When working with patients with borderline personality organization, we are almost never dealing with a “pure” form of transference. Beneath the patient’s observable behavior lies a complex relational structure in which different transference configurations overlap, mask one another, and constantly change their form. It is within this field of tension that four basic chronic transference paradigms in the treatment of patients with borderline personality organization (BPO): narcissistic, antisocial, paranoid, and depressive. Any of these basic transference paradigms may be colored by pervasive narcissistic defenses, giving the underlying transference a narcissistic flavor.

Let us take a closer look at narcissistic transference.

Narcissistic transferences are characterized by an incapacity to depend on the therapist, unconscious dismissal of him or her, and more or less overt devaluation of the therapist in an effort to eliminate him or her as an important object who would otherwise be feared and envied. 

Narcissistic transferences are generally defenses against the deepening of an underlying paranoid or depressive transference. 

In Transference-Focused Psychotherapy (TFP), narcissistic defenses are understood not as a peripheral form of resistance, but as a central organizing mechanism of the transference. TFP is aimed at the consistent identification, containment, and interpretation of the dominant transference configurations in the here and now, which makes it possible to gradually access underlying, more primitive affective states and object relations.

An extreme narcissistic transference may be in the form of either intense devaluing of the therapist or, less frequently, a superficial idealization of the therapist.

The patient treats the therapist with such pervasive devaluation and indifference that it may appear on the surface that there is no transference—that the therapist does not matter enough for the patient to care about. 

In TFP, such an apparent “absence of transference” is understood as a clinically significant phenomenon that requires particular attention from the therapist. In this context, devaluation and indifference are interpreted as active narcissistic defenses aimed at avoiding dependency, fears of persecution, or depressive loss. The therapist’s task is not to “break through” these defenses, but to make them the subject of joint exploration within the transference.

In these cases, narcissistic defenses can be interpreted to reveal the underlying transference. In some cases, the narcissistic defenses remain in place over months. This occurs in narcissistic personality disorder proper, which can range in functioning from higher level to antisocial. In these cases, the priority issue is the continued analysis of the narcissistic defenses. 

Thus, in TFP, narcissistic transference in patients with a borderline level of personality organization is not an obstacle to the therapeutic process, but rather a key to understanding the deep structure of their object relations. Devaluation, idealization, and demonstrative autonomy conceal intense affects of fear, envy, and dependency, which become accessible for therapeutic work only through the systematic analysis of transference. It is precisely the consistent work with narcissistic defenses that opens the possibility of moving from superficial interactions toward deeper psychic integration.

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(c) Yuliia Holopiorova,

Ukrainian Association of Transference-Focused Psychotherapy