Kohut’s theory of self psychology, centered on the concept of narcissism, has vastly influenced the way narcissism is perceived in the psychoanalytic community. Yet while significantly contributing to the psychoanalytic discourse, his theory gives rise to some issues and concerns. This article deals with the problematic aspects of Kohut’s theory, specifically with reference to the identification, diagnosis, and treatment of pathological narcissism. The article discusses the conceptual ambiguity surrounding Kohut’s proposed model of narcissism vis-à-vis his notion of the self. I suggest that this conceptual ambiguity could lead to an erroneous attribution of narcissism to patients who are not necessarily narcissists but who have failed to develop a mature sense of self. I would further argue that Kohut’s diagnostic method, primarily based on selfobject transferences, is not only inadequate, but potentially misleading, since such selfobject transferences are commonly observed in patients who are not suffering from narcissistic personality disorder. Two clinical case studies illustrating my point are presented next. Finally, I explain my critique of Kohut’s view of narcissism, which highlights self-selfobject relationships rather than the relationship with a separate other and fails to take into account the complex and dynamic inner world of the narcissist and the defensive function of narcissism.

中文翻译：

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对科胡特的自我心理学和病态自恋理论的反思——局限性和担忧。

科胡特的自我心理学理论以自恋的概念为中心，极大地影响了精神分析界对自恋的看法。然而，虽然他对精神分析的论述做出了重大贡献，但他的理论引起了一些问题和担忧。本文讨论了科胡特理论的问题方面，特别是关于病理性自恋的识别、诊断和治疗。这篇文章讨论了围绕 Kohut 提出的自恋模型相对于他的自我概念的概念上的模糊性。我认为，这种概念上的模糊性可能会导致错误地将自恋归因于不一定是自恋者但未能形成成熟的自我意识的患者。我会进一步论证 Kohut 的诊断方法，主要基于自体客体移情，不仅不充分，而且可能具有误导性，因为这种自体客体移情通常在未患有自恋型人格障碍的患者中观察到。下面介绍两个临床案例研究来说明我的观点。最后，我解释了我对科胡特自恋观点的批评，该观点强调自我-自我客体关系而不是与单独的他人的关系，并且没有考虑到自恋者复杂而动态的内心世界和自恋的防御功能。