ABSTRACT
We propose to critically evaluate and strengthen the level of clinical evidence in psychoanalysis, using a strategy of triangulating clinical phenomena from different perspectives and increasing contextual knowledge. Insufficient discussion of alternative hypotheses and limited contextual information are two Achilles heels of psychoanalytic case presentations. We examine the concept and quality standards of clinical evidence in psychoanalysis and related disciplines, with particular attention to the contribution of the three-level model (3-LM). We analyze the case of a patient treated with transference-focused psychotherapy (TFP), making explicit the theoretical-clinical agreements and disagreements of the authors. We discuss the strengths and limitations of triangulation and contextualization, concluding that they make clinical work and psychoanalytic writing more reliable, transparent, auditable, and replicable.
Subject(s)
Psychoanalysis , Psychoanalytic Therapy , HumansABSTRACT
This paper explores two clinical forms or aspects of narcissism and their psychopathological implications: thin-skinned, or vulnerable, narcissism (VN) and thick-skinned, or grandiose, narcissism (GN). The different names used and the characteristics with which they have been described are reviewed. Clinical vignettes are examined for both types of narcissism, emphasising their diagnostic characteristics and discussing their similarities and differences, in addition to the factors that may confer additional complexity to the clinical case. The importance of the experiences of shame and humiliation are emphasised. Based on these comparisons, the psychodynamic mechanisms at play are examined in both cases, especially their relation to the levels of mental functioning. The paper concludes that both VN and GN constitute failed ways to face the difficult dialectic articulation between self-affirmation and acknowledgement of the other.
