the
Flintstones, telling the two women what to do” (Card III) lacks the full
import of angels as self-cohesion-building or protective figures. These
angels are not so exalted as controlling, and they represent comical figures
at that. Thus, they can hardly represent strong idealizable figures.
Similarly, Schafer (1954, pp. 255-267) presented the Rorschach record
of a patient who gave several responses suggestive of idealization, but the
figures repeatedly failed to come through for the patient. For example, this
patient reported a percept of fire and brimstone on Card II, followed by a
cathedral with a little steeple, indicating its smallness or powerlessness
against the overwhelming imagery of the fire and brimstone image preced­
ing it. On Card IV, this patient produced no less than 12 responses, dominated
at the outset by an emaciated cat-like figure, a villainous character, and a
disfigured mermaid. This patient also delivered a percept of a citadel-church
image “in the distance” seen in a minute detail on the blot, followed by “an
old warrior.” Neither the distant, minuscule citadel nor the weakened,
one-time warrior-protector (to which the patient also added: “Shadowy, of
course”) was likely to do much good and must be considered to represent
feeble efforts to secure needed, idealizing selfobjects to little avail.
170 CHAPTER 6

Other examples from Schafer’s patient included small male lions, an­
other temple “from a distance,” still another temple as drawn by a child,
and two torches from the days of Charlemagne or King Alfred as “carried
by a man but the man is not here.” These percepts are consistent with the
impression of misguided attempts to mobilize potentially idealizable sel­
fobjects. The patient’s efforts failed to produce a sufficient degree of vigor
to sustain an overwhelmed and vulnerable self state.
In chapter 5 ,1cited examples of defective mirroring by this same patient.
At that time, I commented that the appearance of both mirroring and
idealization selfobject needs was not conceptually inconsistent but can
illustrate the appearance of one type of selfobject function as an attempt to
create a compensatory structure when another selfobject function (usually
mirroring) had failed to bolster an injured self. In the present example,
however, Schafer’s patient provides an illustration of her apparent failure
to secure mirroring and idealization selfobjects to sustain a weakened self.
This idea conveys the seriousness of the self disorder when compensatory
structures fail to take hold or when there is chronic or massive empathic
unresponsiveness in more than one sector of the self. The case of Ms. T.,
reported in detail in chapter 7, also illustrates defective mirroring with
unsuccesful efforts to develop idealizing selfobject functions as a compen­
satory structure.
The following example illustrates a sequence of three Rorschach re­
sponses to Card VI, in which the middle response apparently represents an
idealizing selfobject need if considered out of context. The sequence of
these responses unambiguously shows that an interpretation of this sort is
incorrect. A 34-year-old female inpatient produced this sequence of re­
sponses to Card VI: “A thing, a living object, I’m beginning to get to know
this ink blot better. The head of a snake, a penis,” followed by “it’s a star
now, a six-pointed star,” which was spontaneously elaborated on inquiry
as: “Judaism, the Star of David. My faith is more spiritual versus religious.
I believe in a divine plan but I don’t go to temple.” This patient concluded
Card VI with the percept of “an ass,” which, on inquiry, was seen because
of the appearance of a split that gave rise to an association of constipa­
tion. By itself, this patient’s Jewish star percept, with her associative
elaborations about faith and spirituality, suggests mobilization of an
idealization selfobject need. Preceded and followed by the snake-penis
and anality responses, however, this interpretation of the Star of David
response may be implausible.
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 171

Subtle Indications of Idealization

This section provides examples of projective test responses other than

images such as exalted figures like royalty or religious symbols to indicate
idealization. The examples that follow contain few if any illustrations of
provocative or suggestive indications of idealization such as wizards or
angels. Here, the images are deceptively simple and subtle, but on close
scrutiny, represent idealizing selfobject functions.
A 30-year-old Black female accountant, who was hospitalized with
depression accompanied by homicidal and paranoid ideation, produced a
projective testing record characterized by notable disorganization. The
patient’s projective protocols revealed considerable preoccupation with
rage and abuse. In addition, other responses indicated idealizing selfob­
ject functions. These responses represented figures whom the patient
turned to for idealization, but whom she ultimately experienced as
disappointing. For example, her response to Card II from the Rorschach
was “a lamp or something, like a genie lamp.” She clarified “genie lamp”
when asked about this reference as follows:

There’s something inside of it. A person. She’s in this thing and can’t come
out until someone helps her out. It’s cramped, there’s no room to breathe.
Someone comes by, rubs the lamp and she’s free for a while until she goes
back in the lamp.

The patient elaborated that the woman inside the lamp was sensitive
or hurting and was being punished by being trapped inside the lamp
because she had done something terrible. Apart from the implication of
wrongdoing of potentially delusional intensity, the crucial reference to
idealization, however, pertained to the wish that some magical, benevo­
lent figure would emerge to ease her distress.
For the same reason, this patient described “a flying animal” (Card
VI), about which she said upon inquiry: “I guess he’s connected to
something, maybe a bigger butterfly, a mother butterfly or something.
[Connected]1 He needs him for support, he can’t do it by himself.”
This patient’s TAT stories complemented and expanded on the ideal­
izing selfobject needs suggested in her Rorschach responses. On Card 1,

Examiner’s queries during testing appear in brackets.

172 CHAPTER 6

the patient described “a little boy that loved to play violin, he played it
wherever he went. One day his teacher said he couldn’t play it anymore
because he wasn’t doing his other work. It made him very sad.” When asked
what sad meant, the patient stated that “he’s trying to understand what she’s
talking about.” Thus, the affect of sadness results from disappointment in
a potential idealized selfobject, represented by the teacher, who has let the
boy down by failing to recognize his need. This interpretation may be more
decisive alongside that of a teacher who is also seen as depriving or punitive.
The teacher need not be seen as great, powerful, or on a pedestal for the
idealizing selfobject function to be present.
This same patient continued with a story on TAT Card 2:

[A] girl. .. loved to go to school but they lived in this house, it needed a
lot of work. The mother was pregnant so she couldn’t do a lot of things.
So the mother made her do chores every day and look after the other kids.
This went on for seven years, then she ran away to the relatives’ house,
and there she obtained the education she needed.

In the next card (3BM), this patient reported that “a child’s been abused.
He’s praying to God to help him stop being abused and to stop his mother
from doing it, but still she abused the child and he just got up and ran away.”
That these stories contain references to abuse or neglect is a matter that
I am sidestepping because it is secondary to understanding the patient’s
depth psychology. These two stories contain clear references to the central
figure’s feeling psychologically ignored, and the self remains unresponded
to in the context of neglect or abuse. Without trivializing or dismissing the
sociological or public policy question of child abuse, I emphasize in the
present context that the more important psychological issue is the patient’s
hope for an idealized figure to come to her aid to restore self-cohesion. The
patient needed the selfobject function of a strong presence to turn to, not so
much for protection as for repairing self-esteem.
These themes continued in the patient’s stories to Cards 7GF and 7BM,
in which the girl of Card 7GF was consoled by a neighbor and the young
man of Card 7BM was consoled by his grandfather. That the idealizing
selfobject function repeatedly failed this patient may be detected in her
resolution to these stories, as well as in the stories cited earlier. Thus, the
girl cannot be reassured by the neighbor because “she learned adults lie ...
she doesn’t trust the neighbor,” and the young man does not believe his
grandfather: “The grandfather may be genuinely concerned about the boy
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 173

but the boy doesn’t know that, he don’t [s/c] know where to go or who to
turn to.”
In his expanded formulation of idealization, Kohut considered idealizing
selfobject functions to include fostering or bringing about a vigorous and
buoyant sense of self-esteem. When sustaining optimal self-esteem is
compromised, TAT responses such as these represent the failure of an
idealizing selfobject need. The patient turns to someone in the hope of the
person’s providing this restorative or rebuilding function, but the need
either goes unrecognized or is rebuffed. The patient then feels abandoned,
ignored, and ultimately diminished. This interpretation is ultimately more
important than are descriptions of figures as strong, exalted, or powerful.
The following case also illustrates the wish for idealizable selfobjects as
seen through either empathic unavailability or failed responsiveness of the
figures to whom the patient turned for repair of his self disorder. The patient
was a 31-year-old male who developed a depressive episode after he had
been discovered in a pattern of chronic lying in which he greatly exaggerated
facts about his education and work. On TAT Card 1, this patient described:

A little boy, he looks frustrated, he can’t understand his instructor and why
he can’t play it. He’s not asking advice from his parents because they think
he should know how to do it, he doesn’t know where to turn. He asks his
parents if he can give it up, and he gives it up, they don’t care.

On Card 3BM, this same patient told the following story:

That little boy is me. Lots of times I’d go in my room and just cry because
I didn’t know what was going on in school that day. I couldn’t go to my
parents. I didn’t think they’d understand, that’s why I left school.

Later on, he commented about Card 7BM: “That’s not our home but it’s a
father giving the son advice. He never showed me how to do things that a
man should know. This man looks like he’s giving the son good advice and
the son appreciates it.”
The noteworthy aspects of these responses concern the predominant need
for an idealizable figure who is portrayed in a position of teaching, advising,
or consoling. In each instance, the sought-after figure failed to fulfill the
idealizing selfobject need that was aroused. This situation predisposes to a
self disorder with a symptomatic expression in depression, characterized
throughout many projective test protocols as devitalization or defeat. It is
not the grandiosity or the prominent wish to be admired, adored, or other­
174 CHAPTER 6

wise mirrored that the patient longs for or seeks. The problem illustrated in
these responses is the empathic failure of a figure to serve a selfobject
function of bolstering undermined self-esteem. The idealization selfobject
need remains, therefore, driven underground, thwarted or unrecognized.
The following two Rorschach responses may seem to represent idealiza­
tion, but only one of these examples properly reflects this selfobject
function. The case is from two adjacent Rorschach responses to the same
card (Card III) from a 15-year-old adolescent, hospitalized in connection
with his unmarried mother’s inability to manage his behavior at home and
school. The first response was “two little spirits,” which this young man
elaborated in the inquiry as:

Conan the Barbarian. They put all kinds of paints on him to keep the spirits
from taking him to wherever he was going to go in his next life, heaven,
like the utopia, where he’s destined to go. They loved him, didn’t think he
deserved to die yet. This girl sacrificed herself to the gods so that he’d live.

It is not difficult to detect that being protected is of utmost concern in

this boy’s response. It is emphasized in his verbalization coupled with his
wish for a benevolent figure to provide for his safety or well-being.
Although it is unclear from the content of this response that a vulnerable
self requires this selfobject function, there are such indications in other
places in the projective protocol.
This boy’s next response to Card III was “two genies playing cards, both
look like they’re reaching in their back pockets to pull out an extra card,
they’re cheating.”
On inquiry, he added:

They’re like misty, like coming up out of their bottle, and form into some
humanistic thing as they go up their body. Some magical type of thing or
person, another type of being, almost like from another world or some­
thing, like this fantasy kind of thing. They’re almost like gods. Something
that doesn’t conform is a type of god, mythologically. These don’t look too
honest, trying to cheat at cards, neither one likes to lose.

Contrasted with the previous response from this adolescent boy, his
percept of a genie seems to suggest that the patient may admire the figure
for its ability to cheat. The genie is also couched in imagery that the patient
described as magical and god-like in quality, unlike his previous spirits
percept in which he had turned to them for calming reassurance or vitaliza-
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 175

tion of the self. His response is also different from the genie response of
another patient (cited previously), in which someone helping her was the
crucial aspect bearing on idealization.
These two responses from the adolescent boy highlight that his responses
required attention to the verbalization that distinguished them with regard to
the specific or unique idealizing selfobject function that each response identi­
fied. The spirits provided a self-restorative function but the genies were not
seen as needed in a similar way. They might be, and the possibility of
idealization should not be ruled out entirely. Nevertheless, the contrast between
these two responses in respect to the selfobject function is still instructive.

Interpretive Cautions About Idealization

The examples described in the previous section show clearly that content
alone can be misleading. Content together with its associative elaborations
reveals the selfobject function. The crucial associations may frequently
require vigorous but unobtrusively elicited inquiry. These examples also
parallel the way that selfobject functions are recognized in treatment. That
is, it is not merely the praise or admiration of great or powerful qualities in
the therapist or analyst or in the people in the patient’s life that is decisive
for idealizing needs. Rather, the disappointment in their empathic failures
reveals that the admired figure or transference object is vitally necessary
for the patient to feel buoyed up or thriving. This quality indicates the
brittleness of the patient’s self-esteem. Likewise, in psychodiagnostic test­
ing, idealizing selfobject needs are usually revealed by their absence or by
their failure to protect self-esteem.
This last point highlights a caution to bear in mind when the relevant
sign or marker is the absence of a clinical feature. There is always a
potential risk in a clinical examination, whether based on diagnostic testing
or interview, that interpretations may be spuriously built up from the
absence of signs or symptoms or the failure of a psychological function to
be present. Several examples of idealization already presented demon­
strate this point. The solution to the problem requires examiners’ vigilant
attention to ensure that Schafer’s (1954) criteria of logical consistency and
regularity or frequency of the sign in the total protocol are kept in mind.
Data of the type I am referring to do not necessitate abandoning an
inference because it may be too “soft” to be sustained. Rather, they require
particularly refined clinical acumen for a seasoned and well-disciplined
examiner to decide whether an interpretation can be sustained or supported.
176 CHAPTER 6

Responses that suggest idealization are less frequent and recurrent in a

projective protocol than are those concerning mirroring. It is also more
difficult to attend to the absence or lack of a feature than to note its presence.
The clinical function calls for examiners’ full empathic listening skills and
for immersing themselves in the response content, and frequently in its
subtleties or nuances.
The problem I refer to is not one that is infrequent, too unreliable to assess
with sufficient confidence, or too atypical to be detected. It is also not just
one of diminished sensitivity or of too many false positives. Its resolution
is not easy. Not only are Schafer’s (1954) criteria for interpretation helpful
in this effort, but they are indispensable in guiding clinicians’ impressions.
When one is in error, the result may be clinically and scientifically indefen­
sible, but when on the mark, the clinical yield is nothing short of powerful.

TWINSHIP

Theoretical Considerations

The twinship selfobject function is the most difficult to discern both clini­
cally and on psychodiagnostic testing. Kohut (1971, 1984) originally con­
sidered twinship to be a subtype of mirroring, but in his final thoughts on the
subject, he regarded twinship as a special function deserving its own status.
The difficulty in identifying twinship selfobject needs is not that of
detecting possible signs or indicators such as responses related to twin
figures or symmetrical objects. These indications are easy to note on
projective tests. The problem, however, is in deciding whether superficial
references of this sort truly represent twinship selfobject needs. There is no
lack of Rorschach percepts about twins or symmetry of the inkblots. Even
TAT stories have references to perceived or fantasied twin relationships.
The overriding consideration must always be one of determining whether
a selfobject function is present. To be judged as present, there must be an
indication that the selfobject exists fundamentally to sustain or bolster the
cohesiveness of the self.
The rarity of this selfobject function is one reason that Kohut’s use of the
term twinship leads to confusion, especially when interpreting projective
test content. The many references to twins that arise, particularly on the
symmetrical Rorschach blots, can more often mislead than amplify Kohut’s
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 177

intended meaning of the twinship selfobject function. Percepts about twins,

even conjoined twins, are no more than suggestive or speculative. The
companionate or “soulmate” qualities expressed in these interactions are
the crucial elements necessary to accurately characterize the selfobject
function in sufficient depth.
Most projective test responses pertaining to twins have little more than
speculative or weakly supported bearing on twinship selfobject functions.
The necessary evidence to best make the case lies not in simple or superficial
percepts, but rather in the richness and depth of their elaboration. Unfortu­
nately, such responses are not frequent, and several responses are often
necessary to be confident that a twinship function has been mobilized.
The twinship selfobject function does not appear prominently in many
interpersonal interactions, including those occurring in psychotherapy, par­
ticularly during short-term treatment. True twinship selfobject function is
nuanced and often subtle. Its clinical presentation may appear relatively late
in treatment, even during intensive psychotherapy or psychoanalysis. It is
often initially mistaken as idealization or mirroring. Sometimes, twinship is
simply unnoticed until a patient is understood in depth. Thus, for projective
testing indicators to identify true twinship selfobject functions is a challenge
that is difficult and prone to error in view of the brief sampling of the patients ’
internal life characterizing psychodiagnostic examinations.
Rorschach content is often the best source for identifying twinship
selfobject needs. The TAT may be too structured to permit deviations from
conventional responses to a story line, and indications of twinship may not
readily appear. Even more important as a consideration than structured
format, the types of stories that the TAT elicits favor themes of mirroring
or idealization. As a result, subtle differentations between mirroring and
twinship can too easily be obscured, particularly when the inquiry is not
sufficiently probing or when a patient is especially defensive, withholding,
or uncommunicative.
In addition, the verbalizations required for the TAT or human figure
drawings inquiry do not characteristically provide sufficiently sensitive
access to a deep level of patients’ selfobject functions. Patients are often at
a loss for words that come close to indicating twinship companionate needs.
This is the case even among the most verbally articulate people, who may
actually experience more frustration than usual in attempting to convey the
specific quality of the alter-ego twinship function that they seem to seek.
For this reason, the nature of the Rorschach technique may reveal
twinship needs in their most direct or unconcealed form. The inkblot
178 CHAPTER 6

method makes it difficult for people to obscure, defend against, or otherwise

distance themselves from, twinship selfobject needs. There are exceptions,
and I have included a number of TAT examples in the vignettes that follow.
Quite a few are from the projective protocols of articulate adolescents.
In my opinion, superficial references to twins or twinning are best
ignored, unless compelling elaboration across several responses can
substantiate such references as genuine indications of a twinship selfob­
ject function. Thus, projective test references to twins or pairs should be
reserved for only the most clear-cut instances of twinship selfobject
needs. In the next section, I provide illustrations of both good and
insufficient examples.
Psychodiagnostic testing clinicians need to contend with the fact that
the best evidence for twinship needs does not emerge from conventional
content analysis in the way that mirroring or idealization is detected. The
twinship selfobject function is often deduced from a clinically well
reasoned analysis of the test material in relation to clinical theory and
in-depth understanding of psychoanalytic self psychology. Conventional
thematic cues are of limited use in the completed interpretation. This
approach requires appropriate caution tempered by the most conserva­
tive scrutiny of customary test evidence, not to mention a thorough and
accurate understanding of Kohut’s self psychological views.

Clinical Indications

My first example vividly demonstrates the essential features of the twinship

selfobject function and illustrates the difficulty in eliciting the twinship
selfobject function when inquiring about projective test responses. The
response is to Rorschach Card II, from a 22-year-old depressed inpatient:
“Two people pressing their hands together, I think they’re two women. They
have those big old hair styles.” To this point, the response is ordinary, and
the beginning of the inquiry is equally commonplace: “The arm’s here, the
left arm’s up to her. Their palms are together. Looks like they have gloves
on, another reason I thought they were women. Here’s the heads. This down
here is menstruation.” On being asked further about the reference to
menstruation, the patient continued in the following way:

It just is. [Q] I guess they are. They’re menstruating. How long have you
been a psychologist? [Q] They’re friends and they know what’s going on,
they’re combining ideas, they’re giving each other the same idea. [Q] They
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 179

understand each other’s life experiences, they’re very happy. [Q: Menstru­
ating?] It’s just about their sexuality. Actually, it’s not menstruation, it’s
more like the feeling they share. Oneness.

Apart from the question of whether a color determinant should be

assigned to this response, there can be little doubt about the selfobject
need that it reveals. This patient defensively attempted to protect herself
from elaborating further about menstruation and its associations. Thus,
after making reference to menstruation for the first time only at the close
of the inquiry, she responded defensively to a question about what made
it appear that way by saying “It just is,” followed by silence. Her
distracting tangential question about the examiner’s experience repre­
sented an attempt to deflect her anxiety. She then took me to task for
exposing her to a vulnerability with which she struggled, and largely
unsuccessfully at that. It is as if her question to me was really: Don’t you
know anything about respecting defenses?
There are two main points to emphasize about this response. The first is
that it demonstrates the core characteristics of the twinship selfobject need.
It reveals an experience between people centering on intimacy and shared
understanding in depth. It captures a feeling of oneness or a deep and close
bond. Although the two figures might have been designated as a pair, the
patient did not describe them so. The fact that two figures, even human
figures, are seen on Card II is not crucial to the identification of twinship.
It is merely incidental to the essential feature of the response, which is the
wish for an experience in depth of significant mutual understanding, alike-
ness, or oneness.
The second important point is that it is easy to miss this very feature of
the response. It is not alluded to at all in the association proper; the inquiry
begins conventionally, and only at the point that the patient might have been
expected to conclude the inquiry did she introduce the reference to men­
struation. Before any elaboration or clarification by the patient, the exam­
iner might understandably be tempted to think that this association
expressed concern about somatic or sexual matters, illness or fear, or even
aggression. One might have to settle for these speculations had the patient
gone no further than her initial defensive “It just is” remark when further
inquiry became necessary.
Only by pursuing the association, despite the patient’s apparent discom­
fort, did her profound vulnerability about the need for twinship selfobject
responsiveness become apparent. This need probably gave rise to her
180 CHAPTER 6

tentativeness or defensiveness and ultimately caused her to feel exposed.

Twinship selfobject needs are frequently seen in just this way, as passing
comments or casual elaborations to the central response. It sometimes
becomes difficult to elicit further clarification about these additions, as the
present vignette illustrates.

Twinship as a Companionate or Shared Bond:

The Problem of Twins
The next several examples are projective test responses based on images of
twins. The symmetry of many Rorschach blots, in particular, readily elicits
pair responses, and it is not uncommon for some of these responses to
describe twins. In a discussion of a self psychological approach to psychodi­
agnostic testing, it is inevitable that percepts of twins are thought of as
potential indicators of twinship selfobject functions. Paradoxically but not
surprisingly, this is rarely true.
A careful reading of Kohut (1971, 1984) shows that the psychological
features represented by twinship are based almost totally on the communion
in depth, companionate functions for calming or soothing that are essential
for repairing an injury to self-esteem, or a shared bond or world view that
becomes a central requirement in the self-selfobject relationship. I have
emphasized precisely these qualities of selfobject functions in general
throughout this book, and these qualities are especially important for the
twinship selfobject function.
The following two examples, both of which involve Rorschach per­
cepts of Siamese or conjoined twins, are analyzed from the viewpoint of
the crucial features that characterize twinship. The first illustration
comes from a patient who produced the following Rorschach response
to Card II:

Siamese twin animals, like puppy dogs. I can see their snouts. They’re cute.
They’re joined at the nose. They could be thinking the same thing. These
are maybe thought waves. They could be kissing. There’s a smile.

On inquiry, this 33-year-old woman, referred for evaluation of the psychi­

atric component of a hyperventilation syndrome, stated:

Here’s the feet, body, ears, eye, snouts. These snouts have a horned effect
which I don’t want to look at, because it makes them look like they’re not
real, like from a fairy tale. They’re cute. [Q: Joined?] They’re probably very
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 181

close, they’re kissing. They’re transmitting with one another. Because

they’re happy and dancing.

This patient offered an indication that a twinship selfobject function might

be evoked, not so much by her reference to conjoined twins as by her
comment, during the association phase, about thinking the same thoughts.
This idea becomes elaborated further in the inquiry as transmission of
thought waves. This interpretation of twinship needs, although suggestive,
still falls short of being compelling. The best way to explain what is missing
from the response is to contrast this percept with that of the previous patient
who produced the response of menstruation.
The previous patient referred to a deep degree of involvement between
the figures in the form of combining ideas, depth of understanding, and a
sense of oneness, as stimulated by the reference to menstruation. The
present patient’s references to conjoined twins transmitting thoughts,
thought waves, or thinking the same thing did not have the same degree of
compelling alikeness. It lacked the “soulmate” quality of a faithful replica
or an intimate bond.
The nature of this contrast is instructive: Twinship selfobject needs are
experienced (and expressed on projective tests) with a measure of depth and
intensity. References to transmitting thought waves or having identical
thoughts, in and of themselves, do not hit the mark, despite the quality of
similarity represented by the concept of twins. Many references to conjoined
twins, for example, als >warrant this caveat, even though it is certainly possible
that a twinship selfobject need could have been simultaneously mobilized.
For example, Kwawer (1979, p. 521) reported the following Rorschach
response to Card VI: “Now it looks like a Siamese twin ... this is half of
the Siamese twin and this is half of the Siamese twin. Separating them ain’t
nothing, but putting them together makes a person even.” The quality of
requiring both parts to make the whole is the crucial comment that qualifies
this response as an indication of a twinship selfobject function. Had the
patient stopped with the reference to conjoined twins, there would not have
been a compelling reason to assume that a twinship selfobject function was
strongly suggested.
Other examples of Rorschach responses that illustrate Kwawer’s (1980)
borderline interpersonal relations scale were provided by R M. Lerner
(1991, p. 216). The first example, under the descriptor of narcissistic
mirroring, is “These are two men mirroring each other, two little mimes”
(Card II). This response approximates a twinship selfobject function but
182 CHAPTER 6

remains, as it stands, insufficient to represent the quality of a faithful replica.

This example also shows, parenthetically, that a patient’s use of a word like
mirroring does not mean that the patient’s selfobject function corresponds
exactly to the term. In this example, as the word is reported with no
additional elaborations, mirroring rather than twinship actually might be
the relevant selfobject function to consider.
Two other responses supplied by Lemer come closer to the mark; both
are categorized under Kwawer’s (1980) descriptor of separation-division:
“These two things appear to have been at one point connected and broken
apart. ... It’s as if on the inside there was some continuity between the two”
(Card IX) and “Looks like a cell in separation. ... One has divided and two
haven’t quite joined together” (Card X).
The component of separation or coming apart appears in these two
examples, which represent a crucial characteristic in the quality of intensity
of the bond. The reference to continuity in the first example and the idea of
a single-unit cell joined together in Lerner’s second example are consistent
with the suggestion or impression that a twinship selfobject function may
have been revived. Further indications of the depth of the bonds implied in
these examples constitutes more persuasive evidence on this point.
Another example of a suggestive but still not quite fully convincing
illustration is taken from Lovett’s (1988, p. 124) description of his scoring
system for narcissistic identification. He provided an example of a reflec­
tion response as follows: “Two people working on something. The red
shows that they’re thinking exactly the same thing” (Card III).
The previous examples were even more subtle than are responses of
twins as illustrations of the problem of interpreting obvious-sounding
responses as indications of twinship. References to separations, disconnec­
tions, and thinking similar or identical thoughts are on the right track.
Responses like these still require inquiry to clarify whether the essential
quality is also contained in a patient’s experience—a clear indication of a
unique or intimate bond, the special significance of the faithful replica, or
the companionate or silent presence providing calm reassurance. Just as
simply referring to twins means very little about the twinship selfobject
function, references to activities such as miming, mimicking, or copying
may not capture the definitive psychological character that the twinship
selfobject function is intended to convey.
The problem of identifying twinship function arises frequently on the
Rorschach, because of the moderately compelling pull for references to
identical figures that are sometimes actually presented as twins, based on
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 183

the symmetry of the inkblots. I close this section with an illustration of two
responses that demonstrate this point. These Rorschach percepts described
twins but lacked the psychological quality of alikeness; as a result, the
responses cannot by themselves represent twinship selfobject functions.
The first response, to Card II, was: “A couple of bears fighting things
out. My twin brother and myself.” A second example was given to Card
VII by the same patient: “Female twins. Probably in the kitchen, using a
microwave oven for the first time.”
Neither response contained inquiry material revealing anything of note
beyond the standard information about location and determinants. These
two responses might well have been viewed as examples of twinship before
the discussion in this chapter, but examples like these do not meet the crucial
test. The responses require a more urgent quality of alikeness, shared
similarity, or bonding as an exact or faithful replica to genuinely represent
the in-depth sense of twinship that Kohut had in mind. The content must
give clear indications beyond a reference to identical or twin objects.
Because of this requirement, the twinship selfobject function is seen only
infrequently in psychodiagnostic testing.
This quality provided a potent psychological moment in the New York
stage production of Side Show, a musical about the autonomous but tragi­
cally conflicted strivings of a pair of real-life conjoined twins. The twins
realized that their separate and different aspirations could not possibly
succeed if they were to remain as one consolidated living unit. Indeed, their
ultimate strength was their synchrony as a unit. Despite this rebuff to the
twins’ individual hopes, their immutable need for each other provided the
strength that sustained them psychologically. Here is the essential quality
of Kohut’s twinship selfobject function: It is not being similar or identical
that really matters, but the mutuality of need or psychological oneness.
Similarly on the Rorschach: Percepts of twins or conjoined twins must
clearly indicate mutuality in the need for the twin for the person’s psycho­
logical survival or sustenance (that is, self-cohesion).

Twinship Selfobject Functions and Adolescence

Some depressed adolescents, prone to sullen withdrawal, isolation, and
loneliness, may be particularly disposed to experience pronounced twinship
selfobject needs. Forming intense relationships with one or a very small
group of friends, they share close-knit bonds based almost totally on
similarity of thoughts and feelings. Such attachments provide cohesion to
184 CHAPTER 6

brittle self-esteem by demanding almost exact matching of affect states.

This strong requirement of matching or similarity seems vital to preserve
the relationship, not to mention the cohesiveness of the self. The intensity
of these relationships is so great that even minor breaches are barely
tolerated and can give rise to rage reactions or depression, sometimes
accompanied by suicidal gestures or self-mutilation.
Breaches or ruptures of this sort frequently result from withdrawal by
the “twin,” sometimes because the other person has formed another attach­
ment fulfilling a different need. Alternatively, the “twin” may have man­
aged to progress psychologically to a level of relatedness no longer based
so completely on the experience of the faithful replica of the twinship
selfobject function. The patient, however, feels left behind and abandoned,
and his or her self-esteem falters. I give two examples of projective test
responses from such patients as illustrations of how this dynamic configu­
ration may be detected.
One patient, an 18-year-old man, was hospitalized following a suicide
attempt after a male friend had rejected the patient and attempted to develop
other relationships. The patient was overcome by experiencing his life as
meaningless and had some indications of subsyndromal depression. This
man’s response to Card II on the Rorschach was as follows: “Two turkeys,
sitting on a table, taking a drink, trying to understand each other’s thoughts
by placing their hands together,” and on inquiry :

Their hands in the background, heads, like sort of contemplating. [Q] Just
their face. I do that with my friends sometimes. Just for fun. We already
know each other’s thoughts, but sometimes we’ll put our hands together
to try to understand it better. And we’re usually right, that’s because we
understand each other so well.

The indication of intimacy and understanding based on an unspoken

capacity to divine each other’s inner states seems evident and represents
another form of the essential characteristic of the twinship selfobject
function. This quality was close to the surface in this patient, as is often the
case with young people compared with adults. The same indication of a
twinship selfobject need can also be noted in the young man’s TAT response
to Card 3BM:

This is Sandra and she has a very close relationship with her girlfriend
Sally, but they’re not sexual. They understand each other so well, that
could best be understood as like one-minded. She begins to depend on
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 185

Sally too much as the only person who can understand her, so she
deliberately cuts off from her other friends to be with Sally. But Sally has
other friends too and doesn’t want to devote her time purely to Sandra,
and she confronts Sandra and tells her she can’t deal with Sandra being
too dependent on her and says she’s sorry but she can’t be friends with
her anymore. Sandra gets depressed and contemplates suicide; there’s
the gun. She’ll shoot herself because only her friend could understand her
instead of anyone else and she latched on to that. They’re two distinct
people but they think the same. That’s what she needs, a feeling of total
understanding.

Another adolescent patient, a 15-year-old girl, was hospitalized follow­

ing a suicide attempt when her boyfriend withdrew from her after an
abortion. She produced the following TAT story to Card 7GF:

It’s Jane and her mom. Jane doesn’t have any friends so she holds on to
her doll and pretends it’s a real person. One day her mother told her she
didn’t think she should use the doll as a friend. Jane said she didn’t want
any friends. One day the mother threw the doll away, Jane got angry with
her mother and said she’d run away. She forgave her mother because on
the way she met a new girl who’s now her best friend.

This example is more subtle. The story is somewhat uncommon for this
card, but is not particularly unusual. The notion of using a doll to compen­
sate for lack of friends or inner emptiness is not exceptional. Holding onto
the doll with such exclusivity or for dear life, as it were, suggests that the
doll has come to substitute for a friend or has become (in an intimate, vital
sense), her friend. It raises the question that a twinship selfobject need may
be operating in maintaining this adolescent patient’s self-esteem. Although
the story also suggests regressive elements, it reveals a capacity to replace
a detached, inanimate relationship with a real one. Clinicians must wonder
about the nature of the selfobject need that predominates in that relationship.
This example is not as evident an indication of a twinship selfobject need
as is the previous example of the boy putting his hand against that of his
friend to intensify their level of intimacy. Nevertheless, I have included this
girl’s story alongside that of the boy to highlight the exclusivity that is
expressed. The story represents an important indicator of a twinship selfob­
ject need. It also shows, as in the previous examples of the depressed adult
patients, that a range of certainty about the presence of twinship selfobject
functions in projective test responses is frequently more evident than is the
case with other selfobject functions. This range of confidence about the
186 CHAPTER 6

revival of the twinship selfobject function is often based on indications

of single-minded commitment to achieve a strong sense of oneness or
kinship. The adequate evidence, on a case-by-case basis, for twinship
selfobject needs relies on the projective test protocol in its entirety.
For example, another adolescent girl, referred to evaluate the reasons
for chronic truancy and poor academic performance, produced the fol­
lowing story to TAT Card 3BM:

This girl found out her best friend died. She thought she couldn’t live
without her best friend. She’s thinking of killing herself. But instead, she
cut her hair so she’d look ugly and always be left alone by others. She finds
another best friend and is happy again. [Q] They were close, they told
each other everything, she didn’t have anybody else she could count on.
Her friend did everything for her, like a mother.

Considered alone, a twinship selfobject function might be a plausible

interpretation of this response, largely on the basis of the degree of involve­
ment with the friend. The intensity in the relationship is greater than
expected in a mirroring or idealization selfobject function. It is something
more than “like a mother”; not only is there a sense of complete need (“her
friend did everything for her”), but doing “everything” adds a quality of an
archaic infantilizing dependency.
The same patient, however, related the following story to Card 6BM:

The mother has shocking news for the son. His father was killed in the war.
The son can’t see how he’d live without his father who he’s admired
through all the years. He finds a woman to take the father’s place.

Here, the intensity of the relationship seems to be based on idealization.

Both stories described a quality of desperation in the face of loss of the
needed selfobject. The hint of a total or exclusive bond on Card 3BM raises
the question of a twinship need, but this response may be just as readily
understood as idealization, because of the story told to Card 6BM.
Note, however, the similarity between this patient’s story to Card 3BM
and the previously cited story by an adolescent girl to Card 7GF, in which
the mother attempted to dissuade the girl from forming a bond with the doll.
In the former case, the relative absence of other selfobject functions
supports the possibility of twinship as the primary selfobject need. In
contrast, in the present patient, her stories to both Cards 3BM and 6BM
indicated at least some ambiguity about the nature of the selfobject need.
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 187

There remains a question, at least, about the primariness of one selfobject

function over another.

Alikeness, Shared Similarity, and the Faithful Replica

The following examples provide two illustrations of responses that point

to a patient’s need for a selfobject to resemble oneself. The first response
reflects a wish to be exactly alike another person, and the second
response represents the need to have another person become what the
patient wished she might have been in her own right. In both instances,
the twinship need is expressed but then quickly renounced. It remains
unclear whether the wish is actually satisfied, rejected, or defensively
concealed behind a facade of mature acceptance. Phenomena that con­
note merger longings or boundary disturbances can also be conceptual­
ized from several object relations viewpoints. My discussion of these
responses is from a self psychological framework.
The patient, a 38-year-old woman in a psychotic reaction precipitated
by self-withdrawal from antipsychotic medication, gave this response to
Rorschach Card VII: “It looks like two women looking at each other
making silly faces, or maybe distorted faces.” On inquiry, after describing
the form-based features of the human figures, the patient stated, in re­
sponse to the examiner’s query about the silly faces:

The faces are sunk in there like maybe an old-fashioned type or a

dumb-looking hat, maybe they’re trying to put on the same type of
clothing to maybe look like a twin or something, and then realized how
silly it was. No matter how they’re dressed, they’re still the same person.
My psychiatrist said that to me. You could admire the person but
couldn’t be that person.

The second illustration from this patient was her story to TAT Card 1:

Looks like my older son when he was taking Suzuki violin lessons. He hated
it. The first thing he said was I don’t want to do that, and someone said it
was what I wanted to do and not him, and I shouldn’t have forced him. I
wanted to play the violin, my father does, he’s very accomplished, he’s
very perfect. I’m more slipshod, I don’t like doing things perfectly, it would
be too much of a strain because everything has to be done rush, rush.
[Patient continues in this hypomanic digression until asked for the out­
come to her story.] He doesn’t take any more violin lessons and he’s glad
and he’s happy. He’s glad he could finally voice an opinion.
188 CHAPTER 6

In these two examples, the need for the selfobject to function as a faithful
replica resembles twinship, but there is some question whether this inter­
pretation is accurate. In earlier examples of the patients discussed pre­
viously, the twinship selfobject function was characterized by a quality of
kinship or a close bond as the basis for the selfobject responsiveness sought
by those patients. In the present examples, the two figures were seen as
exactly alike, as if they were the same person. The wish for shared
alikeness or similarity is more than a perception of resemblance based on
looking alike or thinking the same way. It seems to run deeper than surface
similarity and is close to the core of the experience of the self. No matter
that the patient dismissed her selfobject need as silly or trivial; that
problem is different and suggests that she might feel unworthy, ashamed,
or undeserving. More to the point, however, is the question of whether the
response expressed the possibility of admiring another person without
having to become that person.
Herein lies the difficulty in the differential diagnosis: Is this response
essentially or primarily a twinship selfobject function, or is it a need for a
level of selfobject responsiveness based on idealization to buttress self-co­
hesion? The answer to this question requires the full projective protocol to
decide the clinical issue accurately. Rarely, if ever, does a single response
contain a sufficiently clear or unambiguous basis for deciding among
various possibilities. The issue of a twinship or idealization selfobject
function is the critical question that an examiner must consider by using the
entire protocol to decide the matter and to determine how to view this
patient’s first response.
The patient’s second response suggests a vicarious experience of at­
tempting to enhance self-esteem. Vicarious gratifications or wishes on
projective tests are not rare. They usually imply some degree of using
another person in the service of fulfilling an unmet need, thereby sustaining
self-esteem. Sometimes, the narcissistic extension is seen as exactly like
the patient (the faithful replica). It may also appear closely bound up with
the patient’s need to achieve a goal by imitation or by becoming a duplicate
of someone else. Both mechanisms should be considered to represent
potential indications of twinship when the heart of the experience is based
on the need for merging with the selfobject.
The patient’s response in which her son was expected to become an
accomplished violinist in the way that her father was but that she could not
achieve comes close to meeting the criterion of shared similarity. In the end,
however, it falls short because the focus of the response is the patient’s
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 189

failed expectation of herself rather than the compelling need for her son to
be like her or like what she wished herself to become. The vicarious
experience must go beyond someone who does something for the patient.
The selfobject must in some central or deeply felt way embody or be the
same as oneself. This experience should not be confused with merging or
loss of self-other boundaries, as occurs in transient psychotic states.
It is always possible that this patient did indeed hope that her son, by
taking up the violin, would become an extension of herself or that his need
would parallel her own need. Through the son, the patient might earn her
father’s admiration, despite the story outcome in which the son managed to
discontinue lessons and the patient allowed him his wish. Her hypomanic
digression in the midst of her delivery of the response adds further uncer­
tainty as to where she might have gone with her story. The answer to the
clinical question at hand remains uncertain; the questions I have posed,
however, illustrate the clinical issue that examiners must decide about this
response as an accurate representation of twinship or some other selfobject
function that has become mobilized.
The patient’s primary concern centered on her own failure as she went
off the point of her story about the son, but her story does not afford an
examiner a clear indication about the central selfobject function. On the
basis of this single response, even in light of the patient’s Rorschach
response noted previously, the most conservative approach to interpreting
Card 1 does not rest on a twinship selfobject function. The possibility of
twinship is worth noting, but the ultimate basis for an interpretation of this
type requires scrutinizing the entire protocol for more persuasive evidence
to sustain the idea of a twinship need.
The following example illustrates that a projective test response signify­
ing a particular selfobject function prepares the way for understanding other
test responses. These subsequent responses might not otherwise have led to
a particular interpretation of a selfobject function. The example is from the
projective testing of a 44-year-old male anesthesiologist hospitalized with
an acute depression. This patient produced an agitated Rorschach protocol,
beginning with “two priests holding up their hands in some kind of bene­
diction” (Card I), which he elaborated further on inquiry by stating that
“benediction is wishing well, it makes me feel good, part of a community,
connected with others.”
This same patient made a figure drawing of a man that he described thus:
190 CHAPTER 6

[A] high school student, with girls and cars on his mind, he probably
works part time at McDonald’s or some such place. He’s very much
worried about his self-image, what he looks like, he just wants to look like
everyone else, to be just one of the guys.

He also made a female drawing of someone “ten years older than him, out
of high school, happily married, responsible, looking forward to sharing a
life together. Most people that age are optimistic that everything will work
out just fine.”
The Rorschach response illustrated here is consistent with a twinship
selfobject need surrounding the desire for kinship and the calming strength
that this provides. As in several of the examples previously considered, a
reference to twins, identical figures, or even similarly appearing figures is
not essential for the identification of the twinship selfobject need. The crucial
characteristic in this response is the reference to belonging to a community
from which he derived a sense of human connection, regardless of the
reference to the priests. This response prepares the way for understanding
the two figure drawing responses in a way that was not otherwise apparent.
Without this patient’s response about priests communing, the examiner
would very likely consider an interpretation of the male drawing as being
centered on regression, immaturity, or insecure identity when a middle-aged
adult, who is a successful physician, appears to identify with a teenager
working at McDonald’s preoccupied with girls and cars. This impression is
pronounced in view of the sharp contrast between this patient’s drawing of
an adolescent boy and that of a mature woman undertaking expected adult
responsibilities. Understanding this patient’s twinship selfobject need, de­
rived from the Rorschach response, provides an insight about that aspect of
the figure drawing inquiry pertaining to the boy’s desire to be accepted by
his peers. This interpretation offers another aspect to consider, as an alterna­
tive to or alongside that of a regressive pull or a problem in achieving mature
adult identification.
One can readily see this man’s difficulty as his struggle to sustain a
twinship selfobject need. His struggle addresses his need for a meaningful
connection with others, a connection through which he could draw on this
resource to feel at one with or at home with the people in his surroundings.
As a result, self-esteem regulation and the repair of an injured, undermined
self can be strengthened by needed twinship selfobject wishes. From this
viewpoint as well, the figure drawing of the older mature woman meeting
adult responsibilities that he felt incapable of facing also suggests the
CLINICAL INDICATIONS: IDEALIZATION AND TWINSHIP 191

possibility that the patient aspired to restore mature adult functioning,

perhaps through twinship.
By now, it should be clear that the mere reference to twins, human or
animal figures that are identical, or any other reference suggestive of
unequivocal alikeness indicates nothing more than that one should con­
sider that the possibility of a twinship selfobject function has been mobi­
lized. The critical criterion for an interpretation of twinship must still
remain the clearly expressed or implied psychological quality of alikeness
or similarity. Twinship should be based on a need for a “twin” figure to
restore or enhance self-esteem in a compelling manner with some degree
of substantial depth.
 7 MS. T.: MIRRORING

A CASE OF FAULTY MIRRORING SELFOBJECT

RESPONSIVENESS AND UNSUCCESSFUL
ATTEMPTS TO ESTABLISH COMPENSATORY
STRUCTURES THROUGH IDEALIZATION

In the previous two chapters, I examined the clinical indications of selfob­

ject functions on projective tests and illustrated the three selfobject func­
tions with vignettes from selected Rorschach, figure drawings, and TAT
responses. This chapter and the one that follows present the complete test
protocols of three projective test instruments for two patients to illustrate
mirroring, idealization, and twinship selfobject functions.
The difference between this material and the previous clinical examples
centers on three important points. First, selfobject functions often appear in
admixtures rather than as clear and discrete forms, although one typically
emerges as predominant. Second, not all responses in a protocol refer to
selfobject functions. Third, the clinical appearance of more than one sel­
fobject function serves an important adaptive purpose for maintaining
self-cohesion. The alternative selfobject routes formed to repair a devital­
ized self appear as compensatory structures in the regulation of self-esteem.
The case reported here illustrates the projective test indications of
mirroring selfobject needs and demonstrates that because these needs had
been chronically rebuffed, the patient’s internal experience was predomi­
nantly devalued. The case also shows an unmirrored self in which inade­
quate responsiveness to normal mirroring selfobject needs led to
pronounced and nonremitting devitalization. The patient attempted to revi­
talize the self through idealization in an effort to build compensatory
structure, although this idealization too was thwarted. My comments em­
phasize the formulations derived from self psychology. Other interpretive
remarks based on either an ego psychological or an object relations frame-

192
MS. T.: MIRRORING 193

work are noted briefly, if at all, to keep the focus of the clinical illustrations
centered on the insights derived from Kohut’s formulations.
Ms. T. was a 30-year-old White, single, female inpatient in her first
lifetime psychiatric hospitalization. She was hospitalized to treat a depres­
sive episode with prominent suicidal ideation, accompanied by associated
problems of decreased sleep, significant weight gain, bulimia, and disso­
ciation. Ms. T. had trouble concentrating on her work when she was
employed as a production coordinator in charge of publishing an industry
periodical. She felt herself excluded from social interactions with co-work­
ers. The patient had a college education and had no previous psychiatric
history. At the time of diagnostic psychological testing, the patient was
maintained off psychotropic medications.

Human Figure Drawings

I begin with Ms. T.’s figure drawings to provide an overview and to set the
stage for a self psychologically based conceptualization. The predominant
self state was clearly conveyed in the verbalization on inquiry about her
initial drawing.
The patient first drew a woman, for which she provided the following
description when prompted to imagine what the person was like:

Let me start over:All we have is clothes with no person yet. I always knew I
didn't have a very good body concept. A very icky hair style. The only thing
that’s sturdy about this whole thing is the outfit. She’s a real disaster. [Why
is that?]1 Because I don’t know how to fix it any better. As long as you said
it’s okay, it’s your mess. Nothing’s real clear, it’s very sketchy, nothing’s real
organized here. Everything’s out ofproportion, everything’s awful. And ugly.
[Awful?] The fingers aren’t right. I know how to make fingers. [Describe the
personality] It’s like a zombie. No expression on her face. [Doing?] On this
side, she’s leaning on a rail, holding on to something, she can’t support
herself So she doesn’t have everything fall apart and collapse.

The elaboration of this drawing as a representation of diminished self­

esteem comes as no surprise to any clinician regardless of theoretical
persuasion. The self-depreciation in this verbalization is clearly evident;
indeed, it is difficult to imagine a better description of a frail and barely
thriving sense of the self. The absence of a firm, well-formed human figure

Examiner’s queries during testing are enclosed in brackets.

194 CHAPTER 7

(at least in the patient’s eyes, because the drawing itself was not seriously
compromised) was accompanied by her perception of the figure as out of
proportion. Her response revealed a self state as devalued as the “awful and
ugly” representation that Ms. T. described.
The “zombie” reference to the personality, together with the figure’s
difficulty in supporting herself to prevent her from collapsing, suggests
inner depletion, diminished self-worth, and a mirroring deficit even though
there is no specific reference to failure to provide affirming or comforting
sustenance. Such indications appeared later; a markedly devitalized self
state such as this verbalization implies that insufficient mirroring is in­
volved in producing a self state so devalued.
A depleted self state expressed in this way suggests that the absence of
a sense of the self as vigorous or buoyant results from an inadequately
responsive selfobject environment. The patient may struggle to conceal the
self state from others because “the only thing that’s sturdy about this whole
thing is the outfit.” Thus, what the world sees externally barely concealed
the internal state of disrepair that is not “sturdy.”
This description of an injured self is just the beginning, however. Kohut
would argue that it is also important to make sense of how the patient went
about repairing the devaluation that was experienced so acutely. Through
understanding selfobject needs, one can understand how the patient at­
tempted to restore the enfeebled self. In continuing to analyze the ongoing
clinical material, it is crucial to bear in mind that Kohut’s understanding of
the self as struggling to preserve its vitality extends beyond simply charac­
terizing the phenomenology, such as that in the previous description. In this
clinical example, the salient question becomes not so much one of identi­
fying the self state (which is already intuitively obvious), but rather of
discovering where the patient turns to replenish what appears to be miss­
ing. This level of understanding requires reconstructing what went wrong
with the selfobject environment that faltered for the patient.
Considered in this light, Ms. T. appeared not to seek out anyone beyond
herself. The best she could manage was to steady her footing by leaning
against a rail to prevent herself from “falling apart and collapsing.” At first,
she revealed her own underpowered abilities, and there was no indication
of her anticipating that her distress could be empathically understood, let
alone of expecting that any need for support or cohesion could be accurately
mirrored. It is not that the patient was depleted and therefore bereft of
resources. Rather, it is a question of what selfobject resources were poten­
tially available to Ms. T., and what did these provide, or fail to provide, to
MS. T.: MIRRORING 195

bolster her devalued self state. The way that this patient made use of her
selfobject milieu is a continuing focus of this diagnostic study.
Ms. T.’s second human figure drawing, a person of the opposite sex, was
described as follows:

Neither one of my people has very good hands. I’ll just eliminate the problem
because I’m going to put this guy’s hand in his pocket. I’d do these stereotypi­
cal things like a tie, which is too wide, a shirt and trousers. [Describe his
personality.] Probably a professional person, he looks like a preppie. He thinks
he’s going to decide what he’s going to do and do it. He’s got big feet so he
must be pretty well-established. [Hou/s that?] Because he’s standing pretty
firmly on the ground. Since you said draw someone of the other sex, I gave
him a beard since not many women have beards.

Her playfulness about the beard and her handling of what she considered
the problem of concealing his hand by drawing it in the pocket are probably
ways to appear engaging. Yet, the defensive solution of eliminating the
offending body part (deficient hand) is transparent. Ms. T. seemed to feel
that there were more options for repairing the drawing of the male figure
than were available for her drawing of the female (by inference, of course,
representing herself). This second drawing depicted a man who was deci­
sive, sure of himself, and firmly rooted—the very picture of healthy
self-esteem by anyone’s definition. The experience of herself in her pre­
vious drawing as enfeebled, unable to overturn an injured self state, and
with no resources besides a “rail” to keep her from “collapsing” contrasted
sharply with the surefooted representation of the male figure.
The patient’s second drawing may also indicate that a potential revitali­
zation of the self was possible. Ms. T.’s sense that there was a way out and
that one need not hold on to a rail for dear life implied at least a possibility
that she could turn somewhere to prevent collapse and to find the means by
which the self could become revitalized as a secure structure.

Rorschach Thematic Content

As I have attempted to demonstrate, the human figure drawings can provide
a broad overview of the personality structure or the lay of the land. The
content analysis of the Rorschach protocol that followed enriches the
general hypotheses raised by the human figure drawings inquiry. Ms. T.’s
complete Rorschach protocol is accompanied by commentary from a self
psychological perspective after each card. Comprehensive System codes or
196 CHAPTER 7

scores are not provided, to emphasize the augmentation that content analy­
sis provides. Thus, the self psychological viewpoint is intended to be an
addition to the main formal analysis of scores, ratios, and cluster interpre­
tation strategies, to provide an expanded conceptual view.

Card I
1. An angel leading a chorus, Maybe because Christmas is com­
but she lost her head. (W) ing up. Trying to get everyone to
sing together so it turns out right.
2. Two elephants drinking out Two ears, the tail, their nose. It
o f a fountain. (W) looks like Dumbo. [Dumbo?]
They're cute little pink elephants. I
think Dumbo couldfly, he could go
wherever he wanted. Actually he
was afreak and he had to get out of
there.
3. A Christmas bell and Christ­ The white is the branches. Every­
mas tree. (D4) body's supposed to be happy.

The first response of an angel could initially be construed as an indica­

tion that an idealized selfobject need has been mobilized, because this
image might connote a turning toward a benevolent but powerful figure.
The angel has been rendered impotent, however, and has not only lost its
head but tries to accomplish the task of leading others without any clear
sense that it has been successful. The presumably warm or affectionate
association to the Christmas season creates the impression that a selfobject
need for someone to make things “turn out right” was evoked. That this
need fails to be satisfied in a dependable manner to sustain a degree of
cohesion of the self might also be seen in the reference to the angel as
headless.
The patient continued on Card I with an elephant, although her associa­
tions emphasized its “cute little pink” quality. The animal was further
diminished in potency by a reference to a children’s cartoon character who
is at once given magical powers (flying) but in the next breath is portrayed
as a freak. It is not possible at this point to decide between two interpreta­
tions of the elephant percept. On the one hand, the percept may be an
indication of a strong, hulking image providing the vigor to sustain an
idealizing selfobject need. The elephant as Dumbo may also represent
something diminished or cut down to size.
MS. T.: MIRRORING 197

The possibility of hostile impulses, either in the form of the beheaded

angel or the diminutive elephant, may be suggested in a classical drive
theory approach to these images. An ego psychological framework may
suggest an interpretation of a passive-dependent position based on the
references to drinking and Christmas. From the perspective of psychoana­
lytic self psychology, aggression or dependency is secondary in importance.
Rather, the disempowering of the angel and elephant is understood as an
indication of a weakened self. The passivity or dependency interpretation
is also secondary and represents the sequela of a devitalized self rather than
a need state. Finally, the halting anticipation of happiness of the Christmas
bell and tree may be understood as restating the theme of longing for
revitalization of the self.

Card II
4. Two people dancing. Here's They have on kimonos, like in Fan­
their heads and their hands tasia. [Q] It's magical, having
touching. (D6) everything come to life and match
the music. Everything!s well organ­
ized and orchestrated.
5. A top in the middle. (DS5) How it's shaped here. I had one
when I was little.
6. Or a rocket with the jet pro­ A jet blasting off. All the smoke and
pulsion. (DS5 + D3) debris. The rocket's off to places
unknown. [Rocket?] No one ever
thought rockets would be blasting
off. You never know what will hap­
pen. Maybe like the one E. T. came
in.
7. A seamstress' model. This A sketch for a dress. It's all ready
manikin doesn’t have a head. for somebody to take it, for some­
A very long neck. It's a pretty thing real special. A special occa­
dress. Mainly to show the sion for a special person. It would
dress off. (DS5) have to be for a skinny person, so
it's not for me.
8. A monument in Arizona: a Like in the artfairs. A desert scene.
monolith. Very pretty colors. [Pretty colors, a desert scene?] It's
It looks like a Navajo paint- foreboding, isolated. Bleak.
ing. (D2)
198 CHAPTER 7

The responses to Card II are very productive. Evidently, Ms. T.’s percep­
tual processes and imagination were compellingly engaged here, particularly
by the center white space, because three of her five responses emphasized
the DS5 area of the blot. Beginning with a percept about festive dancing and
ending in a bleak desert scene, Ms. T. revealed wide oscillations of affect.
These could easily be considered to reflect the lability of a borderline
disorder or, in a previous diagnostic era, hysteria. Nevertheless, the diagnos­
tic issue is a separate question from that of the psychodynamic interplay of
conflict, anxiety, and defenses. A self psychological view of labile affect is
understood as indicating that the self is in a state of unstable cohesion. This
view reveals as much about defective selfobject responsiveness as about the
diagnostic condition giving rise to this degree of affect dysregulation.
From this vantage point, Ms. T.’s percept of people dancing with their
hands touching evoked her desire for a stabilized self, “well-organized and
orchestrated.” The “magical” fantasy reference could partially stem from
her final response to Card I (a Christmas tree), as a continuation of the hope
for securing a revitalized self. Like the succeeding response of a top and its
association to a childhood memory, this percept of well-organized dancing
can be seen as a wish for a vulnerable self to be repaired. This view is at
variance with a typical interpretation of regressive wishes.
The theme of her need for restoring the self persisted, despite her third
response about a rocket blasting off and leaving a trail of debris and smoke.
The association on inquiry was not to falling apart or destruction; rather,
she marveled about the achievements of space science. This response
repeated the wish to restore a sense of calming stability. (It is an error to
automatically equate an image of debris and smoke with an interpretation
of a distintegration product.) The desire for stabilization holds even though
it is experienced with the child-like, wondrous appeal of the familiar
benevolent character of E. T.
This same sequence of responses might well be viewed differently by
followers of drive theory; they would emphasize the extensive defensive
layering to contain the hostile images of a rocket creating debris. The view
of self psychology, however, is that interpretations about aggression or rage
are misguided. The ego psychological view fails to take full account of the
patient’s expression of a self that she attempted to preserve as viable or
animated. This patient sought to restore some measure of calmness in the
aftermath of a disruption to self-cohesion as inferred from her association
to debris. It is not the rage that is fundamental, at least in Kohut’s view; the
rage represents a byproduct of the failed attempt to preserve self-cohesion
MS. T.: MIRRORING 199

when the self state is threatened. Ms. T. was not blowing up; she has been
blown away.
Her response of a seamstress’ model of a headless manikin that displayed
a pretty dress “for a special person ... not for me” began a downward spiral
from her earlier percepts. These had included optimistic wishes such as
dancing in a magical setting, a top like one she had as a child, and a
wondrous appreciation of rocketry and the benevolent imagery of E. T.
Later, she failed to see herself as the intended owner of the pretty dress and
was no longer the special person she might wish to be; ultimately she ended
with the self state conveyed in the isolation of the bleak desert scene. As
Ira Gershwin wrote in the song lyric “They’re writing songs of love but not
for me”, so, too, does Ms. T. convey this sentiment by her comment that the
dress was for someone special “but not for me.”
Ms. T.’s capacity to present a stable, invigorated self continued to waver,
as already noted on her figure drawings and on Card I. Indeed, by the end
of Card II, little was left but bleak isolation of an unstimulated self as
represented by the desert monolith percept. Even her attempt to introduce
“very pretty colors ... like in the art fairs” failed to work well for her. Her
inquiry response was dominated by the desolation suggested by this percept.
Whether hypomanic denial or an indication of her symptomatic dysphoria,
the response pointed to the difficulty that Ms. T. experienced in her effort
to preserve a consistent, ongoing level of self-esteem.
Her faltering effort in this regard implies that the desolation in these
responses represented a disintegration product. In this context, the rocket’s
debris may now be considered to be part of this self state of desolation, but
not for the reason that it connotes enraged destruction. Instead, debris as a
disintegration product might belong with the devastated self state domi­
nated by affects such as bleak emptiness and isolation.
With regard to the question of selfobject function, in this sequence of
five responses, potential saviors of her faltering self were unavailable or
impotent. Thus, the headless angel of Card I, the headless seamstress’
manikin, and the benevolent figure of E. T. cannot apparently prevent her
final percept of the bleak desert monolith, which was the manifestation of
unavailable or inadequate responsiveness to legitimate selfobject needs. It
is, by inference, profoundly deficient mirroring, despite a feeble attempt to
seek idealizing selfobjects such as the imposing rocket, a magical, Fanta­
sia-like quality, or the angel of Card I. Her rocket ended in debris, and her
angel was headless. Even the animated Fantasia scene and the top could not
prevent her final response of the bleak desert scene.
200 CHAPTER 7

Such responses are significant indicators of deficient mirroring. Patients

who are chronically left too much to their own devices ultimately wind up
feeling ignored or forgotten. Ms. T.’s responses are notable for the absence
of figures who might provide the selfobject mirroring function of affirma­
tion. The other pathway to detecting faulty responsiveness from selfobjects
is the more easily visible expression of disappointment. Here, the emphasis
is on figures who fail in one way or another to come through for the patient.
Ms. T. displayed the pattern of deficient mirroring characterized by being
unnoticed or left too much alone for her own good, unable to hold up a
cohesive sense of self to the world. Her devitalized self became like her
percept of the top on Card II; had it been seen as spinning, its momentum
would wind down and, like her brittle self, come to a grinding halt.

Card III
9. That's stereotypical: two Af­ It's just the bodies of the two peo­
rican people, pointed face, ple, beating on drums right here.
the Afro hair styles. Beating
on drums, trying to get a mes­
sage. (Dl)
10. Neanderthal people. They They're cave people. [How does it
both fell out of a tree. This is look that way?] It looks like a cave
what they were hanging on painting. They're hunched over
to, it probably broke. (D2) like gorillas. They 're primitive, not
very smart. That's why they fell out
o f the tree.
11. A bust o f Beethoven. A big I'm looking at a negative image.
red bow tie so it'd be cute as Beethoven because his hair is stick­
a button. (D3) ing out. He's all jazzed up with the
bow tie. [How does it look that
way?] You mean sophisticated,
class and culture? A desired goal.
In the midst of this primitive stuff:
Neanderthals falling out of a tree
because they're stupid.

The popular response of the opening percept (No. 9) was conventional

enough. The variation on this response in the next percept (No. 10) con­
firmed any indication of primitiveness suggested by the image of people
beating a drum. Although a percept of primitive figures is often interpreted
MS. T.: MIRRORING 201

in classical drive theory as indicating the activation of a drive, usually

aggression, this notion is rarely uppermost in the self psychological view­
point, in which it more likely refers to denigration. Ms. T. attempted to
minimize the primitive aspect of the percepts cited here by making them a
piece of art (“a cave painting”). This attempt failed as a defense when she
referred to the gorilla-like, hunched-over appearance. She noted that the
figures fell from the tree because they were not smart. It could be argued
that for Ms. T., smart was her way of saying fortified. She was telling the
examiner that she cannot hold her own very well. In effect, she could fall
down and find herself unprotected.
In drive theory, this response is an indication of diminished ego resil­
iency, in which defenses are weakened, anxiety is not sufficiently contained,
and adaptation becomes compromised. A self psychological interpretation
takes the position that the patient is speaking here of the vulnerability of a
self that cannot sustain itself and lacks strength or endurance. Its very
cohesion feels threatened, and the selfobject need is for something external
to come to the aid of a self that experiences itself as “primitive” or brittle.
Even in her “cute as a button” bust of Beethoven, Ms. T. could not resist
referring still another time to an enfeebled self “in the midst of this primitive
stuff.” Her attempt to introduce a “jazzed up ... cute red bow tie” on a figure
not infrequently referred to as a titan among composers was insufficient to
repair the injury to the self. One cannot know all that underlay Ms. T.’s
association to Beethoven or be sure that she realized Beethoven was often
scorned during his lifetime, despite the esteem his music engendered. It is
not too speculative, however, to consider that the percept of Beethoven
represents a figure suitable for idealization. In this regard, it probably cannot
provide what Ms. T. sought in the way of an idealizing selfobject function
when it was portrayed as “cute as a button” instead of as a giant.

Card IV
12. A big monster. Here's his His hands fell off. Here's his tail.
head and his hands. An ac­ [Hands fell off?] The worst thing
tion shot because his feet go he can do is step on you. His head
up and down. (W) is pretty small.
vl3. A medieval castle. All this This is how it would look here s the
protection. It's very danger­ top right here.
ous down there. To keep peo­
ple out. (Dd99; lower half of
Dl)
202 CHAPTER 7

vl4. Like Georgia O'Keefe, it’s The nasal cavity and horns. It's real
reminiscent o f some of her neat. A dead buffalo and they made
works. It reminds me of a buf- something pretty out o f it.
falo skull in the desert. (W)
vl5. A king. His crown, his head, His outfit, the beard, his head and
all this is pomp and circum- hair. It reminds me of the emperor's
stance. (W) new clothes. They were all just
fooling him.
Ms. T. did not describe her monster as threatening, although she referred
to his large size from the perspective of an “action shot.” She wasted no
time in immobilizing the monster, first by removing his hands and later by
referring to his small head. Perhaps severing the hands was sufficiently
immobilizing so that this figure did not also need to be beheaded, as Ms. T.
had already done on Cards I and II, but she had not thereby protected herself
from injury because the monster could still “step on you.”
There followed a percept of a medieval castle, fortified but still not invul­
nerable. In needing “to keep people out,” Ms. T. had expended so much mental
effort on protecting herself and staving off injuries to the self that she became
deadened in the process by the time she reached the percept of the buffalo skull.
No matter that she tried to defensively represent this state of depletion and
mental exhaustion as an artistic product. Even her closing percept to this card,
that of a king, was undermined, because the power expected from a king was
weakened and illusory. Ultimately, the king too became an unreliable basis for
establishing idealization as a compensatory structure. The percept continued
her reference to the bigger-than-life Beethoven as diminished and “cute as a
button.” As with her association to the fairy tale about the emperor’s new
clothes, one is not fooled by her diversionary kings, castles, Beethoven, and
big monsters. She could not conceal that the king was just “pomp and
circumstance,” the castle held danger, the monster’s hands fell off, and
Beethoven was reduced to a “cute as a button” statue.
Card V
16. Two people sleeping. (W) The legs here, the elbow. Like at the
beach, resting. It's calm.
17. A mythical animal getting It's mythical because there's no ani-
readyfor a take-off. (W) mal like this. His feet are getting
ready to run and take off. He's fine
once he gets going, but taking off is
hard.
MS. T.: MIRRORING 203

I don’t like this one very well.

[Q] I t ’s not too exciting.
There’s not too much happen­
ing.

Ms. T. began her responses to Card V with the appearance of what seemed
like a recovery from the preceding upheaval. By psychologically “sleeping,”
she managed to feel “calm.” Inasmuch as her vigilant efforts to protect the self
from depletion consumed so much of her psychological resources, she seemed
to be alone in this attempt. There is barely any indication of selfobject
responsiveness that she could rely on. Her mythical animal percept could refer
to a feeling that no one else seems to have to work this hard (“there’s no animal
like this ... taking off is hard”).
She might be sleeping her way through Card V, but her comment about not
liking the card became, in effect, a powerful quasiresponse: She did not like
the quietude that was the price she paid for feeling calm. Thus, hardly a
“sleeper,” this response was a good example of a situation on the Rorschach
when less is more.
The excitement that she missed here perhaps reminded her too much of
the inner deadness suggested by the buffalo skull of Card IV and the desert
scene of Card II. If so, did this reminder re-expose an unresponded-to self to
a sense of dread about the threat of depletion? Could a sense of calmness
also be intolerable because feeling comforted might prove to be illusory or
undependable? These possibilities must remain tentative, however compel­
ling they are at this point in the protocol. Speculation about these dynamics
raises the question of what happens when it becomes necessary to self-pro-
tectively drive one’s selfobject needs underground to protect the self from
further devitalization.
This phenomenon may represent a milder form of the pronounced with­
drawal states associated with the schizoid or depressive positions to which
patients defensively retreat to protect themselves, similar to the states empha­
sized in the writings of Melanie Klein (1935/1975) and Guntrip (1969).
Kohut did not attach the same significance to this phenomenon that Klein
and Guntrip did, nor did he conceptualize clinical material in the same way.
Nevertheless, there may exist some commonality between these points of view.
This patient’s comment about the lack of excitement on Card V, coupled
with her earlier responses of the desert scene and the buffalo skull of a Georgia
O’Keefe painting, revived the fear of dissolution of the self. This reaction is
reminiscent of the disintegration anxiety that M. Tolpin & Kohut (1980)
204 CHAPTER 7

believed to underlie several forms of self disturbances. Her animal who

seemed to need a push to get going was still a “mythical” animal. Thus,
feeling “fine” was illusory because the push (that is, selfobject respon­
siveness) of a suitably mirroring or invigorating selfobject was absent
or in some vital sense not real or present for her. It was in this sense that
“it’s not too exciting.”

Card VI
vl8. A buffalo skin hanging on a The front, his back legs, the spine
wall for decoration. (Dl) I is curved, the tail here. I feel sorry
don ’tfeel like doing this any­ for the buffalo: Where does that
more. leave him? You’re supposed to be
nice to them, they’re an endan­
gered species.
19. Waves coming in, slopping The foam hitting the beach. Soon
all over the place. (Dl) the water will be all over, there
won’t be any land left. [How do you
see it?] The way thefoam goes over
the beach. It’s like writing mes­
sages in a sand castle and they’re
erased away, they’re only left in
your memory. The waves wash
everything away. It’s night.
20. A kiwi fruit that somebody This black looks like the stripe
splashed. All the seeds ex­ down the middle of a kiwi fruit.
ploded all over, just gushed [Stripe?] It’s something special,
out. (D ll) unusual. It’s just coincidental.
I thought these were in
colors.

Ms. T.’s remark at the end of Card V was restated even more strongly
after her first response to Card VI. Evidently, she was becoming increas­
ingly perturbed by some quality of the blots that made her wish to
withdraw from the testing situation. Her earlier response of a buffalo
skull now became a buffalo skin, and the mythical animal of Card V
became endangered. She seemed to complain that the buffalo, an endan­
gered species, was maltreated. Even her attempt to make the skin a wall
decoration was no more convincing than her earlier attempt to turn her
bleak desert scene into a Navajo painting.
MS. T.: MIRRORING 205

At the conclusion of Card VI, Ms. T. complained further of her need for
color in the cards, a response perhaps signifying that she was growing
overburdened by the bleak task that the Rorschach had become for her. Her
response seemed to capture how she experienced much of her life. The
understimulation signified a self that was desolate, unresponded to, and
ultimately devoid of the buoyancy required to sustain itself in a psychologi­
cally alive manner.
She felt drained (“I don’t feel like doing this anymore”) and perhaps
frustrated with an examiner who continually re-exposed her to the devitali­
zation of her self-esteem. She appealed to me and expected understanding
or sympathy (“I feel sorry for the buffalo; where does that leave him?”) as
if to say to me: “What’s wrong with you? Can’t you see how much I’m
hurting? You’re supposed to be nice to someone like me who feels so
endangered.” My restatement of her inquiry comments practically defined
this patient’s complaint about an unresponsive or unavailable mirroring
selfobject environment that did not notice her distress and needs.
The theme of an understimulated, unresponded-to self seemed to pervade
the rest of Card VI and was captured in the melancholy tone of lost,
unpreserved, or erased “messages.” This theme foreshadowed a forgotten-
about self in danger of eroding or being “washed away.” It was reminiscent
of her other castle (Card IV) that was in danger. Is the danger that something
imposing or vigorous is elusive or transitory? Can it be “washed away”?
Note also her comment about the castle on Card IV (“this is how it would
look”) as if she were reconstructing something from a memory; she
repeated this image in her “memory” of the sand castle on Card VI.
Even the “special” quality of the kiwi fruit was problematic: A black
stripe “exploded ... gushed.” As much as she craved it, is gushing excite­
ment or enlivenment too hot for her to handle (“exploded”)? Perhaps
self-protectively, Ms. T. contained this upsurge of affect by converting
something “special ... unusual” into something merely “coincidental.”
(Recall again how her dress from Card II for someone special to show off
is “not for me.”) Perhaps, alternatively, the kiwi, with its associations of
tropical colors, revived the wish for the enlivening of a depleted self. Its
failure or disappointment might have disposed Ms. T. to comment about
missing the color on the ink blots. Was she giving the examiner another
chance to enliven her, only to have her hopes dashed?
On this card, characterized as it was by the most compelling indication
of decompensation to this point, there was still no indication of a clearly
stated selfobject need. This patient craved mirroring, complained about its
206 CHAPTER 7

absence, but finally felt that mirroring was too unsafe or unreliable to
tolerate, and withdrew into a self state of depletion depression. This is the fate
of the unmirrored self (M. Tolpin, 1993). There is some risk in making a point
by reasoning from the absence of a function rather than from an interpretation
about an actual percept. I nevertheless argue that what is seen here is a self state
experienced as forgotten about and depreciated. It seems as if this patient could
only complain about continuing the Rorschach at this point or wonder about
why there was no color in the blots. This reaction is either a defensive
withdrawal from a situation that has become too burdensome to bear or an
expression of a veiled statement expressing a need for a selfobject to become
available to enliven, revive, or otherwise add “color” to her depleted self.
That the selfobject need is expressed in only a veiled manner does not,
however, mean that it is absent. If it is concealed by being driven underground,
the examiner’s task becomes more difficult; he or she must make something
of so little. Sometimes, the selfobject function is not contained in the elabora­
tion of the percept itself but may appear in a patient’s indirect, associated
comments in reference to the task itself. Thus, Ms. T.’s remarks about not
liking a card, not wanting to go on, or asking for cards with color managed to
convey what the response proper did not. Transference manifestations
directed to the examiner could reflect the selfobject needs that characterized
much of her life. Undergoing projective testing represented a microcosm
of the patient’s life and re-exposed her to the draining ordeal of her devitalized
existence. When Ms. T. said in effect, “I don’t like this any more, I want to
stop, you don’t give me anything with more color to work with,” she perhaps
expressed a wish for a selfobject to bring her back to life.
One does not see here the specific selfobject transference represented by
mirroring, idealization, or twinship, but rather the general manifestation of
a self state in disrepair. The specific selfobject function may not often be
clearly indicated on the Rorschach but may appear vividly on a task such
as the TAT, which evokes relationships among figures and ways that one
figure fails to provide some selfobject function for another. Similarly,
figure drawings may suggest depreciation of the figure and sometimes also
contain an indication of what is needed to repair the defect in self-esteem.
The Rorschach, on the other hand, more often captures the push and pull of
conflicts, defenses, and anxiety, and reveals more about ego resiliency
in the process. In a similar fashion, the Rorschach may often indicate
more about the self state than about particular selfobject needs.
This is the case with Ms. T., whose clear manifestations of selfobject needs
do become evident on the TAT. I describe this process more fully later, in the
MS. T.: MIRRORING 207

discussion of the material about Ms. T.’s TAT. The tentative speculations
noted here, however, provide a way of thinking about the probable selfob­
ject functions underlying the self states that are so richly evident in the
content analysis findings from this Rorschach protocol.

Card VII
v21. Two people bending over They ’re women, on tippy-toe so you
backw ards. Their arms know they’ll fall over for sure. The
reaching out. (W) arms have to be out. You balance
so not to fall over. Also, they’re
balancing on their brains because
that’s the only thing that’s touching.
v22. Napoleon. His head, collar, The hat part. He was a ruthless
the funny hat. (DS7) leader, a military genius, and pow­
erful. A little guy who got where he
wanted to, even though he ended in
exile. So, he gave it a go, and got
as far as he could.
23. Two people balancing on the Here’s the ponytail. Balancing on
very edge of the top of a rock. the base so they don ’tfall over.
They’re trying to communi­
cate either by using their
arms for gestures or their
heads coming together. (W)

By now, there was little new. Most responses essentially restated earlier
themes. Beginning with people precariously balanced to avoid falling down,
Ms. T. proceeded to the diminutive but powerful Napoleon who wound up
defeated. Thus, she ended as insecurely balanced as she began. Ms. T. never
managed to gain a solid foothold for her precarious self state. Her elaboration
at the end of the inquiry to Response 21 was unclear; in an otherwise
non-thought-disordered record, she seemed to struggle with headless or brain­
less imagery, and with desperation. This statement is another instance of a self
state that lacks what is needed for its cohesion or stability.

Card VIII
v24. Somebody’s brain. Some of The pons, midbrain, cerebrum, me-
the parts are rotted out. A lot dulla oblongata,
o f the parts are missing. (W)
208 CHAPTER 7

25. Noah's ark. Rocking on the It doesn't exist. The boat that was
edge of a mountain top, kind supposed to save everybody.
o f tipping. Even though it's
been there thousands of years
I think it's going to fall off.
Everything there is petrified.
(D4)
26. Two bears climbing up the They're supposed to have big
side with their hand reaching strong hands, so they yre nonfunc­
out but it doesn't look like a tional, sickly.
bear hand. The fingers don't
look good. (Dl)
v27. Two unicorns. Maybe just be­ Here's the horses' heads, the sad­
cause th e y're white. I dles. They're comforting, rocking
changed it to rocking horses. back and forth.
(Dds99=D5 + Dd33 + DdS28)

The neuroanatomical sophistication was surprising, but Ms. T.’s opening

response to this card did not obscure the theme of rotting away. The theme
continued the precarious “balancing on their brains” from Card VII, ex­
tended her reference to missing parts of a structure as vital as the brain, and
persisted with the failure to keep afloat in the Noah’s ark percept. The
ominous-sounding petrification became more predominant as Ms. T. expe­
rienced the profoundly distressing devitalization of the self over and over
again. Perhaps there was a hint of an idealizing selfobject need emerging
here, with the hope of the figure represented by the biblical story of Noah
coming to her rescue. His “boat that was supposed to save everybody” failed
her, however, as did the powerful Napoleon of Card VII who was finally
impotent in a state of exile. Her hopes were met with disappointment
wherever she turned in her attempt to find a suitably idealizable selfobject
to compensate for defective mirroring. Powerful figures were of little use
to her; they become like her “cute as a button” Beethoven.
She continued valiantly forward with a percept of bears climbing a
mountain, but these normally vigorous, burly animals were also “sickly.”
Ms. T. finally resorted to the mythical figures represented by unicorns. Like
her Dumbo on Card II who was a “freak” and the mythical animal of Card
V who had trouble “taking off,” her unicorns quickly changed to inanimate
rocking horses. Apart from the possible connotation of a wondrous or noble
unicorn that is reduced to a child’s simple toy, her unicorn, together with
MS. T.: MIRRORING 209

her Dumbo figure, offered little more than minimal comfort as she contin­
ued to experience considerable desperation in her effort to repair an enfee­
bled self.

Card IX
28. Two witches over a big pot, A looking up shot so you can't see
throwing all sorts o f stuff in. what's in there, but everyone knows
It's all poison. (D3) witches always make poison.
v29. A pelvis area. (D ll) Its shape. Now I can see the organs
and muscles (points to D6 area).
30. The back view of somebody's From the back. [Pretty?] The ele­
shoulders with a real pretty gance, fanciness. Wealth.
fancy evening gown. But you
can't see the rest of her head,
but it's a very nice hair style.
(Dd99: lower half of D3 and
upper projection o fD l area)
31. Two women with long The two white things. Like a myth
dresses. The wind is blowing where the people weren't supposed
th eir hair and dresses. to do something and they turned to
(DdS99: two larger white stone and got petrified. That was
space areas on either side of their punishment.
Dd30)

The percept of witches introduced something not noted previously:

malevolent figures up to no good. Although not a surprising response in
this blot area, there had been no previous indication in the protocol to
prepare the examiner for a response of malevolent figures intent on
creating harm. The percept of a pelvis that followed did not help to clarify
matters.
Ms. T.’s subsequent response, flowing evening gowns, was in sharp
contrast to the witches’ robes often seen in this D1 area. The witches’
poisonous brew percept may be construed in several ways. Its meaning
in regard to hostile wishes is clear; it may also be another manifestation
of a vulnerable self struggling to preserve cohesion in light of forces that
undermine this effort. Witches may further represent an aspect of self­
depreciation.
What, then, of the elegant gown of the woman whose face cannot be seen?
The fancy quality can be considered to represent Ms. T.’s need to feel proud
210 CHAPTER 7

of herself, perhaps even to be seen as beautiful or admirable by others. That

she could not, in effect, show her face, represented either shame or the
inability to feel proud and worthy of admiration. The response was remi­
niscent of this patient’s earlier response of a headless manikin used only to
display the special dress not meant for her. Although headless, “but it’s a
very nice hair style” she tells us: Is one really to believe her? Is Ms. T. not,
after all, the one with the “icky” hair of the depreciated, enfeebled drawing
of the woman she described earlier on the human figure drawings? Laudable
as it may be that Ms. T. still manages to sustain some hope for mirroring, it
should not be forgotten that she is also skeptical that the realization of her
need may be “fanciful.”
The reference to wealth is consistent with the few other expressions of
selfobject needs for idealization, needs that also have not materialized.
Therefore, the reference may be consistent with the previous percepts of
Napoleon in exile, the petrified Noah’s ark, or the king’s crown that is
merely pomp and circumstance and that people can see through. The percept
may represent the wish for admiration, and in its absence, the attempt to
turn to an idealized selfobject to compensate for defective mirroring.
The final response to Card IX, women in long, flowing, white dresses,
became in the end another fanciful myth. She appeared to convey the sense
that any hopeful attempt, however tentative in her imagination, was still
ill-fated. She imagined that her longing for the admiration that comes with
empathically attuned mirroring would be punished. For this patient, the
punishment of petrification was once again that state of devitalization of
the self from which she found little relief.

Card X
v32. Bugs, like in a movie I saw. The colors and squishiness, like a
They ate the brain out. The caterpillar that crawled and slith­
Wrath of Khan. Could trans­ ered. I clean my ears twice a day
mit their thoughts. They because I don Ylike icky things.
didn't have any control of
their actions when the bug’s
in their ear. (W)
33. The Fontainebleu and sea­ The way there's statues around the
food restaurant in Paris. The fountain. When I used to go on va­
Eiffel Tower is nearby. (D2 + cation, I went wherever I wanted
D ll) and did what I wanted.
34. Crustaceans. (Dl) The shape they have here.
MS. T.: MIRRORING 211

35. Disneyland. When the Magic That's how it looks. Everyone has
Kingdom comes out at night. to clap their handsfor Tinkerbell so
(DIO) they wouldn't die.
36. Two pterodactyls. They kiss The bodies, their fancy tails. They
and there's a blue heart. But kissed and their heart grew.
they're extinct, so it doesn't They're prehistoric birds. Like a
make any difference. (D6) cartoon thing. The heart means
they kissed.

Ms. T.’s opening response on Card X sounded ominous at first glance. It

resembled the “rotting brain” of Card VIII and her “balancing on their
brains” comment on Card VII. It also followed from her response of the
witches’ poisonous brew on the previous blot. Perhaps the chromatic cards
triggered a previously concealed or effectively defended layer of this
patient’s pathology, but the reference to a horror movie somewhat mini­
mized this concern.
The primitive quality of a percept with mention of eating the brain or bugs
in the ears, together with Ms. T.’s overpersonalized comment about cleaning
her own ears, nevertheless suggested that at least momentary loss of distance
occurred. Whether or not an examiner may regard a response such as this as
psychotic-like, its meaning can still be empathically understood from the
vantage point of psychoanalytic self psychology. Even psychotic produc­
tions contain indications about the self state.
From this viewpoint, Ms. T. managed to vividly convey that she experi­
enced herself as depreciated, with an intensity not previously seen in the
protocol. Here, Ms. T. presented herself as so devalued that she felt herself
without any means to restore even minimal self-esteem. The chromatic blots
indicated that the depths of the self disorder reached deeper than pre­
viously recognized. The percept of the rotting brain and the petrified
Noah’s ark on Card VIII provided the first signs of this degree of psychopa­
thology, but not until Card X did this level emerge in its most profoundly
devalued form.
As profound a picture of a depreciated self state as these responses
indicated, Ms. T. did manage to recover sufficiently to produce a grand
Parisian scene. This quasirecovery occurred immediately after the Card X
percept of bugs, a percept that would probably be considered her most
regressed depiction of the self state. Her associative comment recalled a
time when she felt herself to be in greater control. This comment indicated
that the self, as embattled or beaten down as it became, still held some
212 CHAPTER 7

possibility, however unlikely, of being restored to a hardier or more robust

and resilient state.
This configuration recalls Kohut’s comment, made on a number of occa­
sions, that there is no self without a selfobject. However devitalized the
experience of the self may be, the possibility that a revivable selfobject can
still be sought points to the means for treating the narcissistic injury or
underlying self disorder. The prognostic implication of such projective test
responses or inquiry elaborations is useful for specifying treatment indica­
tions or recommendations. Some clinicians may dismiss this interpretive
view as merely mistaking an instance of hypomanic denial, but this criticism
overlooks the important point about the repair of the self. Regarding this
sequence of responses on Card X as simply an attempt at denial is shortsighted.
Ms. T. followed her Parisian scene response with the magical wonder of a
Disneyland image, complete with a reference to having to clap hands “so they
wouldn’t die.” Although this response could be understood as magical thinking
and hypomanic denial, in another sense it is one more indication of what has
to be done to preserve a faltering sense of self-cohesion. To conclude, this
patient described a myth about a prehistoric animal and its needs for the “heart
to grow” and therefore to sustain the self to forestall its extinction.

Summary
In Ms. T.’s Rorschach findings, a consistent picture emerged of a dimin­
ished self, unable to sustain a robust state of vigor to enable the patient
to turn pridefully to others in anticipation of being admired or under­
stood. Again and again, Ms. T. appeared to experience the depletion of
a self that could not hold itself up to the world. She could not expect the
selfobject responsiveness that she required to assist her in preserving self-es­
teem and was easily devastated as her efforts to seek admiration went unheard.
As a result, assertive selfobject-seeking attempts at restoring self-cohesion
were driven underground.
Ms. T. attempted to turn to idealizable figures for their imagined strength to
buoy the chronic selfobject failures of mirroring to which she was continually
re-exposed. Persisting disappointment and disintegration products permeated
this protocol. Her attempt to establish idealization as an alternative pathway to
self-cohesion was Ms. T.’s effort to revive faltering self-esteem. In this way,
she tried to build a compensatory structure that might lead to the restoration of
the self. That her attempt characteristically led to her sense that idealized
selfobjects were impotent, immobilized, or illusory only further undermined
MS. T.: MIRRORING 213

Ms. T.’s self disorder and intensified the prevailing beaten-down adaptation
at the core of her experience of the self. She was unable to emerge from this
state sufficiently revived.
A compensatory structure to take the place of chronic, ongoing, deficient
mirroring is not the same thing as filling a gap. The goal of selfobject
responsiveness, or optimal treatment for that matter, is structure formation
rather than feeding, sustenance, or any other variation of supplying temporary
palliatives. None of these is particularly therapeutic as far as analysis or
intensive psychotherapy is concerned. The repair of empathic failure is accom­
plished by creating a new, efficacious pathway through which the self becomes
firmed up. For this patient of poor or marginal prognosis, the outlook for repair
of the self cannot be particularly optimistic. This guarded outlook leaves little
room for the hopeful indicators on her Rorschach protocol to survive strongly
enough to help her very much. Her protocol results offered a picture of chronic,
unrelenting mirroring selfobject failure with far more defensive than compen­
satory structures. Despite her insightful and richly productive percepts, the
nature of the psychopathology and the impoverishment of self-cohesion that
characterize this patient’s personality structure cannot sustain an exploratory
treatment effort beyond support. To attempt much more is arguably misguided
and clinically ill-advised, although she could derive benefit from a cautiously
supportive treatment.

Thematic Apperception Test

Card 1.

It’s time for the boy to practice his music lesson. He doesn't want to but he
knows he's supposed to or he'll get in big trouble. He didn't want to play but
his parents decided he would play. Everyone else is having fun playing
outside. [Outcome] He sits there for 3 hours and stares at the violin. He gets
so disgusted, and he puts in his 1 hour of practice. So he didn't get to play
with his friends, and wasted 3 hours just staring at the thing. He doesn't have
much say in whatever he does even if he's miserable.

The basic theme of the story is typical and the resolution of giving in
to the parents’ demand not uncommon. Spending 3 hours staring at the
violin could be either a passive-aggressive position or an attempt by the
boy to assert his own desire. A better understanding is gained, however,
by attending to the affect state of disgust or misery in the boy’s futile
effort to assert his own will. Although Ms. T. did not use the word
214 CHAPTER 7

defeated in her story, it is not difficult to imagine that she felt that way. Here
is another instance, as in several of her Rorschach responses, in which she
felt undermined after attempting to stand up for herself. She ultimately gave
in to defeat and had no impact on the parents. In this respect, feeling
“miserable ... disgusted” was a euphemism for feeling devitalized.
When the self was not responded to, Ms. T. gave up in defeat.
In the story cited here, the boy appeared to seek some sense of
understanding by or meeting of the minds with his parents, but there is
no indication that the parents (at least in the storyteller’s eyes) showed
a capacity for recognizing the boy’s plight. Thus, any sense of compro­
mise, understanding of the boy’s conflicting wishes, or even an aware­
ness of his conflicts was lacking. His selfobject need was at least to be
understood or to have his needs recognized. The failure at this level gave
rise to a self state characterized by feeling impotent and devitalized in
the face of unresponsiveness from the selfobject environment. The
ensuing depletion of the self, expressed in the story by the affects of
“disgusted ... miserable” resulted from this lack of responsiveness or
selfobject failure.

Card 2.

You're not paying attention to me, so I wont pay attention to your cards. All
these people live on the farm. She has to go away to school It looks like she
doesn't want to. He works the farm. He gets visual—he gets feedback what
he's done. So everything he does has some obvious causal effect. She doesn't
look happyf also her dress is crooked, so she doesn't take very good care how
she's dressed. It looks sad, I don't know what she wants to do. [Led up?]
These two people just figured she should go to school. [Who are they?] It
doesn't really matter. [Outcome?] Even though she doesn't want to, she does
what everyone wants her to do. Even though she's miserable and her
sweater's on crooked.

Whatever momentarily distracted the examiner, Ms. T. showed her

exquisite sensitivity to even the slightest withdrawal of attention. Her
comment censuring the examiner, framed with an “eye for an eye” quality,
could be viewed by many clinicians as a two-pronged expression of hostil­
ity; first, she called me “on the carpet” for my inattention, and then retaliated
in kind. It is characteristic of a self psychological approach, however, to
understand this remark as provoked by feeling ignored or not responded to.
Thus, the anger or rage is not interpreted as the primary consideration but
is secondary to the central injury.
MS. T.: MIRRORING 215

From this viewpoint, both the beginning of the interpretation of Card 2

and the end of the interpretation of Card 1 were statements about Ms. T.’s
self state: She felt that she was not taken seriously or listened to and that
she was responded to in an offhand or dismissive manner. In both stories,
she was asked to do something she did not want to do or that she found
unappealing. She added the “eye for an eye” retaliative aspect to her
outcome in which she defied the examiner’s objective by withholding what
I asked for. This response may also represent her attempt to master a
situation that left her feeling immobilized and “miserable.” Her solution
was to stand in the way of what I as the offending examiner asked her to
do. Perhaps standing up to disappointing selfobjects was preferable to
passively (or passive-aggressively) “wasting” time, as on Card 1, and
ultimately feeling defeated.
Note how Ms. T. began her story with another reference to having to do
something she did not want to do. As on Card 1, she was made to do
something distasteful to her. In contrast, the man of Card 2 got the better
end of the deal, like the boy’s friends on Card 1, who got to play. She seemed
to say that other people come to feel that they are responded to (“has some
obvious causal effect”), whereas she, like the boy on Card 1, “doesn’t have
much say in whatever he does.” References to the crooked dress and to not
taking good care of her appearance may be other indications of indifference
to herself, indifference resulting from depression. Indifference or disinter­
est become, therefore, euphemisms for depression, like the boy of Card 1
who felt “miserable.” The disheveled appearance reflected the devalued
self-esteem she felt when what she did or wanted was treated with casual
indifference, or when she was unnoticed and ignored.
When Ms. T.’s story suggested that “it doesn’t really matter” who made
the girl go to school, she again retaliated in kind against her family, as if to
say that if she did not matter to them, they did not matter to her. This
response recalls her comment to me at the beginning of Card 2. Even more
important, Ms. T. conveyed the impression that selfobject needs for
mirroring were submerged or given up. When she said, “It doesn’t really
matter” who the people are, she resembled a young child who petulantly
says, “You can’t hurt me.” This response may reflect Ms. T.’s feelings about
her unmirrored, unresponded-to self. It was her defensive rejection of her
selfobject need for others to notice that she was injured.
Finally, the outcome of her story reflected her unenthusiastic compliance
by going through the motions (“she does what everyone wants her to do”).
She was still surrounded by the empathic failures of a selfobject environ­
216 CHAPTER 7

ment that dismissed her need for mirroring. This fact predisposed her to the
depletion depression or devitalization that typified much of her ongoing
experience (“even though she’s still miserable”). Although it may sound
flippant when she followed this statement about feeling miserable by
commenting “and her sweater’s on crooked,” it no longer seems so when
considered from the viewpoint that her sense of herself is devalued.

Card 3BM.

1don’t know. There's tons of stuff to do and so many tasks to finish. They're
so tired, they put their head down for a minute. Then they'd have enough
energy to finish. They'll fall asleep and won't get it done and get in trouble.
[Outcome?] They'll be disappointed she didn't finish it.

The quality of being overburdened was notable in Ms. T.’s emphasis on

the “tons of stuff to do” and the fact that the person is “so tired.” She
experienced life as requiring much effort; her fatigue and diminished energy
might be associated with a retarded depressive syndrome. The strain re­
ferred to in her response can also stem from a self state stretched to its limits
as she tried on her own to keep herself afloat. Her story contained no
indication that someone will come to her assistance; once again, Ms. T.
expected her selfobject environment to fail to notice her burden. Rather,
there is “disappointment” in her inadequate functioning, disappointment
that brings only “trouble” instead of the empathic understanding she desires.
Being disapproved of and found wanting were what this patient experi­
enced from her selfobject environment. Her needs were ignored or unno­
ticed; she felt the effort to continue as a burden. She wished for the selfobject
environment to wake her up, in effect, and to take note of her need for
mirroring selfobject responsiveness.

Card 7GF.

The perspective is off on this. The little girl and the lady are both waiting for
something. The little girl's distracted, looking to a spot where she hopes
something will happen, but she looks disinterested like there's got to be
something else better. So she obediently sits there waiting, wishing to do what
she wants. They told her to just sit there and wait. [The lady?] She doesn't
even know the little girl. They're just waiting for some unknown reason. She
has something productive to do while waiting. The little girl's just hopelessly
aimlessly waiting.
MS. T.: MIRRORING 217

The major themes were much the same as on the previous cards. Her
initial comment about the “perspective” suggested being caught off guard
when presented with this card. The threat to self-cohesion by the marked
selfobject failure was triggered from the start because she seemed taken
aback that the “perspective is off.” She proceeded to tell a story as if the two
people were sitting in different spaces (the lady “doesn’t even know the little
girl”). The activity of waiting “for some unknown reason” remained the same
for both. The two figures could hardly be more uninvolved with one another
as they were described in this story. Indeed, one could almost imagine that
there were two completely separate cards with the same story.
The girl was “disinterested,” Ms. T.’s metaphor, like “miserable ...
disgusted ... so tired,” for disengagement in the face of mirroring selfobject
failure. She “obediently” complied with what was asked of her, as in the
previous stories of not enjoying practicing the violin or not wanting to go
to school. She felt emptiness and lack of enthusiasm for what she was
expected to do. These feelings arose from a selfobject environment in which
parental figures were uninvolved with Ms. T.’s needs. Consequently, she
revealed a self state of emptiness, unresponded to by the depersonalized
mother figure referred to as just “the lady.” The girl was “hopelessly
aimlessly waiting” for this “lady” to come to life for her in an important
psychological sense. The impersonal, psychologically bereft, and empty
quality contained in this response is the sort of material that plays by
David Mamet capture in a raw and gripping way by the bleakness and the
starkness of their stagecraft.

Card 7BM.

It’s the middle of a serious conversation. This is just a break in the topic.
Either an insurance policy or money matters. [Who are they?] They’re
relatives. [Make up a story.] It makes no difference. Otherwise they
wouldn’t be that close to each other. [What led up?] Some acute situation.
Now they have to band together and decide what to do. [Outcome?] They
come to a consensus.

This card seemed more difficult for Ms. T. to tell a story about. It required
more prompting to elicit important story features, and even with this amount
of inquiry there was less specificity compared with her other TAT stories. She
was reluctant to indicate exactly what relationship these relatives had. There
was some degree of closeness or need to “band together” in this story, but who
they were and how close they were to each other were irrelevant. Indeed, as
218 CHAPTER 7

she said, “It makes no difference.” The closeness was apparently based on
the consensus of equals or nearequals, without any indication of the guiding
parental function frequently elicited on this card.
On the previous card, Card 7GF, the girl did not feel attached enough to
consider initiating contact with the “lady” who “doesn’t even know the little
girl.” The present card was also notable for the absence of a selfobject
function characterizing the relationship between the two men. There was
distance despite the fact that the men were relatives. There was also an affective
estrangement to the “acute situation” that momentarily brought them together
to reach a consensus. Although perhaps not totally distant, cold, or business­
like, this relationship was not particularly warm, benevolent, or characterized
by paternalistic concern. Ms. T. was again driving underground her need for
selfobject responsiveness, which could occur only with an “acute situation.”
An empathically attuned response should be one of concern or at least a
sense that one party feels threatened or that self-cohesion is in danger. The
response represented here is different: A dispassionate “serious conversation,”
even though it may lead to a resolution (“they come to a consensus”). Ms. T.
might have been turning from the mother who did not know the girl (that is,
the patient herself) or her need for mirroring selfobject responsiveness (Card
7GF) to the “relative” of Card 7BM. The somewhat more involved relation­
ship between these male figures led to a more satisfactory resolution by
“consensus” compared to the “hopelessly aimlessly waiting” of Card 7GF.
Still, there was the perception of these men as “relatives,” but “it makes no
difference” just who they were. It is difficult to see this response as even a
remote indication of idealization. It is also doubtful that this attempt to
compensate for what was unavailable by mirroring was psychologically
satisfying or that Ms. T. felt sufficiently invigorated to revive an enfeebled,
understimulated self.

Card 18GF.

That's odd. Two people, a lady holding another person up. Something must have
happened. It looks like something pretty sad or serious. [Led up?] The person
collapsed or got sick or something. She’s probably been taking care of this person
for a while. [Who are these women?] I didn't say two women. I was very careful
to say a woman and a person. Ones a caretaker, the other one is just a person.
[Male or female?] Neither. I can't tell. Maybe an old man. She's taking care of
her father or a relative or something. [How does she feel?] All worn out and
frazzled. He's dependent on the lady. She's pretty sad and distraught. The
person's sick and needs her help. Because it's no fun to have to be responsible
and take care of someone else.
MS. T.: MIRRORING 219

Again, this patient was momentarily thrown off guard by something about
the card, possibly its stark bluntness connoting distress. This reaction appeared
in her opening comment of “that’s odd” and later in her insistent correction of
the examiner’s error in thinking that both figures were women. Furthermore,
her terse closing of the story much sooner than most of her other stories also
required a greater degree of inquiry to elicit important details. Even at that,
Ms. T. was uncharacteristically guarded about revealing too much. She
grudgingly allowed that the person in distress was an old man and was
surprisingly reticent about deciding whether the man was a “father or a relative
or something.” After that, one is still in the dark about this point. A self
psychologically informed interpretation of her “worn out and frazzled ... sad
and distraught” feeling indicates the same self state already revealed consis­
tently across the TAT cards. The chronically lacking acknowledgment that she
was asked to assume so much responsibility is noteworthy; she felt
depleted or “all worn out.”

Card 13MF.

The next morning. He just got up out of bed, got dressed and ready to go.
[Who are they?] They have a steady relationship. He’s nice enough not to
wake her up in the morning.

Card 14.

The inside of a building. He’s busy working all day, and just took a minute
for time out to get some fresh air for some relief.

These two cards contributed little to the clinical picture. The responses
added nothing noteworthy to what Ms. T. already said.

General Discussion of Ms. T.

This case, reported in its entirety, illustrates a number of important

aspects of a self psychologically informed approach to psychodiagnostic
test material. It reveals that oscillations in the self state can be detected
in relation to events or affects that interfere with sustaining self-esteem.
This approach, guided as it is by Kohut’s theoretical formulations,
revealed that Ms. T.’s attempts at restoring self-esteem were provoked
by reactions to others’ failures to recognize that she was in distress. She
experienced self states of devitalization or anergia, which were aggra­
220 CHAPTER 7

vated by the unresponsiveness of the selfobject environment to her need

for being heard.
Because of this deficient or unresponsive mirroring, Ms. T. turned
hopefully to others to enliven her or to provide enthusiasm. Some of
these manifestations took the form of an attempt to establish compensa­
tory structure to restore self-cohesion through idealization. These efforts
met with limited success and only compromised Ms. T.’s capacity to
buoy up faltering self-esteem. In the end, therefore, she experienced
herself as diminished and had pronounced feelings of depletion. These
feelings were the basis for several of Ms. T.’s responses such as “icky
hair,” “awful and ugly body proportions,” “an angel without her head,”
“Dumbo,” “a special dress ... so it’s not for me,” on the Rorschach, TAT,
and human figure drawings.
Ms. T.’s devalued self seriously compromised her capacity to sustain
zest or a thriving, vibrant internal experience. This aspect of the self
differs from the customary sense of thinking well or favorably about
oneself, because Kohut’s view of the self reached deep to capture a
quality of a viable, buoyant self state. Many clinicians may not readily
apprehend this aspect of the depleted or devitalized self as fundamentally
different from self-esteem, but such a simplistic view about identity or
lowered self-esteem is too limited.
The idea of an attempt to protect against devitalization by seeking
reparative selfobject responsiveness in the form of compensatory structures
was not one of Kohut’s familiar concepts, and it has received virtually no
attention in the psychodiagnostic testing literature. This case provides
ample opportunity to observe the degree to which a chronically injured self
is mobilized repeatedly in the projective test content. It also demonstrates
that this patient attempted unsuccessfully again and again to repair the
injury to the self or to restore some measure of enlivenment so that the
depletion might be better tolerated.
This case also illustrates the patient’s alternation between understated
yearnings for mirroring and for idealization. This alternation is related to
her efforts to revive the deadened self state and her attempts to find
alternative selfobject functions when mirroring selfobject responsiveness
failed her. Ms. T. made some attempts to obtain what she needed for
sustaining the self through abortive attempts at idealization. That these were
quickly dashed rather than pursued with hopefulness demonstrates how
ultimately unsuccessful her attempts to restimulate faltering self-cohesion
became. Nevertheless, this case illustrates the effort to develop compensa­
MS. T.: MIRRORING 221

tory structures. It also shows what happens on projective testing when that
attempt is thwarted and when the mirroring sector of the self has been as
chronically and seriously damaged as it has been for this patient.
As I have already indicated, it is necessary to consider the self state and
attempts to repair defective self structure together with patients’ experience
of their external world or selfobject environment. Through selfobject re­
sponsiveness, people manage to re-establish or revive what they need to
preserve self-cohesion. With Ms. T., the mirroring selfobject function
necessary to respond vigorously to her need to be kept “afloat” was again
and again deficient. The repeated empathic failures that she experienced
left her chronically disappointed. As so many of her TAT stories and
Rorschach responses suggested, she felt unresponded to in her attempts to
secure mirroring, and she was ultimately defeated. Attempts at establishing
another route to repair the self by forming idealizing selfobject transfer­
ences were either halfhearted or did not go far enough. She quickly
abandoned hope that there was anything there for her “in the midst of this
primitive stuff’ beyond the “pomp and circumstance.” Her confidence was
undermined: Ms. T. referred to a “Napoleon ... who got where he wanted
to,” but he “ended in exile,” or “Noah’s ark ... that was supposed to save
everybody” but “doesn’t exist” and is “petrified.” Consequently, a compen­
satory structure as an alternate route to repair a devitalized self failed to
develop reliably for her.
Beyond her diminished self-esteem, Ms. T. indicated in her projective
test protocol the central significance of the buoyancy or vitality of the
experience of the self. A normal expectation of mirroring is essential for
ensuring self-cohesion, and building compensatory structures protects
against devitalization of the self by attempting to establish another route to
secure selfobject responsiveness. This protocol shows the failure of mirror­
ing, and it also reveals idealization as a compensatory structure. The
characteristic experience or phenomenology of the devitalized unmirrored
self is conveyed most tellingly in this patient’s projective test content,
which depicted the remains of a self so devastated by both deficient
mirroring and idealizing selfobject responsiveness that it was unable to
sustain itself for long. Ms. T.’s self markedly lacked a quality perhaps best
denoted as resilience or hardiness.
In the next chapter, I present the projective testing protocol of a patient
who demonstrated more interplay among selfobject functions than did
Ms. T. Like Ms. T., this patient showed a basic mirroring deficiency, and
he also attempted to establish compensatory structures centered on
222 CHAPTER 7

idealization and, to an extent, twinship. Ms. T.’s self disorder was more
severe; as a result, her feeble attempt to establish an idealizing selfobject
transference quickly failed. Thus, her protocol illustrates a more pre­
dominant mirroring selfobject disturbance than does the protocol dis­
cussed next. The patient whose projective test findings are presented in
chapter 8 repeatedly attempted to seek idealizing and twinship selfobject
functions, although in the end he too was unable to secure them with any
greater success than did Ms. T.
The contrast between the two cases demonstrates the differences in level
of psychopathology of the self (despite comparable overt symptomatic
disturbances), differential utilization of selfobject functions and attempts to
establish compensatory structures, and approximately similar outcomes as
far as the success of these efforts.
 8 Mr. L.: Idealization
and Twinship

A CASE OF ADMIXTURES OF SELFOBJECT

FUNCTIONS

The second case that I present in its entirety is of interest for several
reasons. This psychodiagnostic protocol has elements of the three major
selfobject functions that Kohut identified, and therefore represents a
typical clinical presentation of selfobject functions. Not a textbook case of
clear idealization or twinship, it shows the difficulty in distinguishing these
selfobject transferences from each other. The patient, Mr. L., alternated
among selfobject functions to find a viable pathway for the repair of
self-cohesion and like many other patients, attempted to establish a com­
pensatory structure in the face of chronic mirroring selfobject failures.
Mr. L.’s case illustrates a point that Kohut came to see over time as his
work progressed: Selfobject functions are not entirely independent of each
other. With the possible exception of mirroring needs, which occur most
often, other selfobject transferences predominate at different times. They
come forward at some points and recede at others, often when an attempt
at restoring self-esteem is either blocked or unsuccessful. Such vacillation
is not an instance of inconsistency or failure to establish a predominant
selfobject function; selfobject functions do not represent formes frustes.
Admixtures frequently appear.
The case reported here is a good illustration of this clinical situation. I
discuss it by considering all three selfobject functions and emphasize
idealization and twinship as efforts to repair self-cohesion when mirroring
has become unavailable or unsuccessful. The patient showed a degree of
overt psychopathology comparable to Ms. T.; the degree of symptomatic
disturbance is approximately equal in the two cases. Mr. L., however, had
a more favorable premorbid adjustment. His disorder was more reactive
and less chronic than the characterologically entrenched pathology of
Ms. T.’s disorder.
223
224 CHAPTER 8

Mr. L. was also more resilient than Ms. T. insofar as he could seek out
idealization and twinship selfobjects to somewhat better advantage than
did Ms. T. Consequently, the admixture of selfobject functions in Mr. L.’s
protocol may appear to be confusing, only because Ms. T. displayed a
clearly demarcated or predominant selfobject need. The arrested develop­
ment in Ms. T.’s self disorder testifies to the difference in degree of
psychopathology in these patients’ disorders. The constriction that charac­
terized the pronounced mirroring deficit of Ms. T.’s condition produced a
more pathological clinical picture and prognosis than did that of Mr. L. In
the end, however, despite Mr. L.’s persistent attempt to secure selfobject
responsiveness through idealization and twinship, the efficacious repair of
a self disorder was no more successful for him than it was for Ms. T.
This case illustrates that the clinical identification of selfobject transfer­
ences varies according to psychological test or procedure. For Mr. L., the
twinship and idealization selfobject functions appeared more distinctly on
the Rorschach yet were barely evident at all on the TAT and figure
drawings. Had the TAT and drawings been performed without the Ror­
schach, a clinician would not have detected evidence for idealization or
twinship selfobject functions, and a disturbance of mirroring would have
been viewed as central. Had the Rorschach been administered without the
TAT or figure drawings, deficient mirroring might not have appeared to
the extent revealed on the TAT and human figure drawings.
Mr. L.’s case demonstrates, therefore, that the interplay of selfobject
functions, like defenses and conflicts, can frequently require an entire
protocol. A complete and balanced diagnostic testing protocol becomes
crucial to identify predominant selfobject patterns and central self psy­
chological dynamics like compensatory structures, as these ideas were
thought about and developed by Kohut.
Mr. L., a 45-year-old married White man, was admitted to the inpatient
psychiatry service of a general hospital following a suicide attempt precipi­
tated by family difficulties. He had been an accomplished learning disabili­
ties supervisor and administrator, who had become enraged when his
adolescent son was diagnosed with an attention deficit syndrome by col­
leagues at a hospital in which Mr. L. worked. He became furious with his
son and argued with his wife about her overprotectiveness of the boy. Mr.
L. experienced an intensification of anxiety, accompanied by shortness of
breath and chest pain; the anxiety had developed in the past 2 years. He
began drinking heavily, although not so much as to raise concerns about
IDEALIZATION AND TWINSHIP 225

alcohol dependence, and he experienced impotence. Mr. L. expressed guilt

over his outbursts towards his wife and son, and he worried about growing old.
The Rorschach protocol for this patient included a second inquiry
following the formal inquiry proper, after 15 of his 40 Rorschach re­
sponses, for the purpose of testing limits. This patient’s protocol was
obtained before the Comprehensive System administration method was in
widespread clinical use. The usual question was: “What comes to mind
about a _____ ?” which is indicated as [Association] in the following
transcript. Some clinicians may regard such questions as provocative and
prefer to emphasize the problem-solving perceptual nature of the Ror­
schach test. Others view this manner of conducting the Rorschach inquiry
as advantageous. The method is derived from examining the psychody­
namic patterns that emerge on projective tests. In this approach, content
analysis is regarded as equal in importance as the formal scores are in the
complete diagnostic evaluation. Some may prefer the leaner Comprehen­
sive System administration procedure for its neutrality and may combine
an interpretive approach based on the empirically grounded Structural
Summary codes and ratios with a judicious use of content analysis.
Not all clinicians will regard the administration of the case that follows
as “true,” and some will consider it “not Rorschach.” I am submitting the
protocol for the consideration of those clinicians who will find the content
rich and revealing. The follow-up inquiry of probing for associations may
sometimes be of critical significance in understanding a self psychological
approach to projective test material. I chose the present case partly because
it illustrates that a judicious eliciting of associations as a means of testing
limits revealed dynamic material for a self psychological interpretation. I
remain convinced that this interpretation might not have emerged as
clearly in the absence of these associations.

Human Figure Drawings

The first drawing was that of a man, which elicited the following elaboration:

A young person going out for a walk. He’s excited that the air is clean and
fresh. He's looking forward to the new things hell find as he explores.
Basically, it's the woods, nature, being alone, smelling the trees and flowers.
[Describe personality]1 Very changeable, moodwise. Sometimes he’s very

lExaminer’s queries appear in brackets.

226 CHAPTER 8

happy, sometimes he's very sad. When the mood changes he likes to be alone.
Basically, he's very free, left to his own thoughts. [Q] There's a contradiction
between emotional involvement and intellectual involvement. He's very
sensitive to the needs of others. It makes him drained, unable to deal with his
own needs. Then he realizes his own inadequacies, because he’s very angry
and oppositional. [Q] Being able to be in total control of his environment and
himself. Wanting to do what he wants to do. He doesn't like being controlled
by authority in his job, by people who know less than he does. It bothers him
when he's unable to obtain what he wants, when he knows he’s right and
he’s misunderstood. When obstacles, such as money, block his goals in life.
[Goals?] Living, not wealthy, but achieving comfortable things.

This verbalization represented Mr. L.’s self state. He experienced tension

in the face of the pushes and pulls impinging on him, while trying to calm
himself. The pastoral-sounding beginning of his description of the person
suggested an idyllic, wished-for self state of a young man with few cares or
worries. This state shortly gave way either to changeable moods that were
vacillations in the self state or to ambivalence. The turning inward that he
talked about may be a withdrawal from the world when he was asked to
attend to others’ needs while his own self-cohesion required him to shore up
needed reserves for himself. In this way, he attempted to protect himself from
becoming “drained” by others and “unable to deal with his own needs.”
Thus, his “moodiness” is the affective vacillation of a vulnerable self that
is exposed like a raw nerve. He experienced this state as an “inadequacy
because he’s very angry and oppositional.” Presumably, demands placed on
him by others were irritating intrusions that conflicted with his preference
“to be alone.” Mr. L. attempted to restore cohesion to a self that he felt was
interfered with and put upon. There is a question about suitable or available
selfobject responsiveness because Mr. L. turned inward when self-esteem
was threatened. He was preoccupied with his feeling undermined. This state
was far removed from the idyllic peace in the communing-with-nature
scene with which he began and suggests that a wish for calmly merging
with a secure or comforting presence was mobilized.
Mr. L. was now threatened by feeling a loss of control and feared
holding on to what he needed to feel calmed. “Achieving comfortable
things” may represent his attempt to assure himself a dependable selfob­
ject environment that he can turn to or rely on to feel comforted. Instead,
he felt “misunderstood” and confronted with “obstacles.” Mr. L. thus
described a self state of disrepair, a vulnerability to others’ demands
when he himself is too much in need of the calm equilibrium that a reliable
IDEALIZATION AND TWINSHIP 227

selfobject environment ensures. He felt out of sorts and dissatisfied, if

not annoyed or distressed.
The second drawing that Mr. L. was asked to supply was that of a
person of the opposite sex, to which he provided the following commentary
on request:

That's a mother-like figure, sweet and gentle, calling her children in to the
house. Very warm and loving. She might appear simple but is a deep
thinker, she's hurt very easily but doesn't show it. She gets a lot of
satisfaction from her family. The family takes advantage of her. Though
she resents it, she'll always have a smile covering up the hurts, with her
arms stretched. She's also there to hold the family together. [Fears or
worries?] That she's not able to protect them the way she should. A lot of
responsibility falls on to her. She's unable to deal with them at times. [Sad
or depressed?] Failure of her children to conform the way she wants them
to, because of her high expectations that's sometimes unrealistic. Failure
also of her husband's inability to take over a lot of chores thrown on to
her. Incomplete communication, feeling the family might be against her.
They're going in different directions with different goals. So, basically she's
given up. [Angry?] Very little. Disagreements with her husband as to how
to deal with the children. Over money, being taken advantage of, that she
has no control.

The description of this female drawing, like his male drawing, began
with a picture of serenity but soon changed to an elaboration of inner
distress taking the form of feeling overburdened with responsibility and
failing to realistically meet obligations. This patient’s elaboration of the
figure drawing conveyed his feeling that other people disappointed by
ignoring what the figure needed in the way of understanding or recogni­
tion. Thus, the woman failed to win adequate mirroring; “basically she’s
given up.” The depletion or diminished enthusiasm gave way to feeling
taken advantage of and lacking control.
Although drawings of same-sex figures frequently offer a good initial
indication of the self state, it is difficult to interpret verbalizations about
opposite-sex drawings. Should the commentary on inquiry be under­
stood as an idealized self representation when the patient feels too
undermined or depleted? Should the female drawing be taken to repre­
sent the patient’s own sense of depreciation of someone important in his
life, perhaps as a defensive effort to protect the self from further injury?
Should this inquiry be thought of as a restatement of the devalued self
228 CHAPTER 8

continued from the previous drawing? The guidelines are rarely clear on
these questions, and examiners must proceed carefully with their interpre­
tations.
In the case at hand, Mr. L.’s description on inquiry to this drawing did not
certainly indicate whom he was speaking about. Nevertheless, the overriding
themes of being overburdened or unresponded to cannot be ignored. He
ultimately gave up in defeat and could not sustain a sufficiently buoyed-up
feeling of self-esteem. This interpretation points to the way that Mr. L. might
experience both his own self state and the selfobject environment he turned
to for assistance in sustaining self-esteem. Whether or not he felt himself to
be faltering and diminished, he continually experienced indifference or
unresponsiveness to legitimate mirroring needs. This lack deprived him of
feeling capable and enthusiastic; instead, he felt devitalized.

Rorschach Content

Card I
1. Two people sitting over a ta­ Here's the table, their heads, rear
ble having dinner. Discuss­ ends.
ing the events o f the day. Both
are coming from work. It's a
pub-like atmosphere. Their
discussion is based on the in­
eptness they came across that
day. They're in disagree­
ment, one trying to quiet
down the other by the raising
o f the hand. (W)
2. A butterfly. (W) Can I turn it The body, the wings here.
around?
v3. Two people dancing around a They're holding hands around it.
maypole. One seems very
happy, the other's very sad.
When they're happy it's more
energetic a movement, when
it's sad, you can tell by the
head being down that he
doesn't want to participate.
(W)
IDEALIZATION AND TWINSHIP 229

<4. Two donkeys. Actually, one Looking down, big ears, here’s the
donkey with a reflection in reflection.
the water. Sees his own re-
flection. (W)
5. An Oriental woman right Theface, hair, standing right on the
here. (D4) ground. Not as gentle as most.
Looks hostile.

Mr. L.’s atypical approach to the inkblot was characterized from the
outset by penetrating behind the imagery of his opening response. His
response was more like a TAT story than a typical Rorschach percept, and
his first response most likely typifies the real-life dilemma that preoccupied
him. Despite the convivial letting-one’s-hair-down mood that he wished to
convey by setting the discussion in a pub, the predominant themes of
criticism or devaluation (“the ineptness they came across that day”), dis­
agreement, and attempts to restore calm interfered with the congeniality he
was striving for.
The predominant self state was characterized by disharmony by seek­
ing calm to re-establish cohesion (“one trying to quiet down the other”). A
specific selfobject need has not yet emerged, but the affective state of
disruption or disequilibrium was clear. The need to restore a state of calm
intimacy or communion is more central than is the wish to discharge a
hostile or critical impulse.
The serene image of a butterfly, coupled with his asking permission to
turn the card, might suggest dependency or fragility. Following the tense
disagreement disrupting the initially harmonious mood of the previous
response, the butterfly and the request to turn the card could also be a
restatement of the need to restore calm. The next percept is dancing around
a maypole, as innocent-sounding as the butterfly, but it quickly becomes
associated with the bittersweet lachen und weinen (“laughter and tears”) of
an affect state that alternates between these moods but does not settle into
either one. The happy affect was experienced as an “energetic” quality of
movement that may connote the vitality of the self state that Mr. L. was seeking.
In similar fashion, the sad affect was represented by the “head being down,”
metaphorically standing for the devitalization of the self that cannot hold its
own, that “doesn’t want to participate” or hold its head up with pride and vigor.
In some clinical conditions in which alternating mood states are promi­
nent, such a response can imply a bipolar mood disorder. Fluctuating affect
states suggested by projective test responses like these may also represent
230 CHAPTER 8

the simultaneous presence of a destabilized self state, independent of the

clinical-biological indications of a bipolar or cyclothymic disorder.
Mr. L. continued with a percept of donkeys, seen as a reflection. It is
tempting to regard reflection responses as manifestations of a mirroring
selfobject function, but frequently no automatic equivalence or similar­
ity is indicated. Other than the fact that mirrors give off reflections, the
in-depth meaning of mirroring, at least insofar as Kohut has richly
characterized this phenomenon, bears little beyond surface similarity to
the idea of a mirror image or reflection.
More telling about Mr. L.’s response, however, is the imagery of
donkeys, particularly as they follow the struggle that he expressed
between disagreement and harmony (Response 1) and sadness and joy
(Response 3), with the butterfly percept between. The depreciated don­
key may convey Mr. L.’s self state when his attempt to resolve the
dilemmas disposed him to feel like the ass represented by the donkeys
of this response. Mr. L. may have felt himself to be an object of scorn or
ridicule. The image of the donkey comes closer to capturing the experi­
ence-near self state of depreciation than do the donkeys seen in reflection
indicate a mirroring need.
The clinical interpretation of this patient’s final response, an Oriental
woman portrayed as hostile, is unclear at this point. Perhaps seeing the
woman as Oriental connoted something exotic, foreign, or otherwise
alien to his life, or more crucially, his internal world or experience. The
possibility of passive gentleness alternating with the unaccustomed
hostility associated with Oriental women recalls the alternating moods
in Mr. L .’s maypole response. The connotation of the woman as hostile
could also be construed as an undoing and a projection of his own hostile
wishes. The possible interpretive options are uncertain at this juncture;
thus, this response must be subsequently reconsidered in the evaluation
in a broader context.

Card II
6. Two people, possibly monks, The heads, bodies. Pressing hands,
having a conversation. like they're having fun, they're in
They're much more compat­ accord, pushing together.
ible as they're touching
hands. (W)
7. Two elephants nuzzling each The same place without the top red.
other's trunks. (D6 + D3) Their trunks and ears here.
IDEALIZATION AND TWINSHIP 231

<8. A rat, down flat, sprawled Looking down at it. A different per­
out. Used like a rug, like a spective. The shape o f the head.
bearskin rug. (D6) The anatomy, the fur. [Fur?] The
roughness o f the surface and the
shading. [Sprawled out?] It’s very
flat.
v9. A bird, a duck in flight. I'm The beak, head, the wings. Like
taking one white part with the looking down from an airplane.
black as background. (DS5 + [Association] Running away. Free­
D4) dom. The softness. Escape.
vlO. Two birds, like little hum­ The little beaks. The rest of the card
mingbirds. Taking nectar is the flower. Stamen, pistils, the
from a flower. (W) petals. The stem. [Association]
Very cheery. Free.

The response of monks on the first chromatic blot of the Rorschach cards
may be surprising, all the more so because the all-red color on Card II
frequently elicits percepts about blood. It is always questionable to assume
that examiners’ preconceived ideas about the meaning of specific cards
parallels patients’ responses. Schafer (1954), R M. Lemer (1991), and most
commentators on Rorschach interpretation stressed this point, which was
discussed in detail in chapter 4. With that in mind, it is advisable to
de-emphasize interpreting this response of monks seeking compatibility as
a defensive denial or reaction formation against hostile wishes. The rela­
tively serene percept of monks as gentle figures, touching hands in a gesture
of accord or compatibility, can be construed as an excessive effort to portray
a conciliatory or cooperative relationship.
This interpretation follows from a drive theory view about the underlying
hostility suggested by the red color presumed to be the driving force behind
the response. This line of thinking applies regardless of whether a reference
to red color or blood is articulated. Although this assumption is under­
standable, most responsible projective testing clinicians probably concur
with the need for caution about this interpretation, regardless of whether the
impression is supported by corroborating evidence throughout the entire
projective testing protocol. The hypothesis-generating potential of this form
of interpretation, at this stage in the workup, must be viewed as tentative.
One need not be similarly cautious about making a self psychological
interpretation of the response of monks in conversation because this
interpretation is not based primarily on the red-blood-aggression link.
232 CHAPTER 8

An interpretation derived from Kohut’s interpretive strategies emphasizes

the cohesion-restoring quality of the selfobject function represented by the
cooperative gesture as a central or salient feature of the patient’s psycho­
logical state. This self psychological interpretation does not ignore the
defensive implication of the patient’s protecting him- or herself from
experiencing aggressive impulses. Kohut more likely would have empha­
sized seeking communion with or establishing a bond between these
figures as the patient’s primary concern.
In his monks response, Mr. L. was apparently seeking either an idealizing
or a twinship selfobject function. Twinship is suggested by the bond of
understanding or accord as the primary mechanism influencing this percept.
The possibility that either an idealized or twinship selfobject function arises
at this point can be examined by considering this response in the context of
Card I. He began Card I with a depiction of a convivial conversation in a
pub-like atmosphere that faltered. This response may represent the need for
an atmosphere of cooperation in which he could be understood in depth by
a like-minded person. The atmosphere might allow the merging or connect­
edness to occur, if the twinship selfobject function in which “one trying to
quiet down the other by the raising of the hand” permitted the self state he
wanted to recapture.
This possibility is consistent with the still tentative interpretation of the
compatible monks touching hands, now retrospectively applied to the
response to Card I. Regardless of the theoretical framework, sequence
analysis may proceed in both forward and reverse directions. The alterna­
tive interpretation of an idealizing selfobject function suggests that the
monks represent a selfobject that Mr. L. turned to for vigor or for a sense
of calm strength or reassurance, or possibly for admiration.
The percept of the monks was followed by one in which elephants
nuzzled each others’ trunks. Nuzzling connotes intimacy, however incon­
gruous this sensation may appear in connection with an anything-but-cud-
dly large animal like an elephant. Elephants, however, may also be seen as
playful, interesting to watch, approachable and gentle, despite their impos­
ing size. Yet the overriding image was the nuzzling, despite its incongruity,
similar to the gentleness of the Oriental woman who was hostile and
perhaps, therefore, unavailable or unapproachable. The image was in keep­
ing with the monks’ desire to press their hands together in accord, a percept
suggesting a wish for closeness, intimacy, or mutuality of the type possibly
understood as a twinship selfobject function.
IDEALIZATION AND TWINSHIP 233

The next percept, of a rat sprawled out like a rug, was all the more unusual
because Comprehensive System criteria were satisfied for coding both
texture and form dimension. Thus, the psychological significance of affec-
tional longing and self-awareness was suggested in this response of a furry
rat. The incongruity of a rat as a decorative rug, with its distasteful qualities
rarely associated with warmth and furriness, suggests that Mr. L. looked in
far-flung places for what he needed to restore either a sense of psychological
connectedness or the calm reassurance to buttress faltering self-cohesion.
These responses are a further indication of incongruity between what Mr.
L. needed and what was possible for him. Was he indicating that he searched
in the most remote places (furry rat rugs, elephants nuzzling) for what the
self needed for its viability? Did he feel that his efforts led nowhere? Most
of his responses to this point, on both Cards I and II, converge on this
possibility. Unremarkably, the rat percept was followed by a bird in flight,
in which his associations of “running away, freedom, softness, escape”
suggest that protecting the self from injury or threat was as much as he
could manage. His association of “softness” recalls the textural quality of
the furry rat, and the softness embedded among associations about escaping
to safety may also indicate the fate of his needs for intimacy or closeness.
In the matter of eliciting associations following the formal inquiry, it is
often difficult to decide when a judicious use of testing limits for select
responses is appropriate. Although advising caution in this regard, Exner
(1993) did not exclude the possibility of testing the limits after the formal
Comprehensive System inquiry but advised against eliciting associations
as an appropriate use of testing limits, as is the case for the response now
being considered, as well as for several others following. Although Exner’s
reasons are compelling, there are arguments in favor of testing limits by
eliciting associations. Mr. L.’s references to escape and softness would not
have emerged without what can be seen as a provocative question that
specifically elicited associations.
Without the associations, the bird in flight would have been thought about
as calm or serene, like the following percept of hummingbirds taking nectar.
It remains to be determined whether one impression was more accurate than
the other or whether these images represented different, conflictual aspects
of the personality structure. Ultimately, the issue of administration proce­
dure is one consideration in the risk-benefit balance involved in this test
administration decision. Whether the dynamic of escape or safety would
have emerged in the absence of obtaining associations as a form of testing
limits must also be determined.
234 CHAPTER 8

Mr. L.’s final response to Card II, hummingbirds taking nectar from a
flower, also has connotations of gentleness and oral dependency. It follows
the hostile Oriental woman, his closing response to Card I, and the furry
rat; the incongruity of these images can suggest the unavailability of a
deeply experienced need state. From the viewpoint of self psychology,
frustrated or interrupted mirroring responsiveness is a probable candidate
for what was amiss. Hostility or anger is less likely; this picture is not so
much one of a drive seeking discharge as it is of a need state that is
profoundly blocked or closed off.

Card III
11. Two men. They appear very The bodies here. They appear just
stagnant even though their to look formal there.
bodies are very free flowing.
They seem stiff and formal.
(D9)
vl2. Two African natives with The shape of the head: negroid.
their backs toward each Doing some type of ritual around a
other. Doing a religious fire. [Fire ?] The red. The color sug­
dance. (Dl + D3) gested fire. [Association] Values,
rituals, tradition. [Q] Conformity.
13. Very segmented parts. Parts The red is the butterfly, the other
o f rats, monkeys, butterflies. red is little monkeys. Fish here, also
Nothing is coming together, two birds like eagles. It could also
though. (W) look like the abominable snowman.
Or a polar bear. [Association:
abominable snowman] I t ’s un­
known. Does it exist? But also the
softness and power.

The stiffness denoted in the initial response contrasted with the reference
to the bodies as “free flowing.” It is yet another inconsistency or incongruity
emerging with increasing clarity as a central feature of Mr. L.’s personality
makeup. First glances, he seemed to tell the examiner, do not convey the
full intensity of what he experienced in depth. Free-flowing people are stiff,
birds in flight run away, a rat is characterized by its furriness, and the
convivial atmosphere of a pub-like, intimate conversation or dancing
around a maypole gives way to disagreement or disharmony. From the point
of view of the predominant self state, it grew increasingly clear that Mr. L.
IDEALIZATION AND TWINSHIP 235

felt keenly that the world was out of kilter for him. His opening response
to Card III of stagnant people revealed that he felt that way himself and that
he needed to recover. He wanted to feel “free flowing,” that is, more
psychologically enlivened or connected, both to others as well as to the
depths of his own internal experience.
Mr. L. craved the ability to feel vibrant or allied with what was important
to him. He felt repeatedly rebuffed or shut out from what he wanted and
had to escape from unpleasant situations with his psychological wounds
exposed like a raw nerve. He struggled to get the psychological oxygen he
wanted even if he seemed to return to the same devitalizing experiences
(expressed in all the incongruous percepts previously noted) that ulti­
mately undermined the self.
Unlike Ms. T., this patient was able to seek out either an idealizing or
twinship selfobject function to help repair the self. For both patients,
however, the attempt came with considerable difficulty. Ms. T. retreated
almost immediately from the possibility of acquiring compensatory struc­
ture through attempts at idealization. Mr. L. continued to try, however,
rather than giving up in defeat that might lead to the devastation of
self-esteem that was so prominent a feature of Ms. T.’s record.
Mr. L. initially attempted to see himself as psychologically alive (“free
flowing”) on Card III but quickly became “stiff and formal.” His next
response aimed to restore some bond or connection in the form of a religious
ritual, although the figures had their backs toward each other. The color
used to indicate the fire could stand for the vibrancy or enlivened feeling
he hoped to establish through the psychological connection of the ritual. It
faded, ultimately, into a routine of conformity and perhaps left him feeling
emotionally flattened.
This self state in which the psychological oxygen or enlivenment he
sought was insufficient, evoked his third response to Card III, segmented
parts of animals with “nothing coming together.” Starting with rats and
monkeys, he managed to end with the possibility that one of the animal
species is an eagle (soaring and majestic by implication, although not
actually stated by Mr. L.). The oscillation again represents his resiliency
in bouncing back after an injury to the self and attempting to restore
self-cohesion.
His final associations evoked the additional response of the abominable
snowman. Again, this powerful image is “unknown,” and Mr. L. asked:
“Does it exist?” When the reference to softness reappeared, it probably
denoted a longed-for calming or soothing to help repair the self state.
236 CHAPTER 8

Soliciting associations generated the interpretive yield of the natives’

ritualized conformity, suggesting devitalization. In addition, questioning
the existence of the abominable snowman, as well as its soft, powerful
quality, indicated his feeling estranged from a self whose reality he ques­
tioned. These features might well have been obscured without this form of
provocative or vigorous inquiry. Detecting these features contributed to a
greater understanding of these characteristics of Mr. L.’s personality.

Card IV
14. The head of a dragon. Bend­ The head, long neck, end part and
ing over, his head's touching back legs. [Sniffing ?] I don't know.
the ground. As if sniffing out Something dangerous.
something. Ready to spurt
fire. (W)
v 15. Two dogs, like puppies. Each The dark shaded area is the cliff.
is on top of a cliff, looking Looking down, giving you height.
down into the valley. (D2) [Association] Just overlooking
everything. The vastness. It's very
comforting, peaceful.
16. Part of a giant, half a part. Here's the boot. [Jack and the
From the waist down. Almost Beanstalk?] Being chased by
like Jack and the Beanstalk. something frightening but able to
Walking toward Jack, with getaway from it. Running, trying to
his boots on. (D7) get away, to find something, trying
to manipulate, outsmart. Going
into the unknown.
17. Now I see the whole giant. The whole thing is the giant. Car­
The head's small, distorted. rying the goose here. [Goose ...
Accentuated on the feet, the golden eggs?] Being able to mone­
boots. He's carrying the tarily afford everything you want.
goose that laid the golden Money growing on trees type of
eggs, you see the head of the thing.
goose. (W)

Card IV not only elicited the common imagery of a strong towering

figure but appeared so compelling that Mr. L. was unable to let go of it
throughout three of his four responses. By now it is clear that idealization
is a central selfobject need for Mr. L. The percepts of giants should also be
considered in relation to the people in the pub comparing notes about the
IDEALIZATION AND TWINSHIP 237

ineptness of others, the monks, and the religious ritual. These powerful or
awe-inspiring figures (giants, monks, the abominable snowman) suggested
that this patient was inclined to turn to strong, idealizable figures for
firming up the self when it was undermined. Likewise, imagery connoting
communion, such as the religious rite or the people in the pub, tentatively
suggested a twinship or companionate selfobject function. The feeling of
being at one with or like others can bolster self-cohesion when the sense of
the self is experienced as weakened, injured, or vulnerable.
Mr. L.’s idealizing and possibly his twinship selfobject needs were
revealed in ways that indicated that these selfobject functions were not
operating effectively. His initial response to Card IV was a dragon, but he
described it in an atypical way as bending over with its head touching the
ground, as if it were investigating a potentially dangerous situation. His
dragon was like a detective, “sniffing out something,” and it was ready to
attack (“spurt fire”) should the danger be confirmed. Rather than standing
up straight, exposing its powerful size for all to see and admire, Mr. L.’s
dragon was in a potentially threatened or vulnerable position from which it
must be vigilant and ready to protect itself.
This image of a dragon was not likely to be experienced as vigorous or
admirable in its great size, nor could it give this patient the comforting
feeling that there is someone in his corner to whom he can turn for
protection or strength. Mr. L. designated the idealized selfobject as an
imposing dragon, which does not exist in reality; he characterized his
dragon as threatened and consequently needing to be watchful (“sniffing
out”). Recall his additional percept of the previous card, the soft but still
powerful abominable snowman, which he also noted to be an imaginary
reference. Did he harbor concerns about whether idealized selfobjects were
really there for him in a sufficiently reliable or dependable manner?
This patient reported puppies perched on top of a cliff, seen with the
benefit of the shading on the blot. The puppies were overlooking a vast
terrain, and the response carried a serene affective tone. These diminutive
puppy dogs, themselves in need of being protected, were depicted as safe.
Before too quickly concluding that this percept connoted vulnerability that
can be calmed or soothed, the following two percepts of giants, the first of
which was “half a part, from the waist down,” were disquieting. One
association included a spontaneous reference to the Jack and the Beanstalk
tale, in which the boy is chased by the giant, tries to run away to safety, but
is “going into the unknown.” The danger of the dragon’s “sniffing out
something” has returned and re-exposed Mr. L. to the dangerous “un­
238 CHAPTER 8

known.” That the giant was headless and the boy of this percept tried to
“outsmart” the giant highlighted Mr. L.’s reliance on intellectual defenses
or resources to protect himself. He therefore turned inward to his own
abilities or talents to safeguard a vulnerable sense of cohesion of the self.
Strong, idealizable selfobjects are vulnerable, weak, nonexistent, or endan­
gered; he must be the strong person with his wits about him.
Idealizable selfobjects may be too unreliable for him to trust that they
can protect him. He thus saw himself once more as the small, powerless
boy, like the puppies of the previous response, who turned to a responsive
and dependably available selfobject environment. Mr. L. found such help
either lacking or too uncertain to last long enough to ensure a sustained
calming, as may be seen when the danger of the giant returned immedi­
ately after the puppies on the cliff who felt comfortable. Note that the
selfobject need (in this instance, idealization) was revealed by its falter­
ing or malfunction.
Mr. L. concluded Card IV with a second giant, this time with the benefit
of a head, but a head compromised by being “small and distorted.” This
giant, bearing the goose with the golden eggs, represented Mr. L.’s hope for
everything he wanted. His hope for the reassurance of an idealizable
selfobject might be illusory, insofar as it expressed the misdirected notion
that whenever the self felt endangered, he needed only the goose that laid
a golden (that is, protective) egg. The giant of this percept, who bore the
magic goose, distorted head notwithstanding, was another reminder that
the golden eggs that Mr. L. hoped to secure for himself probably fail him
in the end. Unlike Ms. T., however, he continued to search for a responsive
idealizing selfobject.
Unsuccessful mirroring selfobject responsiveness may have set the stage
for the readiness of the self to feel itself undermined or threatened. This
patient’s figure drawings had already indicated that Mr. L. felt devitalized
and experienced his existence as out of kilter and lacking equilibrium. Thus,
it is not difficult to understand this patient’s desire for a strong, resilient
figure to emerge as an idealizable selfobject, to assist his overtaxed capacity
to preserve self-cohesion. Puppies overlooking the peaceful expanse of land
and the association to money growing on trees are characteristic indications
of his need for calm security. Mr. L. was trying to find a way to keep a
vulnerable self sustained or afloat.

Card V
18. A bat, flying. (W) The wings. The body of it.
IDEALIZATION AND TWINSHIP 239

v 19. A bush. The legs on two sides The dark area is the bush. Leaping
o f two animals, rabbits. Run­ in for cover. [Q] They jump, hop,
ning behind the bush. They and they're swift. They run fast.
escaped from something, They're usually hunted.
possibly a hunter. (W)
20. A ballerina. Arms raised, and The head, chest, arms raised as in
leaping into the air. (W) a swan. Flight into the air. Freedom
of flight. The body's very graceful.
v21. A person diving into a swim­ The body; legs here, and the head.
ming pool. Right in the midst [Association] Being swallowed up.
o f the dive. Both arms and Encompassed by the water.
legs extended. (Dd99: W ex­
cluding D6 area)

After the conventional bat, Mr. L. returned to what has been emerging
as the predominant theme of seeking safety from threat. In his response of
a scared rabbit, he commented on the swiftness of the rabbits, perhaps
another indication of his resiliency at times of danger or anxiety, reminis­
cent of his percept on Card IV of the boy who used his skills and talents to
“outsmart” the foreboding giant. Mr. L. knew what his resources were, and
did not feel as defeated and defenseless as Ms. T. By this point, however, it
was becoming clear that it was a great strain for Mr. L. to sustain this effort.
There was hardly a moment’s respite, and he constantly needed to be
watchful and vigilant, like his rabbit “leaping for cover ... they’re usually
hunted.”
There followed another serene image, this time, a ballerina. Also por­
trayed as a leaping figure, the ballerina was not leaping like the rabbit to
save her life from a hunter. Rather, she had “freedom of flight.” This pattern
was seen previously, on Card IV, on which the dragon spewing fire when
he sensed danger led to a puppy overlooking a peaceful terrain. Now, on
Card V, a rabbit using its wits by leaping quickly and agilely to save itself
was followed by a serene percept of a graceful ballerina calmly and freely
leaping. This calmness, however, was again transitory. The following
response represented a graceful dive, but on a probing association on
inquiry, Mr. L. confirmed the resurgence of threatened self-cohesion in his
comment about the diver’s being swallowed up. The incongruous furry rat,
hostile Oriental woman, and nuzzling elephants percepts, with their conno­
tations of closed-off affectional need, are also relevant in the present
context.
240 CHAPTER 8

Card VI
22. An insect coming out o f a co­ The wings. Freedom.
coon, trying to fly. (W)
<23. A man lying down. Along a The nose, arms raised, his legs.
pool of water. The image be­ [Association] Restful, peaceful,
ing reflected, too. (Dl) but he knows he shouldn't be be­
cause o f the rigidity o f the arm
extended. He's doing it but knows
he shouldn't be.
24. Two monkeys back to back. Just their bodies.
They're very happy. (Dl)
<25. A bird's nest. The heads of The nest is over here, and the
birds. Chirping, waiting to be birds are in it.
fed. (D4)
26. Two little boys, trying to The legs here, they're unable to
reach or grab something. get what they want on the coat
Their hands are extended up. rack.
Possibly from a coat rack.
One foot on the ground, one
foot up trying to reach what­
ever 's on the coat rack. (Dl)

Despite the rich productivity of Card VI, it revealed little new. The
significance of an insect emerging from a cocoon and attempting to fly is
familiar enough to clinicians, and hardly requires much discussion. In
consideration of the self psychological view of the emergence of an invigo­
rated self, it is useful only to point out that this self materializes through
transmuting internalizations in small increments, such as the percept of a
cocoon represents. Therefore, projective test imagery such as a cocoon is
misleading for an interpretation of genuinely firmed-up or stabilized self­
cohesion. There is little in Mr. L.’s record to suggest anything different. The
image’s appearance now was merely a hope or wish that a strengthened or
cohesive self might still develop.
The image of a cocoon developing wings may also express this patient’s
need for a reliable selfobject to help consolidate more than a fleeting sense of
self-cohesion. That Mr. L.’s last response on the previous card involved a diver
being swallowed up emphasizes how crucial this need had become. His
response certainly indicated nothing about feeling that he was close to
reconstituting self-esteem.
IDEALIZATION AND TWINSHIP 241

The following response was notable first for its indication about passiv­
ity. Moreover, this water scene captured the disparity between the theme of
peacefulness conveyed by the restful figure and the rigidity of the arm
position suggesting tension and distress. This incongruity is consistent with
several similar responses examined thus far in Mr. L.’s Rorschach record.
He seemed to grasp how little the serenity of the pool image indicated about
his internal self-experience. His comment about “he’s doing it but he
knows he shouldn’t be” may convey this experience.
Happy monkeys back to back, his next response, seemed relatively
innocuous and diagnostically noncontributory as well. This response was
followed by the bird’s nest with the young waiting to be fed, another passive
reference, with no further associative elaboration. Mr. L. seemed to want to
take a break on Card VI, to yield to passivity and to convey the impression
of not wanting to get too worked up or provoked by this Rorschach blot. At
the same time, he recognized that the picture of calm or peaceful images
did not reflect his actual internal state. His closing percept, describing two
little boys’ inability to get what they want, was in contrast to the nesting
birds being fed. This response suggested the association between passive
dependency and frustration of need, but it added little to what has already
been noted about the self state and predominant selfobject functions.

Card VII
27. Two little imps looking at The heads, hands, rear ends.
each other. Very mischievous. [Imps?] The shape of the face. [As­
Planning what to do to have sociation] Childish-like, fun.
some fun. (W) Devil-may-care. Sitting on rocks.
v28. Two women doing the Char­ The movement or positioning of the
leston. (D2) body. [Association] Devil-may-
care.
v29. A mother dog and two baby The head and body. Nuzzling one
dogs. (W) baby dog and the other one coming
toward her.
v30. Two dogs, pulling, tearing Instead of this as the mother from
some material. Fighting over before, it's like a washcloth or
it, pulling it apart. (W) something. They're tearing it. It's
not a whole anymore, it's being
torn.
242 CHAPTER 8

Playful imps may be a continuation of the childlike, mischievous re­

sponses from Card VI. That he also attributed a devil-may-care quality to
the imps, which he then repeated in the next response of two women
dancing, suggests that he desired to throw caution to the wind, to disengage
from responsibilities and adult cares, and generally to give in to a passive,
uninhibited, even hedonistic life. The passivity and dependency of being
cared for emerged most clearly in the percept of the mother dog with her
pups. This theme continued in his last response to this blot, the playful,
carefree activity of the puppies, which is as important as, if not more
important than, an interpretation based on oral aggression.
Some of Mr. L.’s previous responses on other cards may be understood
as clearly belonging with this aspect of the personality as it was now
emerging. For example, the hummingbirds drinking nectar from a flower
(Card II) suggested dependency and passivity, as did his references to the
abominable snowman on Card III as both powerful and soft, the elephants
nuzzling on Card II, and the free-flowing bodies on Card III.
Note, in addition, the contrasts in these responses, in which references to
vigorous images alternated with softer qualities. Thus, nuzzling and the
free-flowing furry rug made from a rat both appeared on Card II, and pre­
viously, the at-first gentle Oriental woman (Card I) was described as hostile.
Earlier in the protocol, when these responses were originally discussed, their
incongruous elements were noted but their meaning was uncertain. Perhaps
these elements indicated ambivalence or an aspect of the self starting to emerge
or break through. A crucial part of the remaining workup centers on the
question of why there appears to be, at this point, an apparent surge of passivity,
dependency, and a generally disinhibited attitude toward responsibilities and
concerns. The central underlying issue has to do with Mr. L.’s moving to this
position from one based on eliciting idealization selfobject needs.
Cards VI and VII have established an aspect of Mr. L.’s personality
previously only subtly foreshadowed, particularly in the context of his re­
sponses about danger, outsmarting malevolent forces, escaping to safety, and
being swallowed up or enveloped. In particular, the self psychological conno­
tations of the references to passivity and dependency of Cards VI and VII
became a major focus of the continuing investigation and analysis.

Card VIII
31. A group o f animals going in It's circular. They're all holding
circles, like ring-around-a- hands,
rosy. (W)
IDEALIZATION AND TWINSHIP 243

32. I'm blocking. Cow's heads. How they're shaped here. [Asso­
(D2) ciation] Milkyfood.
33. A rat. (Dl) The body, its shape.
34. A parrot. I can't find it now. [Association]
They're talkative, imitative. Stable
on his perch, staying in one place.
I also see two birds within a nest.
It's allfragmented, doesn't go
together.

Mr. L. experienced difficulty on this card, possibly because of the

introduction of the multiple colors. Most patients do not experience this
degree of distress on Card VIII. Indeed, some patients often seem to
welcome its introduction and spontaneously comment on the pleasant­
ness of the soft colors after the drab black-white-gray tones and the
blood-red color of the seven preceding blots. In view of the passivity
and dependency that emerged on Mr. L.’s responses to Cards VI and VII,
the soft, muted colors of Card VIII might have been expected to evoke
further passivity. Instead, Mr. L .’s opening response to Card VIII was
“going in circles,” which then gave way to his comment about blocking.
He proceeded to deliver a percept that he failed to locate on inquiry, and
his closing remark conveyed just how lost he was by this point. He
appeared to be in a state of distress. Presumably, the disequilibrium of
the self state, foretold earlier, now returned with great urgency.
This patient’s customary defensive operations eluded him because he never
reconstituted despite four responses to this blot, and he failed to recover his
composure. This pattern represents an example of a disintegration product,
even though it does not approach the severity of a transient psychotic lapse.
Nonetheless, the failure to achieve a stabilization of self-cohesion depicted a
self state characterized by the experience of feeling without an anchor. Mr. L.
attempted to hold onto his bearings, although with limited success. The
association to ring-around-a-rosy, a children’s game, leading to the passive-
dependent oral association of feeding linked to the percept of the cow’s
head, and the birds in the nest, all suggested a regressed quality in the midst
of his attempt to anchor himself by being “stable on his perch.” The signifi­
cance of the response of a rat in the midst of all this is unclear.
Of four responses to Card VIII, none produced a scoreable color code,
notwithstanding the administration procedure of eliciting associations on two
244 CHAPTER 8

of these four responses. Perhaps the color was destabilizing, and Mr. L.’s
avoidance of its mention represented his adaptive defense to minimize
the apparent distress that this blot provoked. Consistent with this inter­
pretation favoring a self-protective dampening down of disturbing affect
was Mr. L .’s description of the parrot as “stable on his perch” as an effort
to prevent an affective breakthrough. A quiescent parrot was preferable
to sudden eruptions of loud, angry squawking, not unlike the equivalent
of a pure C response.
Thus, the parrot was reined in, dampened down, and in control. In this
respect, from the standpoint of the psychology of the self, color (or its
notable absence) can be understood as a manifestation of a self state in
varying stages of cohesion. The optimal form-dominant (FC) response
might imply good or at least reasonable self-cohesion, whereas progres­
sively less stabilized degrees of self-cohesion or infirmity of the self might
be associated with the CF and C codes.
Absence of color might be understood as this patient’s attempt to find a
tolerable level of affective experience compatible with preserving optimal
self-cohesion. Avoidance of color could be understood as protecting a
vulnerable self state. Mr. L. might have too easily yielded to the overstimu­
lating pull of color by giving in to the less well-integrated CF and C
manifestations of color on the Rorschach blots. The price that he paid was
a damping down of affect, a process that drove the self into hiding, as it
were. This reaction resulted in a lack of enthusiasm or vigor and captured
the affective deadness or mechanical plodding through life seen in many
patients with prominent pathology of the self. In this view, the absence of
color does not signify the defensive withdrawal from drive states but the
self-protective attempt of an injured or vulnerable self to ensure whatever
degree of cohesiveness it can manage to preserve.
Mr. L.’s overall protocol has not been characterized by affective empti­
ness suggestive of depletion. The record revealed distancing from disrup­
tive affects threatening to undermine his attempt to preserve self-cohesion.
Being “stable on his perch” in the midst of a world that was “all fragmented”
was the best that this patient could manage. Responsiveness to color was
disruptive to his effort. This degree of minimization of color may also
suggest that Mr. L. experienced the selfobject environment around him as
unavailable or unresponsive to his needs and thus failing to serve as a source
of assistance to buttress a vulnerable self in the face of threat or disrepair.
Mr. L.’s breakdown or loss of composure on Card VIII needs to be
understood in the contexts of the emergence of the passive-dependent mani­
IDEALIZATION AND TWINSHIP 245

festations indicated on Cards VI and VII as well as the clinical picture of

the self and its selfobject needs that had characterized the protocol during
the first half of the Rorschach. I already noted that his responses to the early
blots showed his floundering around, feeling depreciated or underpowered.
He seemed to be searching for idealizing selfobject responsiveness to enable
the self to become invigorated or buoyant. Incongruous responses inter­
spersed with percepts characterizing a vulnerable self state created the
impression that Mr. L. was casting about at random to restore the needed
level of self-cohesion, however unresourceful these efforts appeared. He
sometimes found himself searching blind alleys and felt disconnected or
lost; the need to escape from potentially dangerous or misdirected object
choices never dissipated.
On Cards VI and VII, a shift or realignment of selfobject functions
emerged. He began to show a pronounced passive-dependent orientation,
possibly resulting from searching for what he needed but looked for in the
wrong places. From this viewpoint, the distress on Card VIII might be
understood as another indication that even his passive-dependent position
failed to sufficiently stabilize the self. Giving in to a regressive adaptation
characterized by passivity did not get him what he needed. Despite the risk
of overinterpreting the sequence of responses and associations seen on Card
VIII, Mr. L. apparently never managed to get beyond a position of “going
in circles” in seeking “milk ... food,” failing to “stay in one place,” and
feeling “it’s all fragmented, doesn’t go together.” He was attempting to
repair a self in disequilibrium by resorting to a wholesale regressive
dependency. From the standpoint of the psychology of the self, however,
the essential problem was the difficulty in relying on the selfobject respon­
siveness needed to buoy up an injured self state.

Card IX
<35. The color ’s hard to deal with. The father, with a moustache, nose,
A family. Thefather, sitting at the eyes. These objects make it look
the table eating dinner. He like he's not alone, but encom­
doesn 't seem happy, he seems passed by the other figures.
very tired and angry. (Dl +
D4 + area adjacent to D4 up
to the midline)
36. Animals grabbing a fish in A dog who grabbed itfor food. The
their mouth. (D12) image o f it looks like a reflection.
246 CHAPTER 8

v37. Two ladies having a conver­ The heads, pony tails, the bodies.
sation together, dressed to­ Standing nose to nose. [Nose to
tally alike. (W) nose?] That's why they're dressed
alike, like they're in some type of
disagreement, like “Why are you
wearing this same thing?" [Asso­
ciation: dressed alike] Imitation,
trying to be different and unable to
do so.
v38. An owl. Staring straight The white area with the shading.
ahead. (DS8) The eyes, the tail. [Association]
Wise, watchful. Just seeing every­
thing but being very watchful,
questioning. Being noncommittal.

As on Card VIII, there was a productive yield of four richly elaborated

responses to Card IX, despite the fact that it is the most difficult blot for
generating responses. Once again, none of the responses produced a score-
able color response, despite the well-embellished descriptions of the per­
cepts and the vigorous inquiry on two responses. His spontaneous comment
at the outset (“the color’s hard to deal with”) may indeed be telling, despite
this patient’s limited use of the color on Cards II and III.
Having noted that color is present, although difficult for him to integrate,
Mr. L. delivered, in effect, a portrait of his chief complaint in the apparent
form of a Rorschach response. In referring to himself as the unhappy, tired,
and angry father, Mr. L. described his self state of depletion. His use of the
term encompassed on inquiry should perhaps have been pursued; it is not
clear whether he meant to connote feeling encompassed in the sense of
embraced and included or surrounded and possibly intruded upon. The
dominant affect state, however, was not depicted as warm or inviting. The
selfobject environment in which he was most closely “encompassed” did
not invigorate the self. Instead, he felt depleted and worn down.
Wherever Mr. L. turned (reflected, coincidentally, in the frequent card
turning), he found more dissatisfaction in obtaining relief or selfobject
responsiveness from any source. In his second response of an animal
grabbing food, the grabbing is more psychologically salient than is the
reflection response, with its less relevant connotations of mirroring or
egocentricism. The animal apparently grabbed the food because it was not
easily available in a nonaggressive way; Mr. L. seemed to suggest that
one’s needs must be met aggressively or with force. Mr. L. did not
IDEALIZATION AND TWINSHIP 247

anticipate that his needs would simply be recognized as legitimate and

responded to. He must demand, struggle, or fight for all he got. His
selfobject milieu was therefore unresponsive and depriving and seems to
have turned its back on him.
By this point, he appeared to feel that there was nothing out there for
him to use to repair an infirm self and so he must grab for what he needed.
Grabbing is not seen by self psychologists, at least in Kohut’s view,
primarily as a manifestation of hostility or aggressiveness. The response
is understood as what the patient must do to secure a needed selfobject
function in the absence of an available or responsive selfobject.
This patient turned next to the figure of women dressed alike and in
disagreement. In this way, Mr. L. expressed friction in association with
similarity. It is tempting to consider that the similarity or “imitation”
referred to a twinship selfobject need; this interpretation might be the
case but equally plausibly might not. His association was derived from
a failed attempt to assert a difference (and by inference, autonomy), but
he had to resort to imitation. The similarity constituted an irritant, a
source of “disagreement” as the patient perceived the matter. Thus, the
similarity represented by the women’s style of dress does not sound like
the shared alikeness or mutuality of finding oneself allied in under­
standing. Rather than linking this response with the disappointment of a
twinship selfobject need, it is more prudent to regard this response of
imitation, ultimately leading to disagreement, as simply a further aspect
of the patient’s problem in locating a source of selfobject responsiveness
that he found restorative or enlivening.
Mr. L.’s final response to Card IX was that of an owl, seen in a stance
of vigilance and not committing to (or perhaps trusting) anything it saw
in the immediate surround. This response recalls the watchful dragon
percept of Card IV. The connotation is not that the world is unsafe, but
rather that the patient was cautious about judging who was friend or foe.
This position is appropriate after having been burned by a hurtful or,
more typically, disappointing selfobject environment. Once burned,
twice shy: Avoiding color, his caution after coming down from his “all
fragmented” experience of Card VIII, the sense that “color’s hard to deal
with” on Card IX, and now the worldly-wise and thus vigilant owl all
represent Mr. L.’s need to protect himself from the potentially disruptive
effects of a world that did not recognize or respond attentively to his
devitalized self-esteem.
248 CHAPTER 8

Card X
39. A king and his court. His sub­ The king, his cape like the King of
jects are looking at him. (W) Siam. The crown, his hair. All the
way around are his subjects. His
arms are outstretched. [Associa­
tion] Total control as if he'll grant
unto thee what he wants to grant
unto thee. Very powerful. Very
decadent and ostentatious. His sub­
jects are very plain and ordinary.
v40. A group o f sea horses. Fish swimming here, fast enough to
There's fis h swim m ing keep each one in its place. [Associa­
around them. Each one is tion] Nothing really. They also
separated by the fish as if carry around their young, protect­
they're captive. And crabs, ing its young.
but again I see things in iso­
lation, nothing together. Like
the crabs alone, the animals
alone, nothing together. (W)

Again, Mr. L. reported no scoreable color responses. His benevolent king

quickly turned into a “decadent” monarch concerned with dominating his
depreciated (“plain and ordinary”) subjects and watching them grovel for
whatever the king was willing to “grant unto thee.” This grandiosity was
little more than defensive bravado, especially as at this point in the protocol
Mr. L. saw himself as no grand figure. In view of his beginning on Card IX
with the devitalized father, Mr. L. may now on Card X be attempting to
continue his theme of needing to revitalize the self. The victory may be
hollow, however; the repair to self-esteem occurred by dominating others
so as to make them feel depreciated.
His association to the King of Siam should probably have been pursued
further; thus, it is not possible to know whether Mr. L. had in mind The
King and I as the basis for his association. Accordingly, one can not know
whether his association to the well-known gruffness and domination of the
king in that popular musical might also have contained a reference to the
king’s hidden, vulnerable inner nature.
Although this notion must remain speculative, the theme of strong-armed
control continued in Mr. L.’s next response to Card X, that of the larger and
potentially more powerful sea horses held captive by smaller fish surround­
ing them by swimming rapidly. He seemed to feel held captive by his own
IDEALIZATION AND TWINSHIP 249

family, represented here metaphorically as the smaller fish, who are pow­
erful enough in their resourcefulness to keep the sea horse immobilized.
Many parents do indeed feel just this way about their adolescent children,
particularly if the children are in trouble. Coupled with the need to be
“protecting its young,” this patient seemed to express here his own conflict
about asserting his control and being protective of his “subjects,” but
feeling undermined and impotent in the struggle.
In the end, he felt “in isolation” (like his monks of Card II); “nothing is
together.” Again, Mr. L. conveyed the self state of an injured, devitalized,
and immobilized man doing whatever he can to preserve self-cohesion. He
was “in isolation” in a selfobject environment that seemed to frustrate him,
and consequently, he experienced himself and his world as one in which
“nothing is together.” This isolation is not that of schizoid detachment.
The course of the Rorschach protocol shows the progressive devitaliza­
tion of the self. Beginning with two people on Card I attempting but
ultimately failing “in disagreement” to establish a viable self-selfobject
unit, Mr. L. came to the end of the protocol with a family in disarray, two
women “in some type of disagreement” over looking alike, and finally
feeling captive by his conflict between “protecting his young” and domi­
nating them in a powerful yet controlling manner.

Rorschach Synthesis and Clinical Discussion

This Rorschach protocol captures in rich detail the way that Mr. L. experi­
enced what happened to him psychologically and the way that he perceived
events intruding on the peace of mind he sought to preserve. I begin my
discussion of Mr. L.’s protocol with this phenomenologic statement be­
cause it directs attention to an important aspect of this patient’s psycho­
logical life. It lends itself to an investigation of selfobject functions as
conceptualized by self psychology. I attempt to maintain this focus on the
patient’s psychological experience of faltering self-cohesion as I proceed
to illustrate the technical aspects of the thematic analysis portrayal of the
devitalized self state. It is important to understand Mr L.’s attempt to
manage faulty mirroring by securing idealization and to some extent twin­
ship as part of his attempt to acquire a compensatory structure to repair the
injuries to self-esteem.
Mr. L. found himself adrift in a world that has stopped working right for
him. Over and over, he conveyed that wherever he turned, his efforts to
secure a stable or familiar anchor were thwarted. This perception was
250 CHAPTER 8

foreshadowed in his opening figure drawings, as his initial exuberant,

joyful anticipation quickly gave way to a mood of disquietude. He felt
drained by inadequacies, loss of control over his environment, and feeling
misunderstood. This basic theme persisted on the Rorschach as well.
The mood of a bubble bursting emerged at the outset on Card I, in which
the convivial dinner conversation turned to disagreement. The dance
around a maypole was spoiled when the person’s sadness prevented him
from enjoying the event. After the initial revival of joyful hopefulness, he
proceeded to experience the devitalization of a selfobject environment that
did not respond to his normal-enough animation. Thus, the downturned
head of the sad person dancing around the maypole was the dispirited,
devalued self that cannot hold its head up in a joyful or proud way. The
figure “doesn’t want to participate” because the self was depleted.
He delivered several more responses that added to the impression that
Mr. L. legitimately sought affection (no excessiveness comes through on
this Rorschach about what he seemed to ask for), but he encountered either
encumberances or disappointing outcomes. Thus, a furry rug was made
from a rat, birds in flight were escaping, and people appeared “free
flowing” but then stiff and formal. His references to segmented parts
showed that his search for contact far too often met with off-putting or
unavailable responsiveness.
These experiences provided the backdrop for what may be inferred as
insufficient mirroring. The evidence for the phenomenon is clear across
many Rorschach blots; the mirroring deficit is based on an empathic
understanding of how Mr. L. reacted to the disappointments of unresponsive
selfobjects. For example, a person who was diving was swallowed up (Card
V) and little boys grabbed for something they could not reach (Card VI).
Against this background, the examiner can begin to see and attempt to
understand that Mr. L. sought other selfobject functions to restore self-es­
teem. Mr. L. first indicated his needs, showed that they were ignored or
rebuffed, and turned to mobilize idealizing and twinship selfobject func­
tions to help fortify self-cohesion in the absence of adequate mirroring.
This differentiating among selfobject functions demonstrates that mir­
roring underlies almost all selfobject functions. Kohut pointed out that
deficient mirroring in early development may have been so extensively
asynchronous with a patient’s need for empathic responsiveness that it can
no longer be trusted as a reliable means for repairing injuries to a vulnerable
self. For Mr. L, its pervasive failure, easily seen throughout his projective
protocols, made it all the more important to identify other selfobject
IDEALIZATION AND TWINSHIP 251

functions to repair self-esteem and to secure what he hoped for to revitalize

self-cohesion.
Other routes, often in the form of compensatory structures, need to be
developed for that purpose, just as coronary bypass surgery secondarily
supplies sufficient arterial circulation to critically diminished regions of
heart muscle. In respect to projective testing, the identification of defective
mirroring does not imply that it is the only selfobject function present,
even though it is frequently the impetus for summoning forth idealization
and twinship functions. It is a starting point or a basic substrate that should
signify to examiners to look for compensatory structures.
Mirroring is sometimes the central or predominant selfobject need (as in
the case of Ms. T., despite her fleeting or halfhearted idealization attempts
that were quickly abandoned). Mr. L., in contrast, showed a generally
sustained effort to search for idealizing selfobject functions, compared to
Ms. T. Therefore, the response contents or elaborations of his Rorschach
percepts may point to other selfobject functions that were more central than
was mirroring. These alternative means to repair the self were compensa­
tory structures he attempted, albeit unsuccessfully when mirroring was too
unrevivable for that purpose. The evidence for idealization, particularly
during the first half of the Rorschach, is generally persuasive.
At certain times, Mr. L. turned to powerful, idealizable figures. At other
times, the imagery of several of his responses suggests that he turned to
companionate twinship selfobject functions for firming up the self when it
was undermined or vulnerable. The evidence indicating that idealizing
selfobject needs were mobilized is more compelling than that suggestive of
twinship selfobject needs. Relying on strong, powerful figures or seeking
to feel at one with others appeared at different times. Both selfobject
functions were intended to stave off devitalization of the self when the self
state was dominated by its vulnerability to injury, weakness, or inability to
sustain itself with sufficient and consistent vigor.
The most definitive statement about selfobject functions depicts the
extent and pervasiveness of the injured self state and typically points to an
absence or deficiency of mirroring. This fact appeared repeatedly and
consistently throughout Mr. L.’s protocol. Thus, the underlying mirroring
selfobject needs were almost always apparent. Neither idealization nor
twinship functions appear as clearly. They may alternate without one clearly
overshadowing the other, as the case of Mr. L. demonstrates. Therefore,
admixtures of selfobject functions are the norm; clear demarcations among
selfobject functions or textbook-style pure forms rarely occur. Pure forms
252 CHAPTER 8

also exist infrequently in life, and intensive treatment is also charac­

terized by admixtures of selfobject needs. Much of the work of psychodi­
agnostic testing centers on identifying these compensatory structures,
which must be strengthened in treatment.
As in the case of Ms. T., Mr. L.’s Rorschach record permits a comparison
between drive theory and self psychological viewpoints. Although neither
theoretical conceptualization is necessarily superior, the clinical material
still lends itself to several interpretive possibilities. For example, as early
as Card II, the response of “monks ... touching hands ... they’re in accord”
introduced the idea that this patient was looking for a calming function or
a degree of cooperative understanding. He was self-protectively cautious
of exposing his need; thus “they’re having fun.” Kohut considered that
people are cautious about expressing legitimate needs because of their
vulnerability to having these needs rebuffed. He did not regard the appear­
ance of defensiveness as a true defense (in the technical sense). Mr. L.
expressed the wish to feel buoyed up or connected with someone, out of
which the possibility of being understood might emerge.
Sidestepping the possibility of a defensive minimization of hostile
aggressive wishes that might be suggested by this response of monks on
this card, I have chosen to highlight instead Mr. L.’s expression of a wish
for contact or communion with a benevolent or soothing figure. A monk
also connotes someone more elevated or principled than the average
person. Monks are respected not so much because a person may turn to
them at times of need, but rather for their dedication to deep reflection
or contemplation. Their dedication occurs even at the cost of some
withdrawal from the rest of humanity. The percept of monks stands for
these characteristics and thus represents either an idealizing or twinship
selfobject function.
Examiners should not discount the possibility that a percept of monks
also connotes the wish to retreat into a protected existence, free of complex­
ity and problems. To some fearful schizoid personalities, such a percept can
represent a safe haven. This view, however, is not likely to apply to Mr. L.:
He wanted something from his life, not to turn his back on the world. The
reference to touching hands suggests seeking a connection in depth, in
which a merging based on similarity or commonality was desired. The
selfobject function might be one of twinship. Mr. L.’s responses of people
trying to engage in intimate conversation with one quieting the other (Card
I) and of elephants nuzzling (Card II) are somewhat consistent with an
interpretation of twinship selfobject needs.
IDEALIZATION AND TWINSHIP 253

The evidence is perhaps thin or at least equivocal, and is not adequate

enough to convincingly sustain this interpretation to every examiner’s
satisfaction. I am nevertheless discussing the twinship implications of
the monks response because the response demonstrates the distinctive
qualities of a level of psychological contact that is deeper or more
intimate than a casual interaction. A response such as monks is clearly
closer to the in-depth meaning of twinship as an intimate level of
understanding compared with a response such as people dressed alike
(Card IX) and its association about imitation (rather than depth of
involvement or understanding).
This quality of merging need not imply a boundary disturbance. Kohut
regarded merging as a normal need for being like or part of another, without
necessarily implying a severe loss of distance. Although he recognized that
prominent boundary disturbances involving merging could occur, the
merger associated with a twinship selfobject function was typically not of
this kind.
It is also possible that the percept of monks stands for a calming or
soothing presence without necessarily representing similarity of thinking
or feeling. In this case, idealization may be the basis for the selfobject
function in question. It is often difficult to make such a relatively precise
differential diagnosis or determination of specific selfobject functions from
Rorschach responses alone. Therefore, the projective test battery is almost
always essential for specifying distinct selfobject needs, even though the
Rorschach can readily reveal the existence and severity of the underlying
self states.
Two other noteworthy features about Mr. L.’s protocol deserving com­
ment are the manifestations of passivity and dependency, and the apparent
disruption of ego functions on Card VIII. Both characteristics are common
events on many Rorschach records. They are all the more interesting in the
present case because they afford an opportunity to conceptualize these
phenomena from the self psychological point of view. Thus, dependency
and passivity have their own unique psychological significance when
approached from the standpoint of the psychology of the self. Passivity
represents the failure of the self to sustain its buoyancy or autonomy:
Prominent dependency and passivity are reactions to being unresponded to,
injured, or chronically undermined. The patient has given up hope. This
state is not unlike a disintegration product such as rageful outbursts or
panic-like states, although certainly a far more subdued and barely notice­
able reaction in comparison to prominent anxiety or rage.
254 CHAPTER 8

Dependency of sufficient magnitude represents an excessive or patho­

logical breakdown of the capacity of an invigorated self to put itself
forward as firmly present or assured. Along with theorists from an ego
psychological or object relations position, one with a self psychological
framework also understands passive longings to be embedded in the char­
acter structure rather than being a symptomatic complaint. From the ego
psychological standpoint, however, dependency is considered either a de­
fense against aggression or an entrenched characterologic position marked
by prominent oral wishes.
Kohut did not apparently discuss dependency as a form of disintegration
or as a breakdown product such as rage, and he might not agree with this
conceptualization of passivity as dynamically similar in this respect.
Whether significant dependency or passivity can be considered in the same
light as aggression, and so represents a disintegration product, its dynamic
significance as a manifestation of a beaten-down or defeated self state is
not far off the mark.
The second feature I want to highlight is the self psychological attempt
to understand fragmentation phenomena as seen on the Rorschach. Of
course, patients can display varying degrees of fragmentation, ranging in
severity from acute psychosis to momentary lapses of clear or orderly
response production in otherwise well-compensated, relatively healthy
people. Mr. L. displayed a degree of severity on the better-adjusted side of
a midpoint of this continuum. This impression is based on the fact that his
difficulty on the Rorschach was not widespread across most of the blots
and his loss of composure remained generally circumscribed and well-con-
tained. His disorder is a good example of temporary fragmentation phenom­
ena of a nonpsychotic nature, often seen in outpatient adults with a
moderately intense self disorder. Mr. L.’s fragmentation began to appear on
Card VIII; thus its possible provocation by the color cannot be discounted.
Mr. L.’s fragmentation reflects a self state characterized by the failure to
maintain stabilization. By this point in the protocol, a nearly intolerable
tension state was evident, whether or not influenced by the introduction of
the multiple chromatic colors. The patient was practically unable to recon­
stitute throughout the entire sequence of responses to Card VIII. Card IX
was barely improved, and he finished the card with an owl staring straight
ahead, watchful and vigilant, at the cost of finding himself “noncommittal.”
Although he recovered and became “stable on his perch,” the repair he
settled for was to feel affectively shut down. He may have restored a
tolerable equilibrium to a self state “going in circles ... it’s all fragmented,
IDEALIZATION AND TWINSHIP 255

doesn’t go together,” but this state is not a restoration of a self charac­

terized by zest and vitality.
Mr. L.’s Rorschach protocol showed that even relatively modest degrees
of fragmentation of the self can be detected. His protocol was typical of
that in outpatients with symptomatic disturbances superimposed on a
chronic self disorder. Aspects of this protocol also resembled rapidly
reconstituting acute reactions that occur in disruptive states, including
psychoses. Rather than representing a breakdown of defense operations or
ego resiliency, fragmentation phenomena on the Rorschach may also be
understood as the reaction of a vulnerable self threatened by diminished
cohesion. This reaction represents disintegration states such as those that
Kohut identified. The absence or temporary empathic unavailability of a
restorative or calming selfobject environment is often implied by the
appearance of fragmentation. The experienced destabilization may be
exacerbated by the diminished selfobject responsiveness that accompa­
nies such states of distress.
Still another issue in this extended case example is the fact that the
testing of limits in expanded Rorschach inquiry was conducted so as to
encourage the production of fantasy material beyond the perceptual prob­
lem-solving task. Because the primary function (if not the only real func­
tion) of the inquiry often yields banal records, it is important to consider
the unique value of a rich, elaborative record such as that produced by Mr.
L. The issue is not one of productivity ; the number of responses that Mr. L.
produced was not influenced by the style of the subsequent inquiry. It is
even arguable whether the procedure of requesting associative elaborations
appreciably affected the resulting clinical interpretation because the asso­
ciation phase was richly elaborated to begin with.
The interpretation of the Rorschach material bearing on the self state
would almost surely have been elicited regardless of the administration
procedure. The multiple indications of depreciation and compromised
self-cohesion were sufficiently abundant in this record were an examiner
favorably disposed to attend to the content in that way. The basis for the
interpretations of Mr. L.’s unstable hold over his faltering selfobject world
would, however, only have been hinted at, but probably not fully clarified
without some additional associations. For example, consider the response
of the abominable snowman and Mr. L.’s wondering whether that creature
actually existed (Card IV), the person diving and being swallowed up (Card
V), the devil-may-care associations on Card VI, and the “stable on his
perch” comment on Card VIII.
256 CHAPTER 8

Thematic Apperception Test

Card 1.

That’s a young boy looking at his violin, very confused. He didn’t know what
to do with it because it’s broken. He thinks it through and decides to repair
it. He has to get glue and glue it together so no one would realize it was
damaged. [Led up?] He was playing around, it didn’t belong to him, and he
was too rough, so he broke off the top part. [How does he feel?] Puzzled and
unhappy. [Outcome?] He’s relieved. No one would find out.

Stories pertaining to the violin as broken and in need of repair are

somewhat less common, but Mr. L. continued the themes that characterized
his Rorschach and figure drawing protocols to this point. Thus, the broken
violin seems to represent the self in a state of disrepair. As on the
Rorschach, his initial reaction was one of confusion as he attempted to
understand why the violin was broken. By inference, this patient wondered
how he could reconstitute himself. The focus of his story is the injury and
his concern that it should be repaired.
The comments that he was confused and that the violin did not belong
to him need not be thought of as a derealization phenomenon. From the
viewpoint of the psychology of the self, they represent instead his affective
reaction to the experience of an injury to the self. He appeared perplexed at
this threat to the cohesiveness of the self; it did not “belong to him.” The
affective state of surprise represented the sudden or acute nature of the
recent disruption in his life, as if to say: “Is this really happening to me!”
This disruption in turn provoked, or more likely reactivated, the underlying
threat to self-cohesion.
It is tempting at this point to quote a comment from a recently published
lecture by Kohut. In explaining his ideas about the repair or restoration of
the self, Kohut (1996, p. 387) paraphrased a line from the play The Great
God Brown by Eugene O’Neill: “Man is born broken; he lives by mending.
The grace of God is glue.” Kohut noted that the characters in the O ’Neill
play wear masks; they sometimes wear one another’s masks, and they
become uncertain about their identities “so there’s a great uncertainty
about the cohesion of their selves” (Kohut, 1996, p. 387). In Mr. L.’s story
about the boy’s confusion over whether the violin was his, the metaphor
of glue in Kohut’s example from the O’Neill play provides a useful link to
understanding Mr. L.’s story to Card 1. The need for glue to repair the
broken instrument represented something vital and central to Mr. L.’s
IDEALIZATION AND TWINSHIP 257

disrupted self-cohesion, just as repairing faulty self-cohesion was the

core problem that required mending in the O’Neill example as reconcep­
tualized by Kohut.
The secrecy about the boy’s having damaged the violin seemed important
to Mr. L. It may be considered alongside his comment about the top part of
the instrument having broken off, as well as related material seen previously
on the Rorschach, notably on Card IV. In view of the phallic appearance of
the scroll of the violin, the references to wrongdoing and secretiveness could
very easily lend themselves to a drive theory interpretation centered on
oedipal concerns. In this view, clinicians may be persuaded to emphasize
the libidinal and aggressive aspects of the psychodynamic conflict. These
aspects also take into account the prominent defenses and the nature of the
resolution of the core conflict indicated by the response.
Before proceeding to present an alternative interpretation from self
psychology, I note that Kohut had not intended to discard or disparage
central tenets of the theory of the interplay of drives in ego psychology.
He did become increasingly convinced, however, that the traditional
oedipal interpretations were not useful clinically in understanding and
treating not only the self disorders themselves, but disorders based largely
on neurotic conflict.
Rather than emphasizing the conflictual interplay of competing drive
states, Kohut focused his attention on the devaluation of self-esteem which
young children may undergo while experiencing oedipal urges. This de­
valuation can occur if parents fail to recognize a child’s healthy libidinal
and assertive steps at this period of development. In chapter 2 ,1 mentioned
that oedipal children feel that their longings are unwelcome and shameful.
Ultimately, their basically healthy wishes for admiration are driven under­
ground rather than coming forward with vitality as a developmental step
toward affectionate intimacy or sensual closeness.
What bearing does this reiterated reconceptualization of the oedipal
situation have on Card 1 of the TAT? The answer may lie in the boy’s
concern about keeping his “wrongdoing” a secret. The violin was not his,
and he had to cover up the fact that he broke it; he hoped that the repair
conceals his damage. The need for secrecy, therefore, may not represent the
patient’s fear of wrongdoing, superego guilt, and punishment. Rather, his
concern may center on his need to protect the self from the criticism he
anticipated at being found out. Mr. L. is worried that whatever he did to
damage the violin was not understood, and an empathic failure precipitates
a fall in self-esteem. The boy was actually resourceful in trying to repair
258 CHAPTER 8

the violin, but he cannot feel pride in making the repair because he was
intent on concealing what he felt was misunderstood as wrongdoing.
The self psychological view of Mr. L .’s story to Card 1 recast the
oedipal theme as a concern that more or less normal inquisitive or
exploratory urges may go awry. He needed to summon the resourceful­
ness to quietly restore the situation to normal by himself. Most important,
this patient felt that others failed to understand his wishes and faulted
him for them or in some manner showed displeasure toward him.

Card 2.

An everyday occurrence on a farm. A mother and father working in the field,

the daughter is going to school. The mother is dreaming about the possibility
of selling the farm. She's rugged, dowdy, thinking about going off to the city
where her life would not be as difficult. [Difficult?] No hard labor, the hours.
She's worked hard all her life. [Father?] He's nebulous. No feeling that it's a
part of everyday life, it's daily routine. [Daughter?] Uncaring. Although
nostalgic, but she's accepted her whole lot in life. [Lot in life?] To grow up like
mama. To be a part of the same thing. [Her relationship with mother?] One
of pity. This is her mother's lot in life, but she pities her. [Mother's relationship
with daughter?] Total isolation. No contact. She knows what her daughter
thinks about her, but she ignores it. [Father's relationship with daughter?] Nil.
He's unaware of the daughter. The family's in total isolation, each one has
their own life.

Mr. L. returned here to the theme of a disjointed, indifferent family. His

response was reminiscent of his initial response to Card IX of the Rorschach
and his elaboration on the drawing of a female. By now, all these
depictions of the family engaged together created the clear impression
of people who went their own way and showed little or no concern for
one another. Most tellingly, this family appeared to represent a selfobject
environment deficient in the capacity for empathic understanding. The
patient experienced life in the family as lacking even a basic awareness
that some recognition of need was in order when someone was in a state
of disequilibrium. In this TAT story, the father was practically not a part
of the fam ily at all, at least p sychologically. M oreover, the
mother-daughter relationship could hardly be imagined to be any more
remote or indifferent than that represented here.
As with both figure drawings and many of Mr. L.’s Rorschach re­
sponses, the initial indications of hopefulness quickly receded to reveal
an undercurrent of depression characterized by a lack of enthusiasm. For
IDEALIZATION AND TWINSHIP 259

example, Mr. L.’s first drawing was that of a young man stimulated by
nature, and Card I of the Rorschach began with the pub-like atmosphere for
a congenial talk, leading up to two figures dancing around a maypole.
These responses soon became dominated by the emerging need of pro­
tecting self-esteem. These enthusiastic openings very shortly dampened
down, to be replaced by feelings of being misunderstood and having to
surmount obstacles. On the previous TAT card, the boy of Card 1 was
able to repair the violin and was “puzzled and unhappy”; his sense of
relief came only from escaping detection rather than from satisfaction.
Now, on Card 2, people accepted their lot in life, ignored one another’s
needs, and existed in “total isolation.” The emptiness and devitalization
were certainly palpable, but so too was the glimmer of what Mr. L.
needed in selfobject responsiveness to find some way out of his dilemma.
Like his monks of Card II, Mr. L. did not seek an isolated existence apart
from a selfobject milieu; rather, he asked only that his environment
should be responsive to his mirroring and idealization needs.
That mirroring has been deficient or undermined was rather evident
by this point, but how Mr. L. attempted to get what he needed to sustain
self-cohesion was not entirely clear. It is important to determine whether
stable compensatory structures became established or whether idealiza­
tion or twinship were viable alternatives to restore his self-esteem. It is
critical to see how the selfobject environment materialized for him as
the TAT continued, in view of indications from the Rorschach about
tentative attempts to secure either idealization or twinship selfobject
functions.

Card 3BM.

A young person, female I believe. Some tragedy just happened. She’s totally
distraught, not knowing what to do. A solution wont be found. [Led up?] A
death. Her husband. [How does she feel?] Distraught, she doesn’t know what
to do next. uHow can I take over, everything’s unmanageable.”[Outcome?]
She picks up after awhile and life goes on. She fits the pieces of her life back
together and possibly remarries.

After the initial reaction to the inability to find a solution, the patient
showed a capacity to regain composure. This resourcefulness was seen
previously, most tellingly following Card VIII on the Rorschach. Moreover,
the figure on Card 3BM recovered from a state of distress by herself, without
any indication that a particular selfobject function was involved in the
260 CHAPTER 8

repair of the self state. The memory of the deceased husband or the prospect
of a remarriage was not compelling enough here to form the basis for a
potential selfobject function. Even a memory might qualify, because as
Kohut emphasized, a selfobject is not synonymous with a person; it is the
function of the object that is crucial, whether or not it takes the form of an
existing person. No one was available or remembered or sought to help the
person. Rather, the person was left alone with her despair.
In a similar fashion, on Card 2, all the figures went their own way,
oblivious to and unconcerned about one another. Previously, on Card 1,
the boy who broke the violin was left to his own devices to find a way
out of his dilemma. Mr. L. seemed to go it alone, but not from a
masochistic need or feeling of unworthiness. Instead, this patient did not
expect someone to become available to whom he could turn to bolster
self-esteem. By itself, this indicates some measure of resiliency or
self-sufficiency and suggests what might be a psychological asset. In a
self psychological view, this apparent strength was simultaneously a
liability insofar as it indicates that the patient existed in a less-than-op-
timal selfobject environment. Why did the patient present a picture of
“toughing it out” of this magnitude?
One answer to this question is derived from the advantage of a test
battery in which findings across several tests combine to highlight a
fuller picture of the personality compared to isolated aspects on single
test measures. Thus, one knows from Mr. L .’s Rorschach that he with­
drew from reaching out to his selfobject environment when he experienced
disappointment or empathic failure. As a result, he felt alone too often with
his own distress to risk seeking self-restorative selfobjects.
As with the dragon sniffing danger (on Card IV from the Rorschach)
when he reduced a powerful image to one that is itself threatened and needs
to protect itself, Cards 3BM and 1 of the TAT showed Mr. L. left to his own
devices to find his way out of difficult straits. The dragon on Card IV was
followed by a boy needing to outsmart a giant to protect himself from
potential harm; on TAT Card 1, the boy thought of a solution by gluing the
broken violin himself; on Card 3BM, the despondent figure also reconsti­
tuted by fitting the pieces of her life together on her own.
Mr. L. seemed to indicate that he has managed to rebuild self-cohesion
by either gluing broken pieces or by slowly fitting pieces of a shattered
life together. Thus, the violin of Card 1 and the distraught situation on
Card 3BM represented an injured and diminished self state. One pathway
to repair was through idealization or twinship, as noted previously from
IDEALIZATION AND TWINSHIP 261

this patient’s Rorschach. Failing at that, Mr. L. had to pull himself up by

the bootstraps.
The affective tone of Card 3BM, understood now in this context,
reflected less the restored self-cohesion resulting from a responsive sel­
fobject environment than a defensively self-sufficient external portrayal
of himself to the world. This patient’s response to Card 3BM was notable
not for its indication of resilience, but for the way Mr. L. shut out his need
for empathic responsiveness to recover from the despair he described on
the card. Perhaps his somewhat arch comment at the outset (“a young
person, female I believe”) was another indication of minimizing or dis­
tancing himself from affective involvement. The subtlety lies in what was
concealed or not said rather than in the superficial story outcome of
rebuilding or of carrying on. In O’Neill’s metaphor for repairing a damaged
self state, “the grace of God is glue” adheres much more durably when
there is an affectively responsive or empathic selfobject environment
behind it to back it up.
I have already pointed out that on all three cards examined thus far, the
principal figures had to resolve their problems by themselves. The boy of
Card 1 was mostly concerned with avoiding the shame or criticism of being
discovered at fault. There is no indication that he turned to anyone for
assistance. On Card 2, all the figures went about the unsatisfying business
of their lives in isolation from each other. They acted as if their existence
depended on turning their backs to their affective states, including the anger
or disappointment they felt toward one another as unresponsive selfobjects.
Now, on Card 3BM, a figure was in great distress and had experienced a
major loss. Once again, the person was alone with the depleted affect state and
compromised self-cohesion. There was nowhere to turn to attempt to restore
self-esteem. The person was left with only the empty sentiment similar to
saying “get on with your life,” which people invariably experience as little
more than dismissive or unempathic and ultimately nontherapeutic. This state
of affairs appears to be the affective picture that Mr. L. conveyed about his life
and the state of his injured and depleted self. The TAT captured this picture in
his interpersonal life, and more important still, internally in depth, as well as
extending what was already seen on Mr. L.’s Rorschach.

Card 4.

A woman is trying to hold her husband back from fighting a person who
insulted her. She tried to do it through reason, but reason’s no longer there.
262 CHAPTER 8

He’s too angry. [Outcome?] He breaks loose and ends up in a big brawl, but
he comes out on top.

On Card 4, for the first time thus far, one figure depicted in the picture
appeared willing to come to the aid of another. The paradox, however, was
that the woman whose honor was being defended was unable to make a
sufficient psychological impact on her protector because “reason’s no
longer there.” This response is not appreciably different from Mr. L.’s
response to Rorschach Card I in which two people tried to talk in a congenial
atmosphere but ended in disagreement. Card 4 resembles other Rorschach
responses, notably the family with the tired and angry father (Card IX), two
ladies in conversation but also in disagreement (Card IX), and the decadent
and ostentatious king surveying his subjects (Card X). As Mr. L. developed
his story to Card 4, it became evident that the woman was quickly forgotten
and receded into the background, whereas the man was consumed by anger,
unreasonableness, and the need to be victorious.
It is difficult to know whether the figure representing the central object
of identification for Mr. L. was the woman whose needs were ignored or
the man whose needs for winning were central. People were not seen as on
his side or acting truly out of concern for his best interest. Previously, on
Card 2, other people were indifferent, if not actually withholding; on Cards
1 and 3BM, other people were unavailable or unempathically responsive.
Mr. L.’s story to Card 4 again showed that he expected little beneficial
concern from others. Even the appearance of coming to his aid was not, in
the long run, truly real or genuinely expressed for him. As conceptualized
in the self psychological framework, Mr. L.’s response revealed a self
experience in which he was ignored. Those selfobject functions, such as
mirroring or idealization, that could help a flagging self, ultimately disap­
pointed because they fail to take account of what he needed to restore
self-cohesion, submerged as they were by others’ needs for power, vindi­
cation, or “coming out on top.”

Card 6BM.

A woman is thinking about something. The man is an investigator who just

told the woman her son was killed trying to commit a crime. The mother’s
staring out thinking about what ways she went wrong. [Relationship with
son?] It’s very close yet she really didn’t know her son. Very protective,
nurturing. [Didn’t know her son?] He never let her. He’d hurt her if he did.
There’s differences in values or ideals.
IDEALIZATION AND TWINSHIP 263

The woman’s first concern was her own failure that contributed to the
son’s wayward behavior. A picture of estrangement was emphasized remi­
niscent of the family scene of Card 2. Although the mother was not depicted
as indifferent to the son’s death, neither was her concern the central
emphasis of Mr. L.’s story. The mother asked what she did wrong and
conveyed herself as being nurturant, but the tone of the story suggests that
the problem lay with the son who did not permit the mother to know him
intimately. Once again, the focus is on protecting her self-esteem, just as
the man of Card 4 was more concerned about his self-esteem in “coming
out on top” rather than about protecting the woman.
Did Mr. L. function in a world in which he saw others as too self-absorbed
to notice him, or was he himself so greatly in need of protecting his own
self-esteem that he has little interest in others? An examiner can identify a
need or feeling state, but cannot always tell whether the need is either
experienced internally or externalized in the form of a projection. The
question is fundamental to the clinical workup of psychodiagnostic testing,
regardless of the theoretical persuasion that any examiner brings to the
interpretation of this material. This element of interpretation has been
stressed by Schafer (1954), Schachtel (1966), and P. M. Lerner (1991).
Regardless of the uncertainty about the answer to this question, the
indications in the clinical material of being unresponded to, ignored, or
depreciated frequently convey salient features about the patient’s self-es­
teem. In the example at hand, one can at best guess at Mr. L.’s capacity for
interest in others, but it is possible to conclude that he very much feels
himself to be ignored or forgotten about.
It is perhaps no accident that references to protective nurturing appear
more directly on Card 6BM than on the previous TAT cards; maternal
responsiveness was strongly evoked on this card. Mr. L. seemed to be
dispassionately wondering aloud: Where did the maternal care go wrong,
or where was it lacking? The theme of the death of a child is powerful,
rarely portrayed more vividly than in Mahler’s Kindertotenlieder, his
setting of haunting elegies to dead children. This extremely rare theme on
Card 6BM is even more gripping than the story about the death of the
husband on Card 3BM, which was dealt with nonchalantly. Granted such a
powerful theme, what is it about a mother who sees herself as nurturant that
leads a child to turn away to the extent that there appears to be so little
internalization of the mother? On Card 6BM, the story ended simply with
the comment about the difference in values between the mother and son and
264 CHAPTER 8

how their lives diverged as a result. This remark is defensive, of course, but
also affectively distanced.
The story outcome recalls the key dynamic of Mr. L.’s story to Card 2,
most notably the marked deficiency of mirroring selfobject responsive­
ness. As with Card 2 and the ensuing TAT responses, the central issue is not
so much the question about defective mirroring but about the potential for
compensatory structure, such as idealization or twinship, to take over as a
viable pathway for repairing and restoring self-esteem.

Card 7BM.

A young man totally rejecting the opinion of his father who is very stem, hard,
and very rigid, uncaring. [Led up?] They never saw or understood each other.
No real interaction. The boy turned his back on his father. [Outcome?] The
father dies, and the son goes his own way. [Why a rift?] The father didn't
have time for his son. He has no concern. He never wanted children.

It is not difficult to see that this father-son relationship was fundamen­

tally characterized by callous disregard. If the family represented on Card
2 could be viewed as ambivalent at best, there can be little doubt that the
near-total indifference on the part of both father and son pictured here
revealed an unusual degree of mutual rejection. The appearance of disin­
terest might obscure deeply submerged longings and the ensuing anger at
their frustration, which could only be guessed at from the available
material. It is nevertheless difficult to imagine that the son missed anything
from what was experienced as an unresponsive and indifferent parent.
The appearance of an unavailable object is more than just an absent
person or an underdeveloped psychological function. From the stand­
point of psychoanalytic self psychology, a deficiency represents a prob­
lematic threat to self-cohesion. It can appear in the form of interfering
with the development of a selfobject function as a primary psychological
structure, notably idealization in the case of a paternal relationship.
Alternatively, a self disorder may be characterized by interrupting the
formation of compensatory structures to strengthen other defective sec­
tors of the self.
It is not possible to determine with certainty which of these instances
applies to the state of Mr. L.’s self-cohesion or to his need for available
selfobject functions. There is good evidence that defective mirroring com­
promised this patient’s attempts to acquire either idealization or twinship
IDEALIZATION AND TWINSHIP 265

as compensatory structures. This conclusion is clearly noted from the

Rorschach protocol, which revealed that his attempts at idealization, and
possibly even twinship, ultimately failed to provide the adequate “glue” he
needed to buoy flagging self-cohesion. Mr. L.’s difficulty in solidifying
idealization as a means for repairing self-esteem may be understood further
in light of what was revealed on Card 7BM. On this card, an impoverished
paternal relationship undermined any potential strengthening that might
otherwise have provided for solidifying viable selfobject functions.

Card 12M.

A woman just died. A priest comes to give her the last rites. She died alone,
with no one around her. The priest was her only friend.

Mr. L.’s story to Card 12M was atypical. Usually, a man is said to be lying
on a bed, and the intention of the figure hovering above becomes the focus
of the story. Here, the figure was mistaken for a woman, and instead of being
ill or asleep, as customarily, the woman was dead. The priest represented the
“psychological oxygen” needed to revive a depleted self, if it is understood
that the figure of the dead person stood for a self in a state of devitalization.
The image of a priest giving last rites recalled Mr. L.’s Rorschach percept of
monks touching hands, from Card II.
Here the priest was cast in the role of supreme comforter. This percept
contrasted with the benign communing of the withdrawn monks, an order
characterized by extreme self-denial and turning away from the world.
Although not quite the same as a savior, here the implication was that the
potentially idealizable priest could not revive the dying person. This pa­
tient’s attempts at idealization or twinship as seen on the Rorschach
became too undependable to adequately do the job.
In some respects, therefore, Card 12M may be viewed as a continuation
of Cards 6BM and 7BM. On Card 6BM, the son has died and the mother
was turned away from; on Card 7BM, the father was emotionally indifferent
and unavailable for genuine responsiveness. Now, on Card 12M, the figure
died alone and without support; her only comfort arrived too late.
The stories for these three cards considered in succession suggest that
the self lacked adequate mirroring of the need to be seen as valued,
important, or as a source of pleasure. The mother of Card 6BM was a figure
who turned away from the unmirrored self, as if to say “You are not my
child; your values are alien to me.” Subsequently, an attempt to revitalize
266 CHAPTER 8

the self through some other potential selfobject function, such as idealiza­
tion or twinship, was spurned by the father of Card 7BM who showed no
interest or availability for that purpose. Thus, the possibility of the father’s
serving a protective or revitalizing selfobject function was virtually oblit­
erated. Accordingly, there was little hope of restoring self-esteem by
developing a viable compensatory structure. As a result, the self was left in
a devitalized state, in effect bereft and dying as on Card 12M, with its only
means of sustaining itself too late to the rescue.
On Mr. L.’s Rorschach, the hope for idealization or twinship as a
means to sustain flagging self-cohesion ultimately became too unreli­
able. This state gave rise to the passivity and “going in circles” that
emerged there. Modestly reconstituting the self allowed him to hold his
own, “stable on his perch,” albeit at some cost to firmly secured self-co-
hesion. It may be anticipated that Mr. L. will find a way to emerge from
the bleak picture of a self in ruin, because this capability was previously
detected on the Rorschach.

Card 13MF.

After making love, a man realized that in the act of love he killed her. He is
totally distraught in what he did, and the passions that led up to it. So he kills
himself.

Mr. L. seemed to say here that strong passions or needs can, in effect,
kill. It is well known that Card 13MF is an emotionally provocative card
for all but the most affectively distanced individuals. That Mr. L. could find
a way for the mother to emotionally wall off the death of her son on Card
6BM points to this patient’s adept way of keeping emotions in check. The
same emotional distance appeared in the marked coldness in Mr. L.’s story
on Card 7BM about a father-son relationship. There, he managed to change
lack of support and emotional indifference to a near virtue, as he did earlier
on Card 2. Now, on Card 13MF, the stimulus may be too overpowering and
may cost him more effort to withdraw affectively. He seemed able to
accomplish this withdrawal only by killing himself off. It is really the
intensity of his affective arousal that was killed off or obliterated.
These responses alongside the passivity and affective flattening seen on
his Rorschach protocol indicate that Mr. L. needed to go to great lengths to
keep himself “stable on his perch.” The self psychological implication,
however, of this degree of emotional withdrawal is that this man was left
IDEALIZATION AND TWINSHIP 267

with a self state that was killed off or driven underground. There seem to
be few real available selfobject functions for him to draw on to sustain a
cohesive self without having to dampen it down to this extent.

Card 18GF.

A mother nurturing her child who's been hurt by falling down the stairs.

At first glance, this response seems to be unexpected, but it is not so

surprising if it is a revival of something that Mr. L. had been looking for all
along: Mr. L. had experienced an injury and wanted to be responded to by
someone who noticed that he has been hurt and that his need for attention
was reasonable and understandable. Only when such normal needs go
unattended do self disorders begin to emerge, at least in Kohut’s view about
how pathology of the self destabilizes normal developmental urges. Card
18GF is a simple expression of exactly this point, and in its simplicity, it
expresses all that a self in a state of injury requires to be sustained.
The selfobject function was clearly stated as well: When the self is
threatened, all that is required is that its vulnerability should be recognized
and responded to empathically, that is, in the more or less normal way that
most people expect to be responded to when undermined. In his simple
story to Card 18GF, Mr. L. said that when a child is hurt, someone must
step forward to tend to the injured child.
This very simple, direct statement shows how patients find a way to tell
us just exactly what they need. In view of all that has preceded this response,
the message of Card 18GF needs only to be listened to at face value and
understood for what it is worth. To reiterate a deceptively simple statement
made by Kohut (1996, p. 208):

From very early on, what a child needs is empathic responses to him as a
self (or at least as an anticipated self). Not to his drives. Every time a mother
gives milk to the baby, she is feeding her hungry child—she is not feeding
a drive. A mother, an empathic mother, an empathic mothering environ­
ment never responds to a drive; it responds to a child.

Discussion of Mr. L.
This patient presented for treatment with a depressive syndrome clinically
similar to that of Ms. T. The chief complaint and mental status findings
revealed a comparable degree of severity of symptomatic distress. The
268 CHAPTER 8

precipitant was more identifiable in Mr. L.’s case and, in addition, he had a
somewhat more favorable premorbid psychosocial adjustment in compari­
son to Ms. T. In generally similar clinical syndromes of comparable severity,
the productive responses that these two patients gave illustrate similarities
and differences in psychodynamic makeup. Both cases illustrate that a self
psychological viewpoint may be applied to projective test interpretation as
an alternative to classical drive theory or ego psychological theory.
Devalued self-esteem with ensuing disruption of cohesiveness of the self
was a prominent feature throughout the projective test protocols. The ways
that these patients attempted to repair a devitalized self centered on the
differential capacity to make use of selfobject functions of idealization or
twinship. These selfobject functions operate as potential compensatory
structures to assist in recovery from a self disorder. They represent alterna­
tive pathways to repair self-esteem in the face of pathogenic unempathic
responsiveness to normal mirroring needs.
Whether or not one follows a self psychological theoretical position as
a basis for interpretation, it is not difficult to see that Mr. L. experienced
almost constant rebuffs or disappointment wherever he turned. One dis­
tinctive contribution of self psychology to understanding the experiences
of a patient like Mr. L. follows from the theory’s emphasis on empathic
failure or unresponsiveness leading to feeling undermined and devitalized.
Diminished or devalued self-cohesion was the basis for Mr. L.’s depression.
It is not difficult to discern how this mechanism operates from the
content analysis of Mr. L.’s projective test responses.
I previously pointed out that several of Mr. L.’s projective test responses
could be conceptualized from the standpoint of an ego psychological
approach to drive theory. In particular, defensive and adaptive aspects of
oedipal dynamics are clear from the patient’s references to strong, overpow­
ering figures on Card IV on the Rorschach, for example, and from his
preoccupation with secrecy on TAT Card 1. Even the oral wishes previously
noted after Mr. L.’s breakdown on the last chromatic cards on the Rorschach
could be viewed as an oedipal regression. I have attempted to show in my
discussion of this material, however, that the same themes may be concep­
tualized from the viewpoint of Kohut’s psychology of the self, specifically,
the relation between the oedipal situation and devitalization of the self.
Kohut thought that oedipal children expect parents to admire or affirm
them; the children’s desires are not primarily drive dominated or sexualized.
If a parent of the opposite sex is capable of resonating with the child’s wish
for acknowledgment in an empathically attuned way, the experience echoes
IDEALIZATION AND TWINSHIP 269

or mirrors the child’s primary need. If the parent is unable to provide this
response to the oedipal child’s essentially normal developmental assertive
or prideful urges on a regular basis, the child again and again is re-exposed
to the empathic failures of the unresponsive parent. This experience inter­
rupts maintaining a buoyant or joyfully expectant self and sets the stage for
chronic injury to self-cohesion. This experience forms the substrate for
diminished self-esteem and predisposes to a self disorder, and as a result,
the child may feel crushed or insignificant. This process is evident in the
sequence of Mr. L.’s anticipation of a welcoming or exuberant response,
which is then followed by confusion, disappointment, and the sense that the
bottom has dropped out. This feature is more telling than the more usual
interpretation of oedipal material.
For example, the design of Card IV was initially elaborated as powerful
and vigorous, but this response was soon undermined and ultimately
became linked with danger. Some caution is necessary before one assumes
that the towering percepts on Card IV represent a disguised oedipal conflict.
In a similar fashion, an interpretation of superego conflict might be pre­
ferred on the basis of phallic-oedipal wishes, such as those suggested on
TAT Card 1 by the broken instrument and the need for secrecy. A genetic
reconstruction based on the oedipal situation is not even uncritically ac­
cepted as a necessary or universal psychodynamic configuration in con­
temporary psychoanalysis.
Without attempting to argue the issue of the fate of the oedipal situation
in psychoanalytic theory, I want to point out that although some clinicians
interpret contents about simultaneously threatening and powerful phallic-
sounding imagery, wrongdoing, or the need for secrecy as derived from
oedipal dynamics, these same contents might also be conceptualized from
a self psychological interpretation of the oedipal situation. Feelings of
shame, smallness, or the inability to stand up for oneself may result from
parents’ inability to enjoy or applaud an oedipal child’s assertive urges,
perhaps because of the parents’ empathic limitations, depression, or vulner­
ability to feeling threatened by assertion. Thus, reactions of devitalization
and depletion depression may be what an oedipal child is left with after his
or her developmentally appropriate stirrings are misunderstood, criticized,
or otherwise undermined. As a result, feelings of wrongdoing or secrecy
might represent what is more accurately the shame or humiliation of
someone who is made to feel insignificant or worthless.
The more important question, however, centers on Mr. L.’s attempts to
repair frequent rebuffs to self-esteem. What did this patient attempt to effect
270 CHAPTER 8

in his world and with others to recover from the injuries to the self?
Identifying the interplay between available selfobject functions and com­
pensatory structures is one way to answer this question.
This approach is not that different from the ego psychological approach
that conceptualizes defenses as attempts to protect the person from anxiety
resulting from superego conflict related to drive discharge. The psychologi­
cal objective for adaptation may differ in the ego psychological and self
psychological viewpoints, in which either the self-reparative or defensive
function becomes a primary focus of the diagnostic study. In the ego
psychological framework, the emphasis is on the identification of defenses
and evaluating their effectiveness or resiliency. From the point of view of
the psychology of the self, the question becomes one of identifying selfob­
ject functions in the service of restoring self-esteem.
This central question forms the basis for the balance of my discussion
about Mr. L. The essential feature of this patient’s self disorder began with
his attempt to turn to others with the expectation of being responded to;
instead, his efforts were ignored. Mr. L. saw himself like the disjointed
family members of Card 2 on the TAT; they went their own ways, unaware
of and unconcerned about one another. As on Cards 1 and 3BM, Mr. L. had
to make his way through life under his own power. He must pick up the
pieces of emotional disarray in whatever way he can and with little antici­
pation of emotional support.
It was difficult for Mr. L. to depend on a selfobject environment to
provide affirming or empathic recognition when he was injured. He could
not expect to receive admiration for his accomplishments or attributes in a
reliably empathic manner. Consequently, mirroring selfobject functions
were driven underground. The hints of budding mirroring longings are best
understood as tentative attempts to secure this function, but these are at
best fragments or glimmers of a selfobject need probably long abandoned.
Any vestiges of mirroring selfobject needs are best construed as remnants
of, or undermined efforts to achieve, sustained mirroring. These needs
were not an established or viable part of Mr. L.’s psychological orientation
to the world.
This fact clearly appeared on the first Rorschach card. After the initial
revival of joyous hopefulness, there followed the re-emergence of the
devitalization he evidently experienced at the hands of a selfobject environ­
ment that failed to respond to his animation. Thus, his needs were unmet
and were empathically misunderstood. For the same reason, the boy of Card
IDEALIZATION AND TWINSHIP 271

1 on the TAT never turned elsewhere for guidance or direction; he had only
his own resources to rely on to find a way out of his dilemma.
Against this backdrop of insufficient mirroring perpetuating a devalued
self, one sees the attempt to seek other selfobject functions to restore
self-esteem. Thus, Mr. L. first indicated his needs, the ways that these were
ignored or rebuffed, and his feeling that mirroring selfobject responsiveness
was not there for him. He conveyed that his attempts to achieve idealization
and twinship selfobject functions might help him fortify self-cohesion in
the absence of adequate mirroring. At first, he invoked images that provided
either a calming function or a degree of cooperative understanding. In this
way, Mr. L. expressed the wish to feel buoyed up or connected with
someone, out of which the possibility of being understood might emerge.
The patient’s urgent wish to feel himself psychologically enlivened
repeatedly met with frustration or rebuffs from the selfobject environ­
ment as seen most clearly on the early Rorschach blots. He continued to
turn to potentially strong, idealizable figures as well as to figures
providing a companionate function, and mirroring selfobjects appeared
as a distant memory from which he has withdrawn. Their chronic failure
to operate reliably led Mr. L. to instead attempt to secure idealization
and twinship selfobject functions that have evidently not become so
totally shut off for him.
His effort was an uphill struggle, and he turned hopefully to idealization
and twinship selfobjects, but had to retreat from these as well. Mr. L. did
not, however, abandon the possibility that either twinship or idealization
could serve as potential routes to repairing the devitalized self state. And
so it went, beginning with Card II and oscillating back and forth in this way
until at least Card VIII.
This process is the way by which, if successful, compensatory structure
is built up, as an alternative pathway to sustaining a cohesive self that is
injured or whose stability becomes compromised. This point is also the most
critical difference between Mr. L. and Ms. T. Unlike Ms. T., who was
probably too damaged to be able to maintain the effort to acquire compen­
satory structure through idealization, Mr. L. showed a relatively less severe
degree of devitalization resulting from inadequate mirroring. He had more
resilience and attempted to seek idealization or twinship selfobject respon­
siveness. Ms. T., in contrast, could make only the most tentative and
short-lived attempt at idealization. Passivity appeared increasingly as Mr.
L. experienced rebuff or empathic failure at nearly every turn. Although
272 CHAPTER 8

better able than was Ms. T. to stay the course, he had only marginal success
in his effort to secure this type of compensatory structure.
By the time he reached Card VIII, this patient showed the first significant
psychological testing indication of what Kohut described as a disintegration
product. He was sufficiently destabilized to abandon the effort to seek
idealization or twinship selfobjects. As a result, he had diminished ability
to continue pursuing the vigor that he sought in a responsive selfobject to
revive a flagging, devitalized self. The disappointment that the selfobject
environment did not respond empathically drove the self, in effect, into
hiding and disposed him to a joyless, mechanical plodding through an
existence in which expecting to be understood, affirmed, or responded to
was considerably diminished.
This deadening of affective arousal produced the ennui or listlessness
that impeded Mr. L. from enthusiastically taking part in life. It appeared
superficially as depression, signifying the failure of selfobjects to function
optimally. It foreshadowed the depletion of the self and its protective
shutting down or withdrawal. The passivity and increased dependency
indications seen before Card VIII did not therefore represent features of
depression or even the ingrained characterologic predisposition to a depres­
sive personality. Rather, the passivity can be understood as this patient’s
best effort to be “stable on his perch.”
Mr. L. briefly revived the effort to sustain self-cohesion, but it led him
nowhere and he ultimately returned to a position of being undermined and
immobilized. He was “in isolation” from a selfobject environment that has
not functioned well for him. When he said “nothing is together,” it became
his metaphor for feeling depleted and worn down.
Failing to restimulate a viable selfobject environment through compen­
satory structures of idealization and twinship, he grew increasingly adrift,
passively withdrawn, and consequently trying to get by in whatever way he
could manage. With a markedly dampened-down affect life, Mr. L. experi­
enced the joylessness and understimulation of someone defeated and had
little reason to struggle in an unresponsive selfobject environment.
It is hardly surprising that Mr. L.’s TAT responses were dominated by
stories in which relationships were characterized by puzzlement and indif­
ference. The predominant feeling tone was one of being alone with his
problems, without considering that someone else could be sufficiently
understanding. The figures in Mr. L.’s stories solved problems alone,
without anticipation of support. The most striking feature of these interac­
tions was not that others failed to comprehend or disappointed in their
IDEALIZATION AND TWINSHIP 273

availability, but rather that nobody ever expected anyone to come to another
person’s assistance.
The main indications about the interplay of selfobject functions appeared
in Mr. L.’s Rorschach responses. Although evidence for faulty mirroring
was consistent throughout all the projective protocols, the emergence of
idealization and twinship occurred predominantly on the Rorschach. There
does not seem to be an affinity between selfobject functions and particular
projective tests. In general, the fact that an injury to self-esteem has occurred
defines the self state. It is the self state that is consistently detected on
projective psychological tests. There may be less regularity regarding the
appearance of idealization and twinship selfobject functions on one or
another projective test.
Twinship and idealization selfobject functions were weakly apparent in
the previous case of Ms. T., but were more vigorously pursued by Mr. L. in
an effort to establish compensatory structures, at least until he became too
undermined to sustain this effort with any success. Regardless of the
viability of idealization or twinship as durable selfobject functions, these
functions do not seem to be characteristically associated with any specific
projective test instrument.
 POSTSCRIPT:
SUMMARY AND REFLECTIONS

In The Future o f an Illusion, Freud (1927/1961) wrote: “The voice of the

intellect is a soft one, but it does not rest till it has gained a hearing” (p. 53).
He was describing how drives can overwhelm, but not totally silence, the
rationality that comes about when internal self-control predominates. Such
internal control is one therapeutic result that marks the strengthening of that
psychological function the ego psychologists would subsequently term the
observing ego. In the language of Rorschach psychology, it can be repre­
sented by acquiring the resilience to produce a sufficient number of M
responses of good quality to compensate for, if need be, impinging deter­
minants suggesting potentially disorganizing affect states.
Notwithstanding Freud’s pertinent observation, there is also a number of
conditions (many of which are character disorders and sub-clinical forms
of character pathology) typified by hypertrophy of rationality and intellect.
Not all of these states necessarily signify psychological health; some denote
obsessions or related characterologic disturbances typified prominently by
isolation or distancing defenses such as intellectualization. Conditions that
are dominated by overintellectualization are frequently associated with
smoothly operating or efficient deployment of defenses. There is charac­
teristically minimal distress, although chronic low-grade dysthymia may
be present. It is a form of defense that appears, on the face of it, to turn
pathology into a virtue.
The disorders of the self sometimes appear this way, often accompanied
by diminished zest or vigor, boredom or ennui, or aimless life paths lacking
in goals or a clear enough sense of direction. The improved efficacy of the
newer generation of antidepressant and anxiolytic compounds effectively
treats the symptomatic manifestations of some of these disturbances, leav­
ing the remaining ingrained characterologic adaptations as the residual
stamp of the personality.
For these conditions, it can be argued, it is the voice of the unconscious
that is soft but persistent. This restatement of Freud’s comment cited

274
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earlier reflects the maladaptive consequences of chronic boredom or anhe-

donia, directionless career paths, and unsatisfying, joyless relationships
with other people. Further, it is a view that highlights one of the most
refined, sophisticated uses of diagnostic psychological tests.
This subtle characteristic is an indication of one way the dynamics of
human personality and its deep psychological layers do not yield their
secrets easily. For this reason, psychodiagnostic testing is typically re­
quested when a clinical interview or early treatment sessions do not suffi­
ciently clarify a patient’s problem. Clinicians hope that psychological
testing will reveal submerged aspects of a patient’s personality; therefore,
testing that merely replicates the clinical diagnostic interview is rarely
useful. If testing does not augment what has been obtained on interview, the
testing has probably failed. Diagnostic psychological testing can be com­
pared to the use of radiologic procedures in clinical medicine when the
history and physical examination are suggestive but not definitive. Test
findings should attempt to reveal what cannot be seen with the naked eye
on clinical examination or by history. Diagnostic psychological testing can
be a more or less invasive procedure, not unlike the difference between a
routine electrocardiogram and a cardiac catherization study.
Regarding the psychodiagnostic evaluation, some clinicians are of a
temperament that remains predominantly if not even inflexibly faithful to
conducting strict logically-driven inquiries on all projective tests. Although
frequently emphasizing obvious details that any layman would have no
difficulty understanding, this particular clinical temperament reflects an
examiner’s view of personality that advances the field in important ways in
its demand that explanations must be logical, internally consistent, and
reproducible. When practiced as a single-minded rigid pursuit of this form
of evidence, however, this approach retards understanding, coming as it
does at the cost of compromising psychological curiosity about discerning
personality dynamics in depth. Although few psychologists regard them­
selves as so dogmatic that they would not even consider an impression based
on less than ideal empirical evidence, there are varying degrees of psycho­
logical depth, nevertheless, that clinicians are willing to examine and
attempt to understand.
The differences in conceptual approaches are at the core of what defines
the meaning of psychological understanding for clinicians. If a clinician
wishes to know if anyone is “at home” (a popular metaphor for the meaning
of the human movement (M) response), the clinician can focus his or her
investigation on determining whether the criteria for scoring M have been
276 POSTSCRIPT

satisfied, or the clinician can probe the associations that (dare I say it)
remind patients or make then think of such responses containing an M code.
It is the difference between ringing someone’s doorbell to see whether the
person is visibly at home and examining the person’s diaries or personal
papers to understand what “floats his boat.”
None of what I have said is new. Of course, it goes without saying that
any psychodiagnostic testing examiner needs to understand which method
or combination of methods is compatible with his or her temperamental
makeup. Like inspecting TAT cards or Rorschach blots, there is no right or
wrong answer to this problem; it is largely a restatement of the age-old
question about how clinicians understand what is inside the black box of a
person’s psychological existence. All that is new about restating this con­
troversy is that examiners who are interested in understanding the interior
life of self states and self disorders will need to probe for a degree of
depth with sufficient intensity and persistence. For the moment, scales of
narcissism or self-esteem simply do not pass muster.
If a clinician seeks answers to questions about problems that are fairly
close to the surface, a probing examination may be unwarranted. If the
problem is deeply concealed, the investigation may need to be aggressive.
I have selected clinical examples that lead to straightforward inferences
about self states. Understandably, the interpretive value of records that are
less well elaborated is not as evident. Indeed, most Rorschach records are
more banal and frequently not as distinctive as many of those reproduced
in these pages.
Thus, there is a difference in kind between the quality of responses or
verbalizations obtained from rich, productive protocols, and those ob­
tained from ordinary or banal records. This difference can be reduced,
however, if examiners are so inclined, by obtaining carefully elicited
associations about motivational states at appropriate points in the inquiry.
Examiners must be diligent in following up salient comments. For exam­
ple, ascertaining a beginning, middle, and outcome to TAT stories usually
does not suffice; provocative comments about the story must be pursued
cautiously but vigorously. The reserve necessary to conduct a careful,
unobtrusive Rorschach inquiry need not be regarded as a model when
applied to the TAT or figure drawings.
Lest my intention be misunderstood, I am not arguing to supplant the
unobtrusive Rorschach inquiry. Rather, I argue that something can be
added by augmenting the standard Comprehensive System inquiry and
moving beyond a perceptual problem solving function to permit the unfold­
POSTSCRIPT 277

ing of the predominant self state. Admittedly, not all clinicians are disposed
to use inquiry data in this way. In the final analysis, the techniques of
administering projective tests ultimately remain a matter of clinical and
theoretical persuasion. Likewise, clinicians need not fear that conducting
probing inquiries inevitably contaminates clinical findings any more than
they should feel they must artificially guard against influencing patients’
responses by looking patients in the eye and thereby revealing the examin­
ers’ reactions to the clinical material. Being well-trained means that clini­
cians have the necessary internal self-discipline to control their reactions
without having to resort to playing “musical chairs” or other contrived
devices to do this for them. Examiners who have difficulty with this
fundamental clinical temperament might find greater satisfaction in other
endeavors. In this context, it is worth remembering that the reason Freud
advocated using the couch was not primarily to stimulate regression or to
facilitate free association. The real reason is because he could not stand being
looked at or scrutinized searchingly throughout the day by his patients.
I argued the case for conducting a detailed and vigorous inquiry at some
length in chapter 4. The extended case study of Mr. L. (chap. 8) demon­
strated this clinical situation compellingly, in a relatively well-compensated
patient. On the other hand, severely disorganized patients, many with
borderline personality disorder, more readily reveal their psychological
distress, which can include states of profoundly disturbed self-cohesion.
Such patients characteristically lack the defensive resilience to protect
themselves effectively. Thus, their painfully experienced affect states and
compromised reality testing emerge in a seemingly uninhibited way, leak­
ing or oozing out, because they cannot prevent this discharge. The case of
Ms. T. (chap. 7) illustrated this form of psychopathology.
Many people have less pronounced self disorders than did Ms. T. and
Mr. L. Many show a level of resilience, despite pronounced disorders of
self-cohesion, intermediate between severe and mild self disorders. These
patients not infrequently manage to elude themselves, the clinicians who
treat them, and the psychodiagnosticians examining their personalities.
Their disturbances are often manifested in subtle nuances and require a
sufficiently probing inquiry.
In chapters 5 and 6, I discussed a number of clinical examples of
devitalized self states that were derived from subtle indications. These
examples require appropriately rigorous restraint to avoid overinterpreting
their meanings. Schafer’s criteria are a helpful guide in this effort. Never­
theless, figures described as standing or looking around with nothing to do,
278 POSTSCRIPT

waiting for someone to come by when nobody is there, or looking empty

can characterize devitalization experiences. Similarly, selfobject failure,
absence, or under-responsiveness may be detected in TAT stories such as
the boy with the violin that no one showed him how to play or a person who
cannot take decisive action, trust someone’s advice, or solve a problem
alone. Drawings of human figures that are small or confined to a corner of
the page or that otherwise suggest a vulnerable appearance (such as a person
with crutches, missing a limb, or nude) point to the possibility of a devital­
ized self state. Inferring such self states from the details of the drawings is
suggestive rather than definitive, and a vigorous inquiry to elaborate the
fantasied inner nature of how the drawn figure thinks and feels is usually
critical to substantiate this type of clinical interpretation.
The thrust of most of the examples I have discussed is that impaired
self-cohesion appears in the broad class of projective test responses denot­
ing experiences of feeling depreciated. On one side of this range of self
states are manifestations of an unmirrored self, usually characterized by
affect states of being rebuffed, slighted, or ignored. A painfully experienced
manifestation of a similar self state is characterized chiefly by a person’s
being made to feel depreciated or humiliated. Accordingly, projective test
responses of this type depict figures such as clowns, hoboes, or other
ignored or stepped-on figures on the Rorschach test, and comparable
imagery from the TAT or projective drawings might contain figures de­
scribed as small, insignificant, or unimportant.
Kohut observed that the selfobject need is best seen clinically when
self-cohesion is threatened. The self seeks a level of responsiveness that
restores a sense of stabilization. What the injured self needs for its repair is
central, not the unique characteristics of the person whom the patient
enlists in that effort. Some patients have built entire lives around conceal­
ing feelings of depletion, and projective testing does not easily penetrate
this defense. The standard unobtrusive inquiry fosters this defense and
may assist patients whose vulnerable self states require concealment.
As a result, vulnerable self-esteem in the form of self-depreciation,
shame, pronounced disappointment, and devaluation do not easily emerge
from patients’ projective test responses in the absence of a sufficiently
probing inquiry, just as people may hide an injured or diminished self on
clinical interview and in treatment. This self-concealment of an injured or
undermined self state is both a measure of the preserved ability of many
well-compensated patients to protect themselves as well as the very prob­
lem that potentiates the illness and the ensuing need for treatment. For this
POSTSCRIPT 279

reason, projective tests that permit a wide-ranging in-depth inquiry become

all the more necessary. In addition to revealing such self states, a probing
inquiry also rewards examiners with a more complete understanding of
selfobject needs (and sometimes, their differentiation from one another) and
the success or failure of compensatory structures.
How unfortunate it is when clinicians, while pursuing reliability, unwit­
tingly contribute to what patients can ill afford. I do not dismiss or disparage
reliability, logical thinking, and the scientific method; I have devoted the
major part of my career to research that values and appreciates these ideals.
My point here is simply that an approach that stubbornly refuses to see
beyond empirically documented evidence deprives itself of the opportunity
to at least heuristically open itself to what is most true and important about
human personality. Some of what Freud could only have guessed about at
the end of the 19th century has proved to be true, but much of it has not.
Similarly, some of what we may only guess about now, at the end of the
20th century, will stand the test of time, and some will not. In the logical
inquiry of a clinical science, it is usually more important to pursue possible
explanations to advance the field than to settle for the comfort of the tried
and true and the superficial.
In my closing remarks, I wish to emphasize that no agreed-on theoretical
approach has achieved supremacy in understanding character pathology.
The same symptoms, associations, and projective testing findings can be
examined from multiple viewpoints, none of which has the last word.
Without advocating an atheoretical position on the subject, I want to stress
that clinical material can be conceptualized from several viewpoints. A self
psychological framework makes no more claim to being the most appropri­
ate theoretical position than does an ego psychological, psychoanalytic
object relations, behavioral, or social learning approach. All these represent
alternative ways of conceptualizing clinical material. My overriding prem­
ise throughout this book has been that one useful way to think about
psychological testing material in a logical and consistent manner is from
the viewpoint of psychoanalytic self psychology.
As always, clinical interpretation remains an exercise in disciplined,
logical thinking, regardless of the data that inform clinical inferences. Even
empathic understanding, as Kohut described it, is not a loose, undisciplined,
feeling-dominated mental activity but a carefully applied and rigorously
self-monitored psychological activity of well-trained clinicians. Thus, my
main point remains that fantasy elaborations can regularly augment empiri­
cally derived, objective clinical findings in the understanding of personal­
280 POSTSCRIPT

ity. The appreciation of self disorders and selfobject functions, in fact,

requires the use of empathically understood data obtained from projective
diagnostic tests. These data expand the richness of the in-depth under­
standing of self states.
 REFERENCES

Abraham, K. (1927). Psycho-analytic studies on character-formation. In: Selected Papers

on Psycho-Analysis (pp. 370-417). London: Hogarth Press. (Original work published
1921)
Akiskal, H. S. (1980). External validating criteria for psychiatric diagnosis: Their application
in affective disorders. Journal of Clinical Psychiatry, 41, 6-15.
Alexander, F., & French, T. M. (1946). Psychoanalytic therapy: Principles and applications.
New York: Ronald Press.
Allison, J., Blatt, S. J., & Zimet, C. N. (1968). The interpretation o f psychological tests. New
York: Harper & Row.
American Psychiatric Association. (1952). Diagnostic and statistical manual of mental
disorders. Washington, DC: Author.
American Psychiatric Association (1994). Diagnostic and statistical manual o f mental
disorders (4th ed.). Washington, DC: Author.
Amow, D., & Cooper, S. (1988). Toward a Rorschach psychology of the self. In H. D. Lemer
& P. M. Lerner (Eds.), Primitive mental states and the Rorschach (pp. 53-70). Madison,
CT: International Universities Press.
Aronow, E., Reznikoff, M., & Moreland, K. (1994). The Rorschach technique: Perceptual
basics, content interpretation, and applications. Boston: Allyn & Bacon.
Athey, G. I., Jr. (1986). Rorschach thought organization and transference enactment in the
patient-examiner relationship. In M. Kissen (Ed.), Assessing object relations phenomena
(pp. 19-50). Madison, CT: International Universities Press.
Bacal, H. A. (1985). Optimal responsiveness and the therapeutic process. In A. Goldberg
(Ed.), Progress in self psychology (pp. 202-226). New York: Guilford Press.
Bacal, H. A. (1994). The selfobject relationship in psychoanalytic treatment. In A. Goldberg
(Ed.), Progress in self psychology: Vol. 10, A decade of progress (pp. 21-30). Hillsdale,
NJ: Analytic Press.
Bacal, H. A., & Newman, K. (1990). Theories of object relations: Bridges to self psychology.
New York: Columbia University Press.
Balint, M. (1968). The basic fault. London: Tavistock.
Basch, M. F. (1983). Empathic understanding: A review of the concept and some theoretical
considerations. Journal of the American Psychoanalytic Association, 31, 101-126.
Basch, M. F. (1984). Selfobject theory of motivation and the history of psychoanalysis. In
P. E. Stepansky & A. Goldberg (Eds.), Kohut’s legacy: Contributions to self psychology
(pp. 3-20). Hillsdale, NJ: Analytic Press.

281
282 REFERENCES

Basch, M. F. (1994). The selfobject concept: Clinical implications. In A. Goldberg (Ed.),

Progress in self psychology: Vol. 10, A decade o f progress (pp. 1-7). Hillsdale, NJ:
Analytic Press.
Beebe, B., Jaffe, J., & Lachmann, F. (1992). The contribution of mother-infant influence to
the origins of self- and object-representations. In N. Skolnick & S. Warshaw, (Eds.),
Relational perspectives in psychoanalysis (pp. 83-118). Hillsdale, NJ: Analytic Press.
Beebe, B., & Lachmann, F. M. (1988). Mother-infant mutual influence and precursors of
psychic structure. In A. Goldberg (Ed.), Progress in selfpsychology: Vol. 3, Frontiers in
self psychology (pp. 3-25). Hillsdale, NJ: Analytic Press.
Beliak, L., & Abrams, D. M. (1997). The T. A. T.y the C. A. T., and the S. A. T. in clinical use
(6th ed.). Boston: Allyn & Bacon.
Bowlby, J. (1969). Attachment and loss: Vol. 1, Attachment. New York: Basic Books.
Curtis, H. C. (1986). Clinical consequences of the theory of self psychology. In A. Goldberg
(Ed.), Progress in self psychology (Vol. 2, pp. 3-17). Hillsdale, NJ: Analytic Press.
(Original work published 1986)
Eagle, M. N. (1984). Recent developments in psychoanalysis. New York: McGraw-Hill.
Elson, M. (1987). The Kohut seminars on self psychology and psychotherapy with adoles­
cents and young adults. New York: Norton.
Erikson, E. (1950). Childhood and society. New York: Norton.
Exner, J. E., Jr. (1991). The Rorschach: A Comprehensive System. Vol. 2, Interpretation (2nd
ed.). New York: Wiley.
Exner, J. E., Jr. (1993). The Rorschach: A Comprehensive System. Vol. 1, Basic foundations
(3rd ed.). New York: Wiley.
Exner, J. E., Jr. (1995). A Rorschach workbook for the Comprehensive System (4th ed.).
Asheville, NC: Rorschach Workshops.
Fairbairn, R. (1941). A revised psychopathology of the psychoses and psychoneuroses. In
Psychoanalytic studies of the personality (pp. 28-58). London: Tavistock.
Fosshage, J. L. (1989). The developmental function of dreaming mentations: Clinical
implications. In A. Goldberg (Ed.), Progress in self psychology: Vol. 5, Dimensions of
self experience (pp. 3-11). Hillsdale, NJ: Analytic Press.
Freud, A. (1936). The ego and the mechanisms o f defense. New York: International
Universities Press.
Freud, S. (1955). Group psychology and the analysis of the ego. In J. Strachey (Ed. and
Trans.), The standard edition of the complete psychological works o f Sigmund Freud
(Vol. 18, pp. 65-144). London: Hogarth Press. (Original work published 1921)
Freud, S. (1959). Inhibitions, symptoms and anxiety. In J. Strachey (Ed. and Trans.), The
standard edition o f the complete psychological works o f Sigmund Freud (Vol. 20, pp.
87-172). London: Hogarth Press. (Original work published 1926)
Freud, S. (1961). The ego and the id. In J. Strachey (Ed. and Trans.), The standard edition
o f the complete psychological works o f Sigmund Freud (Vol. 19, pp. 12-59). London:
Hogarth Press. (Original work published 1923)
Freud, S. (1961). The future of an illusion. In J. Strachey (Ed. and Trans.), The Standard
edition o f the complete psychological works o f Sigmund Freud (Vol. 21, pp. 5-56).
London: Hogarth Press. (Original work published 1927)
REFERENCES 283

Gabel, S. (1994). The development of a self-psychological theory of dreams: Historical and

clinical considerations. In A. Goldberg (Ed.), Progress in self psychology: Vol. 10, A
decade of progress (pp. 183-196). Hillsdale, NJ: Analytic Press.
Galatzer-Levy, R. M. (1988). Manic-depressive illness: Analytic experience and a hypothe­
sis. In A. Goldberg (Ed.), Progress in self psychology: Vol. 3, Frontiers in self psychology
(pp. 87-102). Hillsdale, NJ: Analytic Press.
Gedo, J., & Goldberg, A. (1973). Models o f the mind. Chicago: University of Chicago Press.
Glover, E. (1955). The technique o f psychoanalysis. New York: International Universities
Press.
Goldberg, A. (1978). The psychology of the self: A casebook. New York: International
Universities Press.
Goldberg, A. (1988). A fresh look at psychoanalysis: The view from self psychology.
Hillsdale, NJ: Analytic Press.
Goldberg, A. (1990). The prisonhouse of psychoanalysis. Hillsdale, NJ: Analytic Press.
Goldberg, A. (1995). The problem o f perversion: The viewfrom self psychology. New Haven,
CT: Yale University Press.
Goodenough, F. (1926). Measurement o f intelligence by drawings. New York: World Book.
Greenberg, J., & Mitchell, S. (1983). Object relations in psychoanalytic theory. Cambridge,
MA: Harvard University Press.
Guntrip, H. (1969). Schizoid phenomena, object relations, and the self. New York: Interna­
tional Universities Press.
Handler, L. (1996). The clinical use of figure drawings. In C. S. Newmark (Ed.), Major
psychological assessment instruments (2nd ed., pp. 206-293). Boston: Allyn & Bacon.
Harrower, M. (1965). Psychodiagnostic testing: An empirical approach. Springfield, IL:
Thomas.
Hartmann, H. (1939). Ego psychology and the problem of adaptation. New York: Interna­
tional Universities Press.
Henry, W. (1956). The analysis of fantasy: The Thematic Apperception Technique in the
study o f personality. New York: Wiley.
Holt, R. R. (1978). Methods in clinical psychology: Volume 1, Projective assessment. New
York: Plenum Press.
Isherwood, C. (1935). The Berlin stories. New York: New Directions.
Jacobson, E. (1964). The self and the object world. New York: International Universities
Press.
Kernberg, O. (1975). Borderline conditions and pathological narcissism. New York: Aron­
son.
Kissen, M. (1986). Object relations aspects of human figure drawings. In Assessing object
relations phenomena (pp. 175-191). Madison, CT: International Universities Press.
Kissen, M. (1986). Assessing object relations phenomena. Madison, CT: International
Universities Press.
Klein, A. (1996, December 8). Baitz and Rifkin: A substantive friendship. The New York
Times, p. LI 17.
Klein, M. (1930). The importance of symbol formation in the development of the ego.
International Journal of Psycho-Analysis, 11, 24-39.
284 REFERENCES

Klein, M. (1975). A contribution to the psychogenesis of manic-depressive states. In: Love,

Guilt and Reparation, 1921-1945 (pp. 262-289). New York: Free Press. (Original work
published 1935)
Klopfer, B., & Kelley, D. (1942). The Rorschach technique. Yonkers: World Book.
Kohut, H. (1959). Introspection, empathy, and psychoanalysis: An examination of the
relationship between mode of observation and theory. Journal of the American Psycho­
analytic Association, 7, 459—483.
Kohut, H. (1966). Forms and transformations of narcissism. Journal o f the American
Psychoanalytic Association, 14, 243-272.
Kohut, H. (1968). The psychoanalytic treatment of narcissistic personality disorders.
Psychoanalytic Study of the Child (Vol. 23, pp. 86-113). New York: International
Universities Press.
Kohut, H. (1971). The analysis of the self. New York: International Universities Press.
Kohut, H. (1977). The restoration o f the self. New York: International Universities Press.
Kohut, H. (1979). The two analyses of Mr. Z. International Journal o f Psycho-analysis, 60,
3-27.
Kohut, H. (1984). How does analysis cure? (A. Goldberg & P. Stepansky, Eds.). Chicago:
University of Chicago Press.
Kohut, H. (1996). The Chicago Institute lectures. (P. Tolpin & M. Tolpin, Eds.). Hillsdale,
NJ: Analytic Press.
Kohut, H., & Wolf, E. (1978). The disorders of the self and their treatment: An outline.
International Journal of Psycho-analysis, 59, 413^4-25.
Kwawer, J. S. (1979). Borderline phenomena, interpersonal relations, and the Rorschach
test. Bulletin o f the Menninger Clinic, 43, 515-524.
Kwawer, J. S. (1980). Primitive interpersonal modes, borderline phenomena, and Rorschach
content. In J. S. Kwawer, H. D. Lerner, P. M. Lerner, & A. Sugarman (Eds.), Borderline
phenomena and the Rorschach test. (pp. 89-105). New York: International Universities
Press.
Kwawer, J. S., Lerner, H. D., Lerner, P. M., & Sugarman, A. (1980). Borderline phenomena
and the Rorschach test. New York: International Universities Press.
Lacan, J. (1978). The four fundamental concepts in psychoanalysis. New York: Norton.
Lachmann, F. M. (1986). Interpretation of psychic conflict and adversarial relationships: A
self-psychological perspective. Psychoanalytic Psychology, 3, 341-355.
LaFemina, K. (1996, February). Twinship: Who it defines and how it is defined. Paper
presented to the Society for Advancement of Self Psychology, New York, NY.
Lerner, H. D., & Lerner, P. M. (1988). Primitive mental states and the Rorschach. Madison,
CT: International Universities Press.
Lerner, P. M. (1988). Rorschach measures of depression, the false self, and projective
identification in patients with narcissistic personality disorders. In H. D. Lerner & P. M.
Lerner (Eds.), Primitive mental states and the Rorschach (pp. 71-93). Madison, CT:
International Universities Press.
Lerner, P. M. (1991). Psychoanalytic theory and the Rorschach. Hillsdale, NJ: Analytic
Press.
REFERENCES 285

Levine, F. J. (1979). On the clinical application of Kohut’s psychology of the self: Comments
on some recently published case studies. Journal of the Philadelphia Association for
Psychoanalysis, 6, 1-19.
Lichtenberg, J. D. (1991). What is a selfobject? Psychoanalytic Dialogues, 1, 455-479.
Loewald, H. W. (1980). Papers on psychoanalysis. New Haven, CT: Yale University Press.
Lovett, C. G. (1988). The Rorschach assessment of internalization mechanisms in depres­
sion. In H. D. Lemer & P. M. Lerner (Eds.), Primitive mental states and the Rorschach
(pp. 107-153). Madison, CT: International Universities Press.
Machover, K. (1949). Personality projection in the drawing of the humanfigure. Springfield,
IL: Thomas.
Mahler, M. S. (1968). On human symbiosis and vicissitudes of individuation: Vol. 1. Infantile
psychosis. New York: International Universities Press.
Malin, A. (1988). A short history of the psychoanalytic approach to the treatment of
psychotic disorders. In A. Goldberg (Ed.), Progress in self psychology: Vol. 3, Frontiers
in self psychology (pp. 81-86). Hillsdale, NJ: Analytic Press.
Mayman, M. (1967). Object-representations and object-relationships in Rorschach re­
sponses. Journal of Projective Techniques and Personality Assessment, 31, 17-24.
Mayman, M. (1970). Reality contact, defense effectiveness, and psychopathology in Ror­
schach form level scores. In B. Klopfer, M. Meyer, & F Brawer (Eds.), Developments
in Rorschach technique, (Vol. Ill, pp. 11-44). New York: Harcourt Brace Jovanovich.
Menninger, K. (1958). Theory of psychoanalytic technique. New York: Harper & Row.
Morrison, A. P. (1984). Shame and the psychology of the self. In P. E. Stepansky & A.
Goldberg (Eds.), Kohut’s legacy: Contributions to selfpsychology (pp. 71-90). Hillsdale,
NJ: Analytic Press.
Murray, H. A. (1938). Explorations in personality. New York: Oxford University Press.
Murray, H. A. (1943). Thematic Apperception Test: Manual. Cambridge, MA: Harvard
University Press.
Ornstein, P. H. (1978). The evolution of Heinz Kohut’s psychoanalytic psychology of the
self. In P. H. Ornstein (Ed.), The search for the self: Selected writings o f Heinz Kohut:
1950-1978. (Vol. 1, pp. 1-106). New York: International Universities Press.
Ornstein, P. H. (1987). On self-state dreams in the psychoanalytic treatment process. In A.
Rothstein (Ed.), The interpretation of dreams in clinical work (pp. 87-104). Madison,
CT: International Universities Press.
Ornstein, P. H. (1990). The unfolding and completion of Heinz Kohut’s paradigm of
psychoanalysis. In P. H. Ornstein (Ed.), The searchfor the self: Selected writings of Heinz
Kohut: 1978-1981. (Vol. 3, pp. 1-82). New York: International Universities Press.
Pine, F. (1988). The four psychologies of psychoanalysis and their place in clinical work.
Journal o f the American Psychoanalytic Association, 36, 571-596.
Rapaport, D. (1951). The autonomy of the ego. Bulletin o f the Menninger Clinic, 15,
113-123.
Rapaport, D., Gill, M. M., & Schafer, R. (1945). Diagnostic psychological testing. Chicago:
Year Book.
Rapaport, D., Gill, M. M., & Schafer, R. (1968). Diagnostic psychological testing: Revised
edition. (R. R. Holt, Ed.). New York: International Universities Press.
286 REFERENCES

Rorschach, H. (1981). Psychodiagnostics: A diagnostic test based on perception (9th ed., R

Lemkau & B. Kronenberg, Trans.). Berne, Switzerland: Hans Huber. (Original work
published 1921)
Rotter, J. B. (1947). The scoring and analysis of the Thematic Apperception Test. Journal
o f Psychology, 24, 319-330.
Rowe, C. E., Jr. (1994). Reformulations of the concept of selfobject: A misalliance of self
psychology with object relations theory. In A. Goldberg (Ed.), Progress in self psychol­
ogy: Vol. 10, A decade of progress (pp. 9-20). Hillsdale, NJ: Analytic Press.
Schachtel, E. G. (1966). Experiential foundations of Rorschach’s test. New York: Basic
Books.
Schafer, R. (1948). The clinical application o f psychological tests. New York: International
Universities Press.
Schafer, R. (1954). Psychoanalytic interpretation in Rorschach testing. New York: Grune
& Stratton.
Schafer, R. (1967). Projective testing and psychoanalysis. New York: International Univer­
sities Press.
Smith, B. L. (1992). An American in Paris. Bulletin of the International Rorschach Society,
2, 5-6.
Stem, D. N. (1985). The interpersonal world o f the infant. New York: Basic Books.
Stolorow, R., Brandchaft, B., & Atwood, G. (1987). Psychoanalytic treatment: An intersub-
jective approach. Hillsdale, NJ: Analytic Press.
Sugarman, A. (1986). Self-experience and reality testing: Synthesis of an object relations
and an ego psychological model on the Rorschach. In M. Kissen (Ed.), Assessing object
relations phenomena (pp. 51-75). Madison, CT: International Universities Press.
Summers, F. (1994). Object relations theories and psychopathology. Hillsdale, NJ: Analytic
Press.
Tolpin, M. (1978). Self-objects and oedipal objects—A crucial developmental distinction.
Psychonanalytic Study o f the Child (Vol. 33, pp. 167-184). New Haven, CT: Yale
University Press.
Tolpin, M. (1983). Corrective emotional experience: A self-psychological reevaluation. In
A. Goldberg (Ed.), Thefuture of psychoanalysis, (pp. 363-379). New York: International
Universities Press.
Tolpin, M. (1993). The unmirrored self, compensatory structure, and cure: The exemplary
case of Anna O. In B. Magid (Ed.), Freud's case studies: Selfpsychological perspectives
(pp. 9-29). Hillsdale, NJ: Analytic Press.
Tolpin, M. (1995, October). Compensatory structures: Pathways to cure. Paper presented
at the 18th annual International Conference on the Psychology of the Self, Chicago, IL.
Tolpin, M., & Kohut, H. (1980). The disorders of the self: The psychopathology of the first
year of life. In S. Greenspan & G. H. Pollock (Eds.), The course of life: Psychoanalytic
contributions toward understanding personality development. Vol. 1, Infancy and early
childhood, (pp. 425-458). Washington, DC: National Institute of Mental Health.
Tolpin, P. (1983). Self psychology and the interpretation of dreams. In A. Goldberg (Ed.),
The future o f psychoanalysis (pp. 255-271). New York: International Universities Press.
REFERENCES 287

Tolpin, R (1988). Optimal affective engagement: The analyst’s role in therapy. In A.

Goldberg (Ed.), Learning from Kohut: Progress in self psychology (pp. 160-168).
Hillsdale, NJ: Analytic Press.
Wallerstein, R. S. (1995). How does self psychology differ in practice? In A. Goldberg (Ed.),
Progress in self psychology (Vol. 2, pp. 63-83). Hillsdale, NJ: Analytic Press. (Original
work published 1986)
Winnicott, D. W. (1953). Transitional objects and transitional phenomena. International
Journal of Psycho-analysis, 34, 89-97.
Wolf, E. (1988). Treating the self: Elements o f clinical selfpsychology. New York: Guilford
Press.
Zubin, J., Eron, L. D., & Schumer, F. (1965). An experimental approach to projective
techniques. New York: Wiley.
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 AUTHOR INDEX

A E

Abraham, K., 16 Eagle, M.N., 17-18

Abrams, D. M., 67,101-102 Elson, M., 29
Akiskal, H. S., 72,90 Erikson, E., 91
Alexander, F., 27 Eron, L. D., 93
Allison, J., 65 Exner, J. E., Jr., xv, 11, 66-67, 75, 89,
Arnow, D., 142-143, 168 93, 96, 98-100, 164, 233
Aronow, E., 66-67, 93-95, 97-98 F
Athey, G. I., Jr., 127
Atwood, G., 18,45, 79 Fairbairn, R., 5
Fosshage, J. L., 41
B French, T. M., 27
Freud, A., 106
Bacal, H. A., 18,45,55,157 Freud, S., 24, 74, 82, 274
Balint, M., 5
Basch, M. F., 18, 23, 25,44-45 G
Beebe, B., 49 Gabel, S., 41
Beliak, L .,67,101-102
Galatzer-Levy, R. M., 17
Blatt, S. J., 65
Gedo, J., 23
Bowlby, J., 5
Gill, M. M., 65, 68,74,78, 83,101-
Brandchaft, B., 18,45,79
102, 106
Glover, E., 48
Goldberg, A., 14-16, 23,28, 34-35,
C 47, 82
Goodenough, F., 67
Cooper, S., 142-143, 168 Greenberg, J., 79
Curtis, H. C., 17 Guntrip, H., 105, 203
289
290 AUTHOR INDEX

H M

Handler, L„ 67 Machover, K., 67,105

Harrower, M., 67, 105 Mahler, M. S., 5, 18
Hartmann, H., 95 Malin, A., 17
Henry, W„ 101 Mayman, M., 74
Holt, R. R„ 67, 74,78, 83, 129-130, Menninger, K, 50
150 Mitchell, S., 79
Moreland, K, 66-67, 93-95,97-98
I Morrison, A. P., 47
Murray, H. A., 74,101
Isherwood, C., 57
N
J
Newman, K, 18,55, 157
Jacobson, E., 18
O
K
Ornstein, P. H„ 3-4,12, 23, 34,40
Kelley, D„ 97
Kernberg, O., 15,53, 131, 166 P
Kissen, M., 18
Klein, A., 61 Pine, F„ 18
Klein, M„ 5,21, 105,203
Klopfer, B„ 97 R
Kohut, H., xi, 3-13,15-17, 20-40,41-
44,46-54, 56-60, 84, 90,115- Rapaport, D„ 65, 68,74,78, 83, 95,
116, 142-143,149, 156, 176, 101-102, 106
180, 204, 257, 268 Reznikoff, M., 66-67, 93-95, 97-98
Kwawer, J. S., 18, 75,144, 181-182 Rorschach, H„ 74
Rotter, J. B., 101
Rowe, C. E., Jr., 45
L
S
Lacan, J., 79
Lachmann, F., 16,49 Schachtel, E. G„ 18, 65,73-75, 95-97,
LaFemina, K, 59-60 263
Lerner, H. D„ 18,65,75,97,105 Schafer, R„ 65-66, 68, 73-74, 77-83,
Lerner, P. M.,18, 65, 67,73,75,97- 85-90, 92,96-97, 101-102,
98, 105, 126,131, 144, 181, 106,123, 126, 131, 133-136,
231, 263 145-147, 154, 166-167, 169,
Levine, F. J., 28 175-176, 231,263
Lichtenberg, J. D„ 49-50 Schumer, F., 93
Loewald, H. W„ 17 Smith, B. L., 93
Lovett, C. G., 182 Stern, D. N., 49
Stolorow, R., 18,45,79
AUTHOR INDEX 291

Sugarman, A., 18, 75,144 W

Summers, F., 18
Wallerstein, R. S., 17, 28, 39
Winnicott, D. W., 5,105
T Wolf, E„ 16, 23,45,51, 142-143
Z
Tolpin, M„ 14, 20, 34, 46-47,52, 61
62, 82, 204, 206 Zimet, C. N„ 65
Tolpin, P., 20,27,40-41,49 Zubin, J., 93
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 SUBJECT INDEX

A Conflict, 17, 32,40, 74, 84, 88, 97,

101, 105, 198, 257
Addictions, 3, 14, 35,46-47, 53, 56-58 Corrective emotional experience, 27
Affective engagement, 49
Alter-ego, see Twinship D
Antisocial behavior, see Sociopathy
Anxiety, 6,48, 62, 70, 72, 201 Defenses, 18, 27, 32, 74, 84, 86-89,
97, 105-106, 252
B Deficit, 17, 32, 105-106
Dependency, 14, 53, 58, 86, 121, 197,
Borderline personality disorder, xv, 234, 241-245, 253-254, 272
15, 107, 160, 198 Depletion, x, xiv, 56-57, 59, 122, 194,
Boundary disturbances, 48, 253 202-203, 220-222, 244, 246,
250-255, 272
C Depletion depression, 47-48,56, 149,
206, 216
Comorbidity, 71, 73, 127 Depression, xiii, 6, 70,72, 121, 126,
Compensatory structures, x, 20, 32- 128, 132, 148, 150, 153, 171,
37, 122, 152,157, 170, 202, 184, 193, 216, 229, 267, 272
212-213, 220-222, 251-253, Devaluation, 48, 115, 119, 137, 166,
259, 264, 266, 268, 271-272 194
Comprehensive System, 11, 66-67, and arrogance, 131-136
71,75,93, 98-100, 225, 233 and faultfinding, 153-154
clusters, 99 and self-depreciation, 128-130
morbid codes, xiv, 80, 119 Devitalization, ix-x, xiv, 7, 14, 21, 53,
Special Scores, xiv, 76, 127 59, 110, 117, 121, 126, 130,
Structural Summary, 76,98-99 149, 152, 155, 197, 212-214,
219-222, 229, 249-258
293
294 SUBJECT INDEX

Disintegration products, x, xiv, 37,46- compensatory structure and, 55-56,

48, 53, 57, 120, 198-199, 251-253
203, 243, 253-255, 272 mirroring and, 55, 134, 170
Drive theory, 20, 32,38, 53, 88, 91, omnipotence and, 58
104, 145, 198, 201, 252, 257 Identity, 22, 256
Dysthymia, xiii, 72, 90, 148, 150, 274 Intersubjectivity, 18,79
E M
Ego psychology, 74,79, 95, 104-105, Mania, 70,72, 127, 132, 199, 212,
197, 268, 270, 274 229-230
Ego ideal, 57 Menninger Clinic, 66-69,75, 77-78
Empathy, xi, 8, 20, 23-30, 83, 91, 109, Millon Clinic Multiaxial Inventory, 67-
125, 150-151, 170, 270 68,71
Minnesota Multiphasic Personality In­
F ventory (MMPI-2), 67, 71,
Figure drawings, 67, 85, 100-102, 76, 102
104, 107-108, 177 Mirroring, 9-11, 21, 34, 51-54, 110,
clinical examples, ix, 121, 133, 141-144, 200, 220-222, 250-
137-138, 158-159, 190, 255
193-195, 225-228 admiration, 116, 123-127
Fragmentation, xv, 14, 22,46,48, 52, affirming, 52-53, 113-120
57, 107, 254-255 entitlement, 116
omnipotence, 117
G reflections, 230
self-depreciation, 128-130, 137,
Grandiosity, 11, 51, 109, 115-122, 137 210
arrogance and, 53, 131-136
defensive bravado, 116-117, 133, N
135-136, 146
idealization and, 166-168 Narcissism, x, 73, 116
self-aggrandizement, 53, 131, 166 transformations of, 90-91
self-depreciation and, 53 Narcissistic behavior disorders, xiii,
35, 52, 56
H Narcissistic personality disorders, xiii,
35, 52, 56,73
Homosexuality, 35
Horizontal split, 52 O
Human figure drawings, see Figure
drawings Object relations, 5, 21, 79, 82, 84, 103-
Hypochondriasis, see Somatization 106, 131
Oedipal conflict, 6-7, 10, 14, 37-41,
I 133, 136, 140, 149, 152, 257-
Idealization, x, 11-13, 21, 32, 34, 54- 258, 268-269
59, 111, 156-176,210, 220- Optimal frustration, 49,56
222, 232, 251-254, 271 Orality, 85-86
SUBJECT INDEX 295

P S

Perversions, 3, 14, 35, 46,48, 56 Self, 20-23

Projection, 68 cohesion, xiii, 5, 14, 21, 27, 58,
Projective tests, 69-72, 79-92, 164- 146, 256
166, 276-279 concept of, 21-23
adaptation, 90-92 disorders of, ix, 6, 14-15, 32, 107,
battery, 253 274
bias in interpretation, 103-104 grandiose-exhibitionistic pole, 6,
clinical indications, 69-72 32, 34,51-52, 109, 115-
content analysis, 79-92 116, 166
depth of interpretation, 85-88 idealized parent imago pole, 6, 33-
diagnostic nosology and, 71 34, 54, 59
hierarchic position, 89-90 states, xi, 226, 255
inquiry, 137, 141, 164-166, 175- Self-state dream, 20,40-41, 83-84
176, 225, 255, 273, 276- Self-esteem, 9, 11, 32, 72, 84, 105
279 Self-help organizations, 58-59
intensity of conflict, 88-89 Self-selfobject unit, 37,42, 113
neurological illnesses and, 70 Selfobject, 43-46
pharmacotherapy and use of, 71 failure, 7, 14,40,46, 52
psychometric properties of, 68,71, faulty internalization of, 263
75, 78, 98 functions, xi, 10-11, 16, 20, 43-46
self disorders and, 72-73 admixtures, 192, 223-224, 251-252
sufficient evidence, 79-85 lifelong need for, 49-50
Psychosis, xv, 17, 22, 72, 107, 120, responsiveness, 25, 27, 49, 56, 108-
171, 189,211,254-255 109, 250, 255, 261
transference, 10-11, 15, 54, 57
R Sentence Completion Test, 87
Sexualization, 47, 53, 57-58
Rage reactions, 6-7, 14,47-48, 53, Shame, 47-48, 52-53, 111, 133
118, 166, 184, 198-199, 254 Sociopathy, 46
Regression, 26-30 Somatization, 47
iatrogenic, 29-30,48 Structural theory, 17, 74
Resistance, 31 Sublimation, 34
Rorschach test, 67, 84 Superego, 128, 167, 257, 270
content analysis, 67, 77,79-92, 96,
98, 100, 106 T
content-idiographic approach, 93-
94, 99 Termination of treatment, 50-51
experiential nature, 95-97 Thematic Apperception Test (TAT),
allocentric, 95-96 67, 85, 94, 100-108, 111, 177
autocentric, 95-96 clinical examples, ix, 102, 104,
inquiry, 68, 94, 108, 138-139, 164- 108-111, 119, 121, 129-
166 BO, 135-136, 138, 140,
sequence analysis, 67, 97, 106 147, 149-153, 155, 160-
symbolic imagery, 83, 86, 93
296 SUBJECT INDEX

163, 171-173, 184-187, exclusivity, 185-186

213-219, 256-267 faithful replica, 182-183,188
Therapeutic action, 6, 32 inquiry and, 179
Transmuting internalization, xi, 20, mirroring and, 59, 188
27, 30-32, 49, 240 twins, 180-183
Twinship, 13, 16, 21, 34, 54, 59-62,
111, 176-191,232,247, 251, V
271
adolescence and, 183-187 Vertical split, 53
alienation and, 62
alikeness/oneness, 179,181, 183, W
186-191,252-253
companionate function, 177, 180, Wechsler Adult Intelligence Scale
271 (WAIS-III), 67,76