International Journal of Group Psychotherapy
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
The Female Delinquent Narcissistic Personality Disorder: A Case Illustration Edward M. Scott To cite this article: Edward M. Scott (1979) The Female Delinquent Narcissistic Personality Disorder: A Case Illustration, International Journal of Group Psychotherapy, 29:4, 503-508, DOI: 10.1080/00207284.1979.11492017 To link to this article: https://doi.org/10.1080/00207284.1979.11492017
Published online: 29 Oct 2015.
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Citing articles: 1 View citing articles
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Date: 07 January 2018, At: 09:54
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The Female Delinquent N arcissistic Personality Disorder: A Case Illustration
E D WA R D M . SC O T T , Ph .D .
M
A:'\ Y A U TH OR S, A~IONG THE~I K OH U T ( 1971), Kernberg (1975), Do roff (1976), Ornstein (19 74), Dysart (19 77), Wo lf (1976) , Stone and Wh itman ( 1977) , Stolorow (197 5) , a nd, of cou rse, Fre ud ( 19 14 ), have writte n on th e conce pt of narcissism a nd ha ve suggested cli nica l sy m ptoms of th e na rcis sist ic personality-d isorder ed individu al. The forth coming DSM -II I has ad ded th e classificat ion Na rc issis tic Personal ity Di sorder, stip ula ting a n op erational criterion for thi s di sorder and requiring t hree of t he following : (1) inflated self-estee m (e.g., exa gger at es ac hieveme n t and ta lent s ), (2) int erperson al exploitivenes s (e.g., uses other s to indu lge desires ), (3) expa ns ive im agin at ion (e.g. , exhib its immature a nd undi scip line d fa ntasies), (4) superci lious unp ertu rbability (e.g ., a ppears nonchala nt a nd coo lly un imp ression able ), an d (5) deficien t social co nscience (e.g ., reveals d isrega rd for person al integrity a nd t he rig h ts of othe rs ). A review of the ab ove- na me d a ut hors leaves the top ic of the a do lescent pe rson a lity-di sorder ed individu a l almost u ntou ch ed . Oniy Kernber g ( 1975 ) a nd Kohut (197 1) att empt to trea t the topic . Kern berg orients his beginning re ma rks aro und the obser vati on s of H elen e Deutsch (1944) a nd Edit h J acobson (19 54 ), both of who m
Dr. Scott is Professor of M ed ica l Psychology, Uni vers ity of Orego n H eal th Sc iences Ce nter. Por tla nd , Oregon .
503
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not ed a n in crea se in na rcissisti c b eh av io r during a do lesce nc e . C ommenting on their id eas, Kernberg suggests th a t a n in cr ea se b e und erstood not me rely in q u antit a ti ve terms but a lso in qualit ative term s. A norm al qu antitative in cr ea se in n arc issism during a do lesce nce would sugge st, Kernberg prop oses, in crea sed self-a bsor pt io n, in creased conce rn over t he se lf, a n d a qu al it a ti ve reg ress ive shift to wa r d "self a n d obj ect " - to be loved a nd ad mi re d by th e m other. The pathologi cal manifest ations wo u ld include " . .. the sea rc h for obj ects th at represent th e infantil e se lf." An even more pathol ogical in d ication occurs in cc • • • the proj ection of a primiti ve, pat ho log ical , gra n d iose self onto th e object. .. . " On a clin ica l level t h is would be manifest ed by c c • • • a dri ven in vestment in ac tivit ies a n d relation ships that brin g about triumph , ad m ira t io n . . . " and by a co ntem p t for oth e rs. Stolorow ( 1975 ), arguing that the notion of qu ali ta ti ve differen ce is a " h igh ly spec u la tive prop osition , " sugges t s tha t , " Na rcissis m embo d ies t hose ment al op era tions w ho se fu nc tion is to regul a te self-estee m a n d to m aint ain t he cohes ive ness and sta b ility of the se lf-re p rese nta tion." Kohut (1 97 1) sta tes that , whil e juvenile delinqu ency of the typ e treated b y A ich ho rn wa s not wit h in the sc ope of hi s direct cl in ica l experience, he would suggest a ra tional e for A ich ho rn 's success : ( I) The delinqu ent w a nts to est ablish a n idealizing tran sference and ye t (2) the delinquent loudl y proclaims a co nt em p t for va lues and id eals . It wa s Aichh orn 's skill c c • • • t o offer himself fir st as a mirror image of th e del inqu ent 's gra nd iose se lf. " C once rni ng d el inqu ent b eh avior o f the narci ssist ic indi vidu al , K ohut postulates that it is not based o n " a defect in the superego " nor impul si vit y, but rather on "an a chievem ent of the ego . . .. " The purpose of t h is a rt icle is to a ttem p t to indi cat e clinical m an ifest ations of the a d olesce nt n arci ssisti c fem al e d el inquent in grou p t herapy by m eans of a ca se illustra tion . T he setting is t hat of . a n in-p a tient juvenile a gency for delinquent girls :
C LIN ICA L MANIFESTATIONS Pat is a tall , good -looki ng, well-p ropo rtioned , verb al , 16- yearold g ir l. During group ( Pa t's fourth session ), man y of the girl s were
The N arcissistic Female Delinquent
505
dis cussing the poor hom e situatio ns fro m whi ch th ey ca me: di vorce, pa ren ts ' d r inking , et c. Pa t :
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Dr. Sc ott : Pat :
Mary : Pa t :
M on ica : Pa t : Dr. Scott: Pa t :
Sue : Pat : D an a : Pa t :
Moni ca :
Pat :
I 'm fro m a goo d hom e. I ca n 't bl ame m y paren ts. I fantas ize a lot about sex. If t he guy is be autiful ins ide, I have sex. H ow do you know if he 's bea ut iful insid e ? What sta rte d it a ll, wh en I was a sop homo re, this se nior , a good -loo king st ud, as ked me for a dat e. I felt so good. H e was a big st u d a rou nd school. H e introduced me to a lco ho l a nd pot a nd pa rt yin g. I did n 't wa nt to lose him so I kep t it up . A way to sed uce yo u.. .. If a gu y tells me " yo u 're prett y " (pa use)-yo u do ha ve a p oint- the a tt ract ive man , I fantasi ze abo ut. D o yo u feel ro tt en ? Not a bit. Eve n here, if a girl says, " Yo u look good, " it mak es me feel goo d . How does it work ? I wasn 't stro ng eno ugh th en , a , now (begins to cry; gro u p silence ). I don 't feel warmth from a nyo ne in t his gro up . It pi sses m e off (a ng ry now ). I didn 't ex pect t his from yo u, Pa t. No one ca ring . . . mak es m e feel like nothing. I a lways t hought you were perfect. I didn 't know about t h is, un til toda y. I feel let down-something ca me out -I feel less than I was . No! Now we ca n help you . I felt it last group . I left cry ing, bu t afte rwa rds a lmos t eve ry bo dy ca me to me a nd talked . It wa s ca ring . I 've be en here seve n months. Now, I find out. (p a use) Thank s, Dr. Sc ott.
Pa t 's mo tiva tio n-t he a d mi ration of the se n ior-a nd t he " p rice " she pa id -alco ho l, p ot , a nd sex-seem to ste m from narcis sism. Kohut (197 1) has suggeste d th a t delinquent be hav ior is b ased on " a n ac hieveme nt of th e ego, " a nd Pa t seems to have felt this. It was not a " defect in t he superego, " since she remarked regarding gu ilt ,
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"Not a b it. " H er na rcissist ic nee d is " ca rried ove r" a t t he agency, wh ere she re q uires th e a d m ira tion of th e ot her girls . Du rin g t he gro u p p rocess, Pat is gea re d tow ard her ow n need s, quickl y sh ifting from hurt to a nge r. H er co m me nt, " I fee l less t ha n I was, " clea rly sugges ts a lessening of self-es tee m . Pat 's sta te ment, " Tha nks, Dr. Sco t t," suggests a n in teresti ng a n d pot entiall y co nfusing co m me nt. It a ppea rs to be a " n ight from the ther apist , " ty p ica lly see n in the seco nd o r t h ird sess io n, acc ord ing to Dysart (1977 ) (t h is wa s Pat 's fou rth session ). Dys art (1977 ) suggests th e m oti vat ion is tha t of fear of dep enden ce. Yet , Kohut ( 197 1) has insi sted th at spontaneous narcissi sti c t ra nsference is " t he best a nd m ost reli a bl e di a gnostic sign ." O rnstei n (19 74 ) ag ree s with Kohut 's opinion, writing th at eva lua t io n ca n be based on t he na ture of the spon ta neo us ly developing t ra ns fere nce relati onship rath er than on presenting symp toms or hi st ori cal data . But th e iss ue is, as Kapl an (1978 ) not ed in his crit iq ue of Stone a nd Whitman 's a rticle, th e di stincti on " between spec ific a n d non sp ecific rea cti ons in gr o u p members. " It is m y clinica l impression that Pa t in iti all y prece ived the grou p as p art of her psyc hic st r uc t u re, a nd wh en th is wa s not realized , a ng rily sna p pe d, " It [the group ] pisses me off." However, she did attempt to maintain a d yadic relationship to the th erapist. It a p pea re d th at Pa t had b egun a posit ive tra ns fere nce at this time-a goo d clinica l sign- ra the r th an a ni ght from dep enden cy. At th e next group sess io n Pat re la ted material concern ing her ea rly famil y life. " I wa s wanted ver y much . They 've a lways given m e eve ry th ing. I had a lmost t he pe rfect paren ts. I was a lo ner at school. I loved a tte nti on! I still do , a nd I tried to m ake friends ; even when I wa s littl e, I 'd do anyt hi ng. I guess I neve r had rea l friends. They 'r e not m y rea l parents. " Pat th en rem arked th at she was a do pted when two week s old. Debbie : Pa t : M onica : Dr. Scott :
Pa t :
You demand too much fro m people, Pat. It hu rt (referring to last gro u p session ). H ow ca n I cha nge ? I like yo ur as king . Pa t , who suffered o r had th e most pain in gro u p toda y ? No t m e. Ki tt y or M oni ca . I 'm a ll confused .
Th e Na rcissistic Female Delinq uent
Dr. Scott : Pat :
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Dr. Sc ot t :
507
Reflect a bit. M o nica , whose paren ts sa id th ey didn 't wa nt her. If t hat had bee n me ! Whe n I wa s told I wa s a dopted- I was four or five- I remember I tho ught I 'd try to fin d m y real paren ts. I like your effor ts.
T h is is a n att empt , a long th e lin es suggested by Kohut ( 197 1), to work wit h th e " rea lity ego " of the pa tie nt. It differs from Stone a nd W hitman 's (1977 ) opi nion t hat , " In essence , the ther api st shou ld poi nt out th e wish for ad mira t ion but not directl y gratify th e pa tie nt. " It a pp ea red a pprop ria te to ac knowledge Pat 's effort to co nsider ot he rs . Is Pa t " d rive n, " du e to t he a do p tion, to " p rove " she is lova ble, or is t he " desire" for ad m ira tion the continua tio n of expecta tio n tha t ot he rs should a d mire her as her (a dop t ive ) parents ha ve? It is too ea rl y in t rea t me nt to a nswe r thi s qu estion. T her e a re some " good signs " a ppea ring : (a ) Pat ca n say th at so meone else suffered more than sh e (rea lity ego at work ) ; (b) recogn it ion of th e need for a d m ira tion ; (c ) th e co nfusion whi ch s uggests a loosening of defen ses ; a nd (d ) identification, sup port , a nd cla r ificatio n a p pear to be helpful. Horn er (1975 ), in pointing out ' some of the problem s of group the ra p y wit h the narcissi sti c pat ie nt, ment ions " sp litt ing," a nd Pat 's sta te ment conce rn ing lack of wa rm t h was a n effo rt, a pp a rentl y, to di vide the group into (" good ") su p por te rs a nd (" bad " ) non-supporter s. A note fro m Pa t 's gro up work er read , " G ood wee k. Tryin g to assu me lea de rship ro le. W ent ho me th is week end . " Pat continue d to ma ke im p rovement in her be hav ior in and out of gro up. A la te r note from the grou p wo rker sta ted , " Pat had a setbac k but b ounced rig ht ba ck. In gro up , she ca n sha re, co nt rib ute, a n d ha s demonstra ted ca re a nd role reversal. " SUM y IA R Y G ro up thera py a ppears to be a n effect ive treatment m od ali ty for the na rcissistic fema le de linq ue nt , p rovidin g t he pati ent with a setting in whi ch she ca n learn to sha re the parental figure with ot he rs. Mo reo ver, th e group sett in g offers a n opportuni ty for a p pro p ria te narcissist ic displ a y a nd a cknow ledg me nt of a c h ie ve-
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ment allows the narcissisti c element to b e int egra ted int o th e personality . A father figure is preferable to a mat ernal one, since it permits a narcissistic female image to op erat e, an important function of the a dolesce nt fem al e.
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REFERENCES Deutsch , H . ( 1944 ), Psychology of H'oman. Vol. I: G irl ho od. New York : Grune & Stratton. DorofT. D. (19 76 ), Develop in g a nd M a intai ning th e T herapeutic Alliance with the N arcissistic Per son alit y.]. A m . Acad. Psychoanalysis, 4 :137-160. Dysart , D . ( 1977), T ransfer en ce C u re a nd Na rcissism . ]. A m . A cad. Psychoanalysis, 5: 17-29. Freu d , S. ( 19 14) , O rr Na rciss ism : An Int roduct ion. Standard Edition, 14 :67-102. London : H ogarth Pr ess. H orner, A. ( 1975), A C ha ra cte ro logica l Contrai ndicat ion for G rou p Psychoth era py . J. A m. A cad. Psychoanalysis, 3 :301-305 . J a cob son , E. (1 954 ), Co nt rib ut ions to the M etapsych o!ogy of Psychot ic Iden ti fica tio ns. J. A m . Psychoanalytic A ssoc., 2 :239-262. Kap lan, S. ( 1978 ), Lett e r to the Edi to r. T his J ournal , 28 : 129-131. Kernber g, O . ( 1975), B orderline Conditio ns and Patholog ical Narcissism . New York : J a son Aronson . Koh u t, H . ( 197 1), The Ana lysis of the Sel f. New York : Int e rn a tion al Un iversities Pr ess. O rnste in, P. ( 1974), O n Narcissism : Beyond th e In trod uction, H ighli ght s of H ein z Kohu t 's Co nt rib utions to th e Psych oanal yti c T rea tme nt of Narcissisti c Per sonali ty D isorder s. Annual of Psychoanalysis. 2 : 17-149. New York: Interna tion a ! U niversities Press. Sto loro w , R . ( 1975) . Toward a Functional Defini tion of Narcissism . Internat . ]. Psychoanalysis. 56 : I 79- 185. Stone . W. , and W hi tman , R. ( 1977) , Contributions of the Psychology of th e Se lf to G ro u p Process a nd G ro up Therap y. T his .Journal, 27 :343 -358 . Wolf. E. ( 1976) , Recen t Ad vances in the Psychology of the Se lf: An Ou tlin e of Ba sic Co nce pts . Comprehensire Psychiat ry , 17:3 7-46 .
D r. Scott 's add ress:
309 S . H". .ith A ve. Portl and, Oregon 9720,1
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
The Female Delinquent Narcissistic Personality Disorder: A Case Illustration Edward M. Scott To cite this article: Edward M. Scott (1979) The Female Delinquent Narcissistic Personality Disorder: A Case Illustration, International Journal of Group Psychotherapy, 29:4, 503-508, DOI: 10.1080/00207284.1979.11492017 To link to this article: https://doi.org/10.1080/00207284.1979.11492017
Published online: 29 Oct 2015.
Submit your article to this journal
View related articles
Citing articles: 1 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ujgp20 Download by: [Purdue University Libraries]
Date: 07 January 2018, At: 09:54
Downloaded by [Purdue University Libraries] at 09:54 07 January 2018
The Female Delinquent N arcissistic Personality Disorder: A Case Illustration
E D WA R D M . SC O T T , Ph .D .
M
A:'\ Y A U TH OR S, A~IONG THE~I K OH U T ( 1971), Kernberg (1975), Do roff (1976), Ornstein (19 74), Dysart (19 77), Wo lf (1976) , Stone and Wh itman ( 1977) , Stolorow (197 5) , a nd, of cou rse, Fre ud ( 19 14 ), have writte n on th e conce pt of narcissism a nd ha ve suggested cli nica l sy m ptoms of th e na rcis sist ic personality-d isorder ed individu al. The forth coming DSM -II I has ad ded th e classificat ion Na rc issis tic Personal ity Di sorder, stip ula ting a n op erational criterion for thi s di sorder and requiring t hree of t he following : (1) inflated self-estee m (e.g., exa gger at es ac hieveme n t and ta lent s ), (2) int erperson al exploitivenes s (e.g., uses other s to indu lge desires ), (3) expa ns ive im agin at ion (e.g. , exhib its immature a nd undi scip line d fa ntasies), (4) superci lious unp ertu rbability (e.g ., a ppears nonchala nt a nd coo lly un imp ression able ), an d (5) deficien t social co nscience (e.g ., reveals d isrega rd for person al integrity a nd t he rig h ts of othe rs ). A review of the ab ove- na me d a ut hors leaves the top ic of the a do lescent pe rson a lity-di sorder ed individu a l almost u ntou ch ed . Oniy Kernber g ( 1975 ) a nd Kohut (197 1) att empt to trea t the topic . Kern berg orients his beginning re ma rks aro und the obser vati on s of H elen e Deutsch (1944) a nd Edit h J acobson (19 54 ), both of who m
Dr. Scott is Professor of M ed ica l Psychology, Uni vers ity of Orego n H eal th Sc iences Ce nter. Por tla nd , Oregon .
503
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304
Edward ,V! . Scott
not ed a n in crea se in na rcissisti c b eh av io r during a do lesce nc e . C ommenting on their id eas, Kernberg suggests th a t a n in cr ea se b e und erstood not me rely in q u antit a ti ve terms but a lso in qualit ative term s. A norm al qu antitative in cr ea se in n arc issism during a do lesce nce would sugge st, Kernberg prop oses, in crea sed self-a bsor pt io n, in creased conce rn over t he se lf, a n d a qu al it a ti ve reg ress ive shift to wa r d "self a n d obj ect " - to be loved a nd ad mi re d by th e m other. The pathologi cal manifest ations wo u ld include " . .. the sea rc h for obj ects th at represent th e infantil e se lf." An even more pathol ogical in d ication occurs in cc • • • the proj ection of a primiti ve, pat ho log ical , gra n d iose self onto th e object. .. . " On a clin ica l level t h is would be manifest ed by c c • • • a dri ven in vestment in ac tivit ies a n d relation ships that brin g about triumph , ad m ira t io n . . . " and by a co ntem p t for oth e rs. Stolorow ( 1975 ), arguing that the notion of qu ali ta ti ve differen ce is a " h igh ly spec u la tive prop osition , " sugges t s tha t , " Na rcissis m embo d ies t hose ment al op era tions w ho se fu nc tion is to regul a te self-estee m a n d to m aint ain t he cohes ive ness and sta b ility of the se lf-re p rese nta tion." Kohut (1 97 1) sta tes that , whil e juvenile delinqu ency of the typ e treated b y A ich ho rn wa s not wit h in the sc ope of hi s direct cl in ica l experience, he would suggest a ra tional e for A ich ho rn 's success : ( I) The delinqu ent w a nts to est ablish a n idealizing tran sference and ye t (2) the delinquent loudl y proclaims a co nt em p t for va lues and id eals . It wa s Aichh orn 's skill c c • • • t o offer himself fir st as a mirror image of th e del inqu ent 's gra nd iose se lf. " C once rni ng d el inqu ent b eh avior o f the narci ssist ic indi vidu al , K ohut postulates that it is not based o n " a defect in the superego " nor impul si vit y, but rather on "an a chievem ent of the ego . . .. " The purpose of t h is a rt icle is to a ttem p t to indi cat e clinical m an ifest ations of the a d olesce nt n arci ssisti c fem al e d el inquent in grou p t herapy by m eans of a ca se illustra tion . T he setting is t hat of . a n in-p a tient juvenile a gency for delinquent girls :
C LIN ICA L MANIFESTATIONS Pat is a tall , good -looki ng, well-p ropo rtioned , verb al , 16- yearold g ir l. During group ( Pa t's fourth session ), man y of the girl s were
The N arcissistic Female Delinquent
505
dis cussing the poor hom e situatio ns fro m whi ch th ey ca me: di vorce, pa ren ts ' d r inking , et c. Pa t :
Downloaded by [Purdue University Libraries] at 09:54 07 January 2018
Dr. Sc ott : Pat :
Mary : Pa t :
M on ica : Pa t : Dr. Scott: Pa t :
Sue : Pat : D an a : Pa t :
Moni ca :
Pat :
I 'm fro m a goo d hom e. I ca n 't bl ame m y paren ts. I fantas ize a lot about sex. If t he guy is be autiful ins ide, I have sex. H ow do you know if he 's bea ut iful insid e ? What sta rte d it a ll, wh en I was a sop homo re, this se nior , a good -loo king st ud, as ked me for a dat e. I felt so good. H e was a big st u d a rou nd school. H e introduced me to a lco ho l a nd pot a nd pa rt yin g. I did n 't wa nt to lose him so I kep t it up . A way to sed uce yo u.. .. If a gu y tells me " yo u 're prett y " (pa use)-yo u do ha ve a p oint- the a tt ract ive man , I fantasi ze abo ut. D o yo u feel ro tt en ? Not a bit. Eve n here, if a girl says, " Yo u look good, " it mak es me feel goo d . How does it work ? I wasn 't stro ng eno ugh th en , a , now (begins to cry; gro u p silence ). I don 't feel warmth from a nyo ne in t his gro up . It pi sses m e off (a ng ry now ). I didn 't ex pect t his from yo u, Pa t. No one ca ring . . . mak es m e feel like nothing. I a lways t hought you were perfect. I didn 't know about t h is, un til toda y. I feel let down-something ca me out -I feel less than I was . No! Now we ca n help you . I felt it last group . I left cry ing, bu t afte rwa rds a lmos t eve ry bo dy ca me to me a nd talked . It wa s ca ring . I 've be en here seve n months. Now, I find out. (p a use) Thank s, Dr. Sc ott.
Pa t 's mo tiva tio n-t he a d mi ration of the se n ior-a nd t he " p rice " she pa id -alco ho l, p ot , a nd sex-seem to ste m from narcis sism. Kohut (197 1) has suggeste d th a t delinquent be hav ior is b ased on " a n ac hieveme nt of th e ego, " a nd Pa t seems to have felt this. It was not a " defect in t he superego, " since she remarked regarding gu ilt ,
Downloaded by [Purdue University Libraries] at 09:54 07 January 2018
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"Not a b it. " H er na rcissist ic nee d is " ca rried ove r" a t t he agency, wh ere she re q uires th e a d m ira tion of th e ot her girls . Du rin g t he gro u p p rocess, Pat is gea re d tow ard her ow n need s, quickl y sh ifting from hurt to a nge r. H er co m me nt, " I fee l less t ha n I was, " clea rly sugges ts a lessening of self-es tee m . Pat 's sta te ment, " Tha nks, Dr. Sco t t," suggests a n in teresti ng a n d pot entiall y co nfusing co m me nt. It a ppea rs to be a " n ight from the ther apist , " ty p ica lly see n in the seco nd o r t h ird sess io n, acc ord ing to Dysart (1977 ) (t h is wa s Pat 's fou rth session ). Dys art (1977 ) suggests th e m oti vat ion is tha t of fear of dep enden ce. Yet , Kohut ( 197 1) has insi sted th at spontaneous narcissi sti c t ra nsference is " t he best a nd m ost reli a bl e di a gnostic sign ." O rnstei n (19 74 ) ag ree s with Kohut 's opinion, writing th at eva lua t io n ca n be based on t he na ture of the spon ta neo us ly developing t ra ns fere nce relati onship rath er than on presenting symp toms or hi st ori cal data . But th e iss ue is, as Kapl an (1978 ) not ed in his crit iq ue of Stone a nd Whitman 's a rticle, th e di stincti on " between spec ific a n d non sp ecific rea cti ons in gr o u p members. " It is m y clinica l impression that Pa t in iti all y prece ived the grou p as p art of her psyc hic st r uc t u re, a nd wh en th is wa s not realized , a ng rily sna p pe d, " It [the group ] pisses me off." However, she did attempt to maintain a d yadic relationship to the th erapist. It a p pea re d th at Pa t had b egun a posit ive tra ns fere nce at this time-a goo d clinica l sign- ra the r th an a ni ght from dep enden cy. At th e next group sess io n Pat re la ted material concern ing her ea rly famil y life. " I wa s wanted ver y much . They 've a lways given m e eve ry th ing. I had a lmost t he pe rfect paren ts. I was a lo ner at school. I loved a tte nti on! I still do , a nd I tried to m ake friends ; even when I wa s littl e, I 'd do anyt hi ng. I guess I neve r had rea l friends. They 'r e not m y rea l parents. " Pat th en rem arked th at she was a do pted when two week s old. Debbie : Pa t : M onica : Dr. Scott :
Pa t :
You demand too much fro m people, Pat. It hu rt (referring to last gro u p session ). H ow ca n I cha nge ? I like yo ur as king . Pa t , who suffered o r had th e most pain in gro u p toda y ? No t m e. Ki tt y or M oni ca . I 'm a ll confused .
Th e Na rcissistic Female Delinq uent
Dr. Scott : Pat :
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Dr. Sc ot t :
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Reflect a bit. M o nica , whose paren ts sa id th ey didn 't wa nt her. If t hat had bee n me ! Whe n I wa s told I wa s a dopted- I was four or five- I remember I tho ught I 'd try to fin d m y real paren ts. I like your effor ts.
T h is is a n att empt , a long th e lin es suggested by Kohut ( 197 1), to work wit h th e " rea lity ego " of the pa tie nt. It differs from Stone a nd W hitman 's (1977 ) opi nion t hat , " In essence , the ther api st shou ld poi nt out th e wish for ad mira t ion but not directl y gratify th e pa tie nt. " It a pp ea red a pprop ria te to ac knowledge Pat 's effort to co nsider ot he rs . Is Pa t " d rive n, " du e to t he a do p tion, to " p rove " she is lova ble, or is t he " desire" for ad m ira tion the continua tio n of expecta tio n tha t ot he rs should a d mire her as her (a dop t ive ) parents ha ve? It is too ea rl y in t rea t me nt to a nswe r thi s qu estion. T her e a re some " good signs " a ppea ring : (a ) Pat ca n say th at so meone else suffered more than sh e (rea lity ego at work ) ; (b) recogn it ion of th e need for a d m ira tion ; (c ) th e co nfusion whi ch s uggests a loosening of defen ses ; a nd (d ) identification, sup port , a nd cla r ificatio n a p pear to be helpful. Horn er (1975 ), in pointing out ' some of the problem s of group the ra p y wit h the narcissi sti c pat ie nt, ment ions " sp litt ing," a nd Pat 's sta te ment conce rn ing lack of wa rm t h was a n effo rt, a pp a rentl y, to di vide the group into (" good ") su p por te rs a nd (" bad " ) non-supporter s. A note fro m Pa t 's gro up work er read , " G ood wee k. Tryin g to assu me lea de rship ro le. W ent ho me th is week end . " Pat continue d to ma ke im p rovement in her be hav ior in and out of gro up. A la te r note from the grou p wo rker sta ted , " Pat had a setbac k but b ounced rig ht ba ck. In gro up , she ca n sha re, co nt rib ute, a n d ha s demonstra ted ca re a nd role reversal. " SUM y IA R Y G ro up thera py a ppears to be a n effect ive treatment m od ali ty for the na rcissistic fema le de linq ue nt , p rovidin g t he pati ent with a setting in whi ch she ca n learn to sha re the parental figure with ot he rs. Mo reo ver, th e group sett in g offers a n opportuni ty for a p pro p ria te narcissist ic displ a y a nd a cknow ledg me nt of a c h ie ve-
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ment allows the narcissisti c element to b e int egra ted int o th e personality . A father figure is preferable to a mat ernal one, since it permits a narcissistic female image to op erat e, an important function of the a dolesce nt fem al e.
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REFERENCES Deutsch , H . ( 1944 ), Psychology of H'oman. Vol. I: G irl ho od. New York : Grune & Stratton. DorofT. D. (19 76 ), Develop in g a nd M a intai ning th e T herapeutic Alliance with the N arcissistic Per son alit y.]. A m . Acad. Psychoanalysis, 4 :137-160. Dysart , D . ( 1977), T ransfer en ce C u re a nd Na rcissism . ]. A m . A cad. Psychoanalysis, 5: 17-29. Freu d , S. ( 19 14) , O rr Na rciss ism : An Int roduct ion. Standard Edition, 14 :67-102. London : H ogarth Pr ess. H orner, A. ( 1975), A C ha ra cte ro logica l Contrai ndicat ion for G rou p Psychoth era py . J. A m. A cad. Psychoanalysis, 3 :301-305 . J a cob son , E. (1 954 ), Co nt rib ut ions to the M etapsych o!ogy of Psychot ic Iden ti fica tio ns. J. A m . Psychoanalytic A ssoc., 2 :239-262. Kap lan, S. ( 1978 ), Lett e r to the Edi to r. T his J ournal , 28 : 129-131. Kernber g, O . ( 1975), B orderline Conditio ns and Patholog ical Narcissism . New York : J a son Aronson . Koh u t, H . ( 197 1), The Ana lysis of the Sel f. New York : Int e rn a tion al Un iversities Pr ess. O rnste in, P. ( 1974), O n Narcissism : Beyond th e In trod uction, H ighli ght s of H ein z Kohu t 's Co nt rib utions to th e Psych oanal yti c T rea tme nt of Narcissisti c Per sonali ty D isorder s. Annual of Psychoanalysis. 2 : 17-149. New York: Interna tion a ! U niversities Press. Sto loro w , R . ( 1975) . Toward a Functional Defini tion of Narcissism . Internat . ]. Psychoanalysis. 56 : I 79- 185. Stone . W. , and W hi tman , R. ( 1977) , Contributions of the Psychology of th e Se lf to G ro u p Process a nd G ro up Therap y. T his .Journal, 27 :343 -358 . Wolf. E. ( 1976) , Recen t Ad vances in the Psychology of the Se lf: An Ou tlin e of Ba sic Co nce pts . Comprehensire Psychiat ry , 17:3 7-46 .
D r. Scott 's add ress:
309 S . H". .ith A ve. Portl and, Oregon 9720,1
