Narcissistic Personality Disorder Treatment

SUMMARY JUDGMENTS: Our daily legal-news aggregator for May 13, 2011

By Dan Slater  

Turn it down! The Florida court system might have to resolve a lower-court split over an ear-splitting issue: What's the standard for noise violations? In one case, Richard Catalano was issued a $73.50 ticket for cranking Justin Timberlake too loudly while driving. On Wednesday, a state appeals court struck down the Florida law under which Catalano was ticketed, finding it was not content-neutral because it focused on amplified music from automobiles rather than excessive noise in general, the St. Petersburg Times reports. The court also agreed with Catalano that the standard for deciding when noise is too loud is too subjective, and thus the statute is unconstitutionally vague. Another Florida appellate court, however, reached the opposite conclusion in a similar case, meaning that the state Supreme Court in Tallahassee could be called on to resolve the split. "If they want to go to Tallahassee," said Catalano, "I say let's go."

Galleon's smaller fish: Lost in the post-verdict hullabaloo of the Galleon trial was a smaller, but related, reckoning: former Ropes & Gray associate Arthur Cutillo - one of three lawyers ensnared in the government's investigation of Galleon Group's Raj Rajaratnam - was disbarred in New York on Thursday, the Am Law Daily reports. The 34 year-old Cutillo, who plead guilty in January to conspiracy and fraud charges, told a Manhattan federal judge that he and another Ropes associate passed on information regarding two deals in 2007.  The other associate, Brien Santarlas, was disbarred in November.

Regulating judicial vitriol: A Minnesota judge may have exploded at members of a court-monitoring team, claiming they used red clipboards as a “not very subtle threat to the judge" and exhibited a “mixture of self-righteousness, officiousness, arrogance, humorlessness and ignorance.” But the state Supreme Court said that's okay: while it might have been preferable that Judge Jack Nordby phrase his remarks differently, "they were not so intemperate as to warrant discipline," the three-judged panel ruled, according to the ABA Journal . Judge Nordby's lawyer, Joe Friedberg, was ecstatic, saying he was glad that the court "recognized the narcissistic personality disorder of the Board on Judicial Standards," which had recommended the ethics charges against Judge Nordby.

Fake discounts: A college student in Texas has been nabbed for hatching an extracurricular money-making scheme. Lucas Townsend Henderson, a 22 year-old, was charged with wire fraud and trafficking in counterfeit goods for distributing bogus coupons, Courthouse News reports. Federal prosecutors say people who bought the coupons redeemed $200,000 worth of Procter & Gamble's Tide laundry detergent. P&G is the largest coupon issuer in the United States. Henderson did not comment.

Theory and Treatment of The Narcissistic Personality Disorder ...

Freud, in his 1914 paper On Narcissism, was the first to advance a psychodynamic theory which explained aspects of adult narcissism. He theorized a single line of libidinal development, from autoeroticism to narcissism to object love. If libido is invested narcissistically, i.e., in the ego or self, it could not be invested in the object, i.e., in relationships.

Since Freud’s believed that psychoanalysis could only be successful when the patient could form a transference neurosis based on object love, narcissistic patients could not be treated using this method. These ideas remained the prevailing view in psychoanalysis until Kohut.

Kohut

Kohut viewed narcissistic pathology as resulting from an arrest of one or both of the two lines of normal narcissistic development: self-esteem, derived from the grandiose self; and guiding ideals derived from internalization of the idealized parent imago. In healthy development empathic responses on the part of the caretakers (which he calls self-objects) to the child’s needs for mirroring and for idealizable models leads to the internalization of the self-objects and their functions.

Failure of maturation of either or both of these lines leaves the individual susceptible to fragmentation of the self, which is defended against by the avoidance, denial, grandiosity, and idealization seen in the adult narcissistic personality.

Perhaps Kohut’s most important contribution is the idea that the narcissistic patient does establish a transference, but that this is based not on object love but on unmet self-object needs. The goal of analysis is to fill the defect in one or both parts of the self through the process he called transmuting internalization, which results from the analyst’s repair of the many inevitable narcissistic ruptures that occur during treatment.

I want to note that this differs from the belief of those who followed Kohut from the intersubjective and relational schools, that empathy and attunement lead to  cure.

For Kohut, health comes from the maturation of internalized self-objects, but there is never a complete separation between self and object; the term ‘self-object’ indicates that important objects are always experienced as part of the self.

Kohut did not see aggression as a drive or primary motivation, but instead solely as a byproduct of narcissistic failures. Thus he sees defenses resulting from failure of self functions, not as a way of keeping libidinal and aggressive representations separate.

Handbook of diagnosis and treatment of DSM-IV-TR personality disorders

Narcissistic personality disorder, poems

Borderline personality disorder, a clinical guide

Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse

Clinical Guide to the Diagnosis and Treatment of Mental Disorders