This volume is a comprehensive introduction to the psychology of the self and the clinical problem of narcissism. Dr. Chessick, a prolific writer, scholar, and gifted clinician, approaches this challenging and controversial subject by placing Kohut’s contributions and those of his followers in historical perspective. He takes a general look at narcissism and demonstrates that some of the difficulties that arise in the treatment of the narcissistic patient are due to confusion about the meaning of narcissistic pathology. A complete review of the psychology of the self is given both as it began in the narrow sense of the term and later in the more controversial broader sense. Kohut’s theories are compared and contrasted with those of Freud, Melanie Klein, Kernberg, Jacobson, Fairbairn, Winnicott, Balint, Laing, Sartre, Lacan, Foucault, and many others.

In Kohut’s later writing, the self as a supraordinate concept becomes elaborated in its bipolar nature (ambitions and guiding ideals), showing itself as a clinical problem primarily when self-cohesion is not firm. According to self psychology, Freud’s structural model (id, ego, superego) attempts to describe the inner psyche through an observer equidistant from the substructures and outside the patient’s psyche, Kohut’s self/selfobject model stations the therapist-observer inside the psychic apparatus so as to conceptualize the patient’s subjective experience. The therapist firms the patient’s sense of self utilizing empathic comprehension. Structure building through transmuting internalization as a consequence of the therapist’s empathic understanding and interpretation establishes a cure of the disorder of the self. The goal of treatment is to strengthen the self of the patient, enabling “right choices” to be made as a result of the reparative activities in the therapeutic process, and a sustaining empathic matrix (that we all need) to be developed.

The core of this book is in the invaluable clinical comments and case illustrations that make clear the full implementation of Kohut’s work for the practice of psychoanalytic psychotherapy. Issues of transference and countertransference, as well as specific techniques in the treatment of the narcissistic patient, are discussed in the framework of self psychology, and Dr. Chessick develops some new applications, for example, in the treatment of psychosomatic disorders. The controversial concept of empathy is central to this approach, and Dr. Chessick clarifies Kohut’s writing on its use and misuse.

Self psychology has innumerable ideas and techniques to offer therapists, especially in the treatment of patients who suffer defects in the sense of the self. Dr. Chessick offers a balanced view and critical perspective on Kohut’s challenging insights into experiencing the patient through empathy, and on the introspective skills required of the contemporary psychotherapist. (561 pp.)