In his article “The disorders of the self and their treatment: an outline”, Heinz Kohut and Ernest Wolf (1978) describe Self Psychology as the ideal treatment for the narcissistic disorders of the self. I agree with them, but would argue that had they known about Psychomotor Therapy (Pesso & Pesso, 1994) they would have viewed it as an important and necessary second phase of the treatment process. This article will describe the relationship between Self Psychology and Psychomotor in the treatment of narcissistic injury. Self Psychology and Psychomotor Therapy both have their theoretical roots in traditional psychoanalysis. Each describes basic needs that when unmet lead to dysfunction in the individual. Pesso & Pesso (1994) note that “Ideally, the child lives in the parent’s gaze. The child is happy in the embrace of the parent’s attention” (p. 185). Various deficits on the part of the parent can result in the provision of a poor or absent response or countershape for the child’s need. Depending upon the type of protection, or limits, Psychomotor posits specific difficulties in development.

While the language used to describe these needs is slightly different, the concepts themselves are very similar to those of Kohut (Kohut & Wolf, 1978). Kohut focuses on the unempathic parent (which is essentially the same as a parent who provides an absent or inappropriate countershape). Kohut argues that if the child’s basic needs for mirroring and idealization are not met, problems will develop.

Mirroring (described nicely by Alice Miller [1980] involves the parent literally mirroring the child’s behavior. This is seen most clearly when a parent coos in response to the baby cooing or smiles in response to the baby’s smile. Mirroring assists in the development of healthy narcissism in that the child learns he exists in relation to others, and that he can impact the environment and those around him. Both mirroring and healthy idealization require a parent who is able to respond empathically.

In a 1976 interview with David Moss, Kohut describes the development of idealization in the healthy child (Moss, 1976). At two to five months the child begins to feel omnipotent. The environment seems to mirror every need which leads the child to have magical expectations. The child is focused on himself and experiences pleasure from the attention and contact of the care givers, “yet with time, a sense of reality intrudes on this omnipotence and with it an awareness of limitations” (Moss, 1976, p. 28). At the same time, the child is beginning to idealize a parent figure. In an effort to ward off sadness, emptiness and fear the child further idealizes the adult as the epitome of power and perfection (Moss, 1976). If the adult is powerful and perfect, the child can feel protected and reassured by being in relation to him. “If the idealized adult responds empathically to this attribution and resonates a positive response, the child will experience a sense of goodness” (Moss, 1976, p. 29). Eventually the child realizes that the parent 17 is fallible, but by then the figure and the accompanying reassurance have become internalized and the need for a god-like other diminished.

Kohut (Moss, 1976) indicates that, “Most often interferences in this growth occur when the child experiences the idealized parent as cold or unempathic. Such arrests or interferences produce feelings of emptiness, depression, a constant wish for self-assurance and an experience of self-fragmentation” (Moss, 1976, p. 29). Children will idealize an unempathic parent and this usually results in a similar lack of empathy for the self and any of the above mentioned problems.

This interview provides a frame for comparing the language and concepts of Kohut and Pesso. Both note the need for a resolution of the child’s omnipotence; the usefulness in this process of the child encountering healthy limits; and the need for a sufficient empathic response or countershape from the parent for the child to internalize support, nurturance, and a sense of goodness and wholeness. Again, these similarities are not surprising given that both theories have their roots in psychoanalysis.

Psychomotor therapy offers the advantages of group and the in-depth personal experience of individual treatment while reducing the intensity of the transference relationship. For most clients this probably provides optimal treatment. However, for those individuals who are narcissistically wounded, individual treatment prior to and then in tandem with psychomotor may be preferable. Although I am prescribing self psychology, any individual approach which recognizes the development of transference and the idealization of the therapist and which allows for weekly testing of trust, protection, and limits with the therapist would be effective.

Go To The Relationship between Self Psychology and Psychomotor in the Treatment of Narcissistic Injury Part Two

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