FR E U D was pessimistic about the psycho-analytic approach to the narcissistic neuroses. He felt that people suffering from these diseases had no capacity for transference, or only insufficient remnants of one. He described the resistance of these patients as a stone wall which cannot be got over, and said that they turn from the physician not in hostility but in indifference. Many analysts have tried to develop methods of analysis which would deal with narcissistic patients-1 am thinking of Waelder (1925), Clark (1933), and later Fromm-Reichmann (1943,1947)9 Bion (1962), Rosenfeld, and others. The majority of analysts who have treated narcissistic patients have disagreed with Freud's view that there was no transference. As the transference is the main vehicle for any analytic investigation, it seems essential for the understanding of narcissism that the behaviour of the narcissist in the analytic transference situation should be minutely observed.
弗洛伊德对治疗自恋性神经症的精神分析方法持悲观态度。 他认为，患有这些疾病的人没有移情能力，或者只是移情能力不足。他把这些病人的阻抗描述为一堵无法逾越的石墙，并说他们对医生的态度不是敌意而是冷漠。许多分析师试图开发出一种分析自恋患者的方法——我想到了维尔德（Waelder，1925)、克拉克（Clark，1933)，以及后来的弗洛姆（Fromm-Reichmann，1943，1947)、比昂(1962)、罗森菲尔德（Rosenfeld）等人。大多数治疗过自恋患者的分析师都不同意弗洛伊德认为他们不存在移情的观点。既然移情是任何分析性研究的主要载体，那么看起来，对于理解自恋至关重要的是——自恋者在分析性移情情境中的行为应该被仔细观察。
Franz Cohn (1940) suggested that the sharp distinction between transference neurosis and narcissistic neurosis should be disregarded. He felt that the transference in the narcissistic neurosis is of a primitive or rudimentary type-for example, there are often serious difficulties in distinguishing between subject and object-and he stresses the introjection and projection of destructive tendencies in oral and anal terms in relation to the analyst. Stone (1954) described transferences which are 'literally narcissistic', where the analyst is confused with the self or is like the self in all respects: the therapist and the patient alternately seem to be parts of each other. He stresses both the primitive destructiveness and the need to experience the analyst as an omnipotent, godlike figure, and suggests that, in the patient's fantasy about the analyst's omnipotence, guilt about primitive destructive aggression plays an important part.
弗朗茨 科恩（Franz Cohn，1940）认为移情性神经症和自恋性神经症之间的明显区别应该被忽略。他认为自恋性神经症的移情是一种原始的或初始的类型——例如，在区分主体和客体时往往有严重的困难——他强调了他们在和分析师关系中，口欲和肛欲的破坏性倾向的内摄和投射。斯通（Stone ，1954）将移情描述为“字面上的自恋”，即将分析师与自我混淆，或认为分析师的一切都像其自我一样：治疗师和患者交替成为彼此的一部分。他强调了原始破坏性和将分析师体验成如同全能之神一般的需要，并指出，在病人对分析师的全能幻想中，对原始破坏性攻击的内疚起了重要作用。
Many of the observations made by Cohn (1940) and Stone (1954) seem to come close to my own investigation. I notice that in their description of the narcissistic transferences the terms 'primary' and 'secondary' narcissism are not used. Instead we meet with such terms as 'omnipotence', 'confusion of the self and objects', 'introjection of objects', 'projection of aggression into objects', 'insatiable demands towards objects', and 'nullification'. The use of these terms in describing narcissistic patients seems valuable, but it appears to me important and necessary to define more clearly the nature of the relation to objects in narcissism and the particular defence mechanisms related to them. This may be a contradiction in terms, because for many analysts primary narcissism implies an objectless state. But we should remember that Freud regarded the oceanic feeling, the longing for union with God or the Universe, as a primary narcissistic experience. Federn (1929), in discussing primary narcissism, describes the baby's craving for the mother's breast, but suggests that the object is as yet not external to the ego feeling. Abraham (1924) discusses limitless narcissism as a relation to an object in which, while the object is incorporated, the individual pays no attention whatever to the interests of his object, but destroys it without the least hesitation. Balint (1960) went so far as to suggest that what Freud described as primary narcissism should be called primary object love. I myself believe that much confusion would be avoided if we were to recognize that the many clinically observable conditions which resemble Freud's description of primary narcissism are in fact primitive object relations.
科恩（Cohn，1940）和斯通（Stone，1954）的许多观察似乎与我自己的调查研究接近。我注意到，在他们对自恋性移情的描述中，没有使用原初自恋和次级自恋（primary and secondary narcissism）这两个术语。相反，我们会遇到诸如全能、自我与客体的混淆、客体的内摄、对客体的攻击性投射、对客体的贪得无厌的需求和无效化（nullification）等术语。用这些术语来描述自恋患者似乎很有价值，但在我看来，更清楚地定义自恋者与客体的关系本质，以及与之相关的特殊防御机制是很重要且必要的。这种说法看起来有点矛盾，因为对许多分析师来说，原初自恋即意味着一种无客体的状态。但我们应该记住，弗洛伊德所认为的汪洋一般的感觉、渴望与上帝或宇宙相结合——是一种主要的自恋体验。费德恩（Federn，1929）在讨论原初自恋时，描述了婴儿对母亲乳房的渴望，但认为客体在自我感觉中还不是来自外部的。亚伯拉罕（Abraham，1924）讨论了无限自恋（limitless narcissism）作为一种与客体的关系——客体被吞并，个体对他的客体的兴趣毫不在意，但却毫不犹豫地摧毁了它。巴林特（Balint，1960）甚至认为弗洛伊德所描述的原初自恋应该被称为原初客体之爱。我自己认为，如果我们认识到，许多临床可观察到的条件，类似于弗洛伊德对原初自恋的描述，实际上是原始的客体关系，就可以避免许多困惑。
In narcissistic object relations omnipotence plays a prominent part. The object, usually a part-object, the breast, may be omnipotently incorporated, which implies that it is treated as the infant's possession; or the mother or breast are used as containers into which are omnipotently projected the parts of the self which are felt to be undesirable as they cause pain or anxiety.
在自恋的客体关系中，全能感发挥着突出的作用。客体，通常是部分客体，乳房，可以被全能地吞并，这意味着它会被当作婴儿的财产；或者母亲或乳房被用作容器，被视为不受欢迎的自我地部分会被无限地投射进去，因为它们会引起痛苦或焦虑。
Identification is an important factor in narcissistic object relations. It may take place by introjection or by projection. When the object is omnipotently incorporated, the self becomes so identified with the incorporated object that all separate identity or any boundary between self and object is denied. In projective identification parts of the self omnipotently enter an object, for example the mother, to take over certain qualities which would be experienced as desirable, and therefore claim to be the object or part-object. Identification by introjection and by projection usually occur simultaneously.
认同是自恋性客体关系中的一个重要因素。它可以通过内摄或投射发生。当客体被全能吞并时，自我与被吞并的客体变得如此一致，以至于所有分离的身份或自我与客体之间的任何边界都被否认了。在投射性认同中，自我的某些部分全能地进入一个客体，例如母亲，接管某些可能被体验为可取的品质，因此声称自己是客体或部分客体。通过内摄和投射的认同通常同时发生。
In narcissistic object relations defences against any recognition of separateness between self and object play a predominant part. Awareness of separation would lead to feelings of dependence on an object and therefore to anxiety. Dependence on an object implies love for, and recognition of, the value of the object, which leads to aggression, anxiety, and pain because of the inevitable frustrations and their consequences. In addition, dependence stimulates envy, when the goodness of the object is recognized. The omnipotent narcissistic object relations therefore obviate both the aggressive feelings caused by frustration and any awareness of envy. When the infant omnipotently possesses the mother's breast, the breast cannot frustrate him or arouse his envy. Envy is particularly unbearable to the infant and increases the difficulty in admitting dependence and frustration. It seems that the strength and persistence of omnipotent narcissistic object relations are closely related to the strength of the infant's envy. Envy has omnipotent qualities; it seems that it contributes to the omnipotence of the narcissistic object relations while the envy itself may be simultaneously split off and denied. In my clinical observations of narcissistic patients the projection of undesirable qualities into the object plays an important part. The analyst is often pictured in dreams and fantasies as a lavatory or lap. This relationship implies that any disturbing feeling or sensation can immediately be evacuated into the object without any concern for it, the object being generally devalued. In severe narcissistic disturbances we can invariably see the maintenance of a rigid defence against any awareness of psychic reality, since any anxiety which is aroused by conflicts between parts of the self or between self and reality is immediately evacuated. The anxiety which is thus defended against is mainly of a paranoid nature, since narcissistic object relations date from earliest infancy when anxiety is predominantly paranoid.
在自恋性客体关系中，发挥重要作用的是防御任何对自我与客体之间之分离的识别。意识到分离会导致对于一个客体的依赖感，从而导致焦虑。依赖一个客体，意味着对该客体的爱、对其价值的认同，这将导致攻击、焦虑，以及不可避免的挫折及其后果所带来的痛苦。此外，当人们认识到客体的好处时，依赖会激发嫉羡。因此，全能的自恋性客体关系，既避免了由挫折引起的攻击性情绪，也避免了任何嫉羡的意识。当婴儿全能地占有母亲的乳房时，乳房不会使他挫败，也不会唤起他的嫉羡。嫉羡对婴儿来说尤其难以忍受，并且增加了婴儿承认依赖和挫折的难度。全能的自恋性客体关系的强度和持久性，似乎与婴儿嫉羡的强度密切相关。嫉羡具有全能的特性; 它似乎有助于自恋性客体关系的全能感，而嫉羡本身可能会同时被分裂和否认。在我对自恋患者的临床观察中，将不受欢迎的品质投射进客体之中起着重要作用。在梦中和幻想中，分析师常常被描绘成盥洗室或背锅侠。这种关系意味着任何不安的感受或感觉可以立即被疏散到客体中而不需要关心它，客体通常被贬低。在严重的自恋障碍中，我们总能看到一种对任何心理现实的意识的严格防御，任何由自我部分之间或自我与现实之间的冲突所引起的焦虑都会立即被清除。因此被防御之焦虑的本质主要是偏执性的，因为自恋性客体关系始于婴儿期，那个时期的焦虑主要是偏执的。
Clinically, narcissistic object relations often appear to the analyst and are also experienced by the patient as very ideal and desirable object relations. For example the relation to the lavatory/mother in the analysis is frequently felt as ideal, because the patient feels relieved when everything unpleasant can be immediately discharged into the analyst during a session. When the patient claims to possess the analysis, as the feeding breast, he gives himself credit for all the analyst's satisfactory interpretations, a situation which is experienced as perfect or ideal because it increases the patient's feeling during the analytic session that he is good and important. Sometimes narcissistic patients picture themselves in a mutually satisfactory ideal relationship with the analyst where the identity of patient and analyst is not differentiated, a situation reminiscent of Freud's description of the oceanic feeling. Another instance of narcissistic idealization is the patient who feels that he is loved by everyone, or demands to be loved by everyone, because he is so lovable. All these patients seem to have in common the feeling that they contain all the goodness which would otherwise be experienced in a relationship to an object. We usually encounter simultaneously a highly idealized self image, which dominates the analytic situation, and anything interfering with this picture is rigorously defended against and omnipotently denied.
在临床上，自恋性客体关系经常出现在分析师的面前，而病人也会把分析体验成非常理想的、满意的客体关系。例如，在分析中，与厕所/母亲的关系经常被感觉是理想的，因为当所有不愉快的事情都能在分析中立即向分析师释放时，患者感到释然。当病人自以为拥有分析时，他相信分析师的所有满意的解释，这种情况被体验为完美或理想的，就像喂奶的乳房一样，因为它增加了病人在分析过程中的感觉，他是好的和重要的。有时自恋性病人会把自己想象成与分析师处于一种双方都满意的理想关系中，病人和分析师的身份没有区别，这让人想起弗洛伊德对汪洋大海的感觉的描述。另一个自恋性理想化的例子是病人觉得他被每个人爱着，或者要求被每个人爱，因为他是如此的可爱。所有这些病人似乎都有一种共同的感觉，即他们包含了所有美好的东西，而这些美好的东西在与一个客体的关系中是可以体验到的。我们通常会同时遇到一个高度理想化的自我意象，它支配着分析的情境，任何干扰这一意象的东西都会被严格地防御和全能地否认。
I shall now illustrate some of the problems related to severe narcissism by bringing case material from a patient who showed a marked narcissistic transference without being overtly psychotic. There is nothing in the patient's history which would seem to account for his persistent narcissistic attitude. He is the son of fairly wealthy parents, and he has two sisters. He had apparently always managed superficially to get on quite well with people, and was successful at school because of his high intelligence. When he started treatment he had just married and he had some difficulties with his wife. Apart from an occasional feeling of oneness with her he was very jealous and intensely preoccupied with her relations with other people, men and women. The analysis revealed the depth of the patient's narcissism, his lack of emotional contact with other people, and, as a result, the lack of pleasure in his life which made him envious of everybody. He particularly envied his wife who, he felt, was far more capable than he was of enjoying relations with people, including himself. When I first saw the patient he appeared slightly withdrawn from reality and from other people, and had a vaguely superior and patronizing attitude which he tried to disguise. He admitted that he occasionally felt frustrated in personal relations, with friends and his young wife, but generally he blamed them for any difficulty which arose. He was very interested in being analysed in spite of the fact that he did not feel that he really needed analysis. He pictured himself almost immediately as the perfect patient who made enormous progress, but in fact he could make very little proper use of the analysis. He constantly projected his problems into his wife or other people, including the analyst, and was quite unable to experience them as belonging to himself. He enjoyed interpreting his own dreams in detail and explaining his thoughts and feelings, but any conflict, anxiety, or depression which emerged was so quickly discharged that it could barely be experienced. He did not resent interpretations, but on the contrary took them up quickly and talked about them in his own way, feeling very self-satisfied with his knowledge since he did not feel that the analyst had made any contribution. His attitude made it extremely difficult to effect any change in his personality, so that one felt up against a stone wall in a way reminiscent of Freud's description. Behind this stone wall there seemed to be omnipotence hiding hostility and envy, completely denied by the patient and difficult to demonstrate in the analytic material. After I had shown him again and again his avoidance of any close contact with myself or with his own feelings, particularly hostility towards me, he came to a session saying that he now wanted to get closer to his problems. He then told me a dream in which he and others were travelling in a very fast train. He suddenly saw a kind of surrealistic machine land near the train and send out towards it a wide ray of very dangerous fire. Luckily the train escaped this attack by quickly moving away, but there was a feeling that the attack would be repeated. The patient felt that this machine was sent over from Russia by a man who had apparently lived in England before but felt bitter and revengeful because of some ill treatment which he believed he had received. There was a feeling in the dream that some widespread attacks were going to be made on various places in England, mainly hotels with such names as Royal, Royalty, Majestic, Palace, etc., and yet that the attacks were being directed against his parents. There also seemed to be a food shortage. Two girls were in the train with him. In another part of the dream there were a number of girls leaning against a stone wall and prostituting themselves because of the food shortage. He approached one of them and said * Would you like a customer?* but she only laughed, and he felt disappointed, since his approach was made seriously. In his associations he thought that the Russian must be associated with himself, as he felt sympathy with him as though the Russian had a right to make these attacks. He thought he must have hated his parents to be important and therefore felt slighted by them. He thought that the Russian must have wanted to be the most important person himself and that the attacks were a result of his feeling humiliated and therefore resentful. The patient had very little emotional reaction to the dream.
现在，我将通过一个病人的案例材料来说明一些与严重自恋有关的问题，这个病人表现出明显的自恋性移情，但没有明显的精神病症状。病人的病史中没有任何东西似乎可以解释他持续的自恋性态度。他的父母相当富有，他有两个姐妹。从表面上看，他似乎总是能与人相处得很好，而且由于他的高智商，在学校里也很成功。当他开始治疗时，他刚刚结婚，他和他的妻子遇到了一些困难。除了偶尔和她有种合二为一的感觉外，他还非常妒忌她，极其在意她和其他人的关系，包括男人和女人。分析揭示了病人的极度自恋，缺乏与他人的情感交流，因此，他的生活中缺乏乐趣，这使他嫉妒每一个人。他对妻子有很强烈的嫉羡，他觉得她比他更能享受与人的关系，包括和他自己的关系。当我第一次见到这个病人时，他似乎有点回避现实和他人，他试图掩饰一种模糊的优越感和居高临下的态度。他承认，他与朋友和年轻妻子之间的关系有时会让他感到沮丧，但通常他会把出现的任何困难归咎于他们。他对被分析很感兴趣，尽管他并不觉得自己真的需要分析。他几乎马上就把自己想象成一个取得了巨大进步的完美病人，但事实上，他几乎不能恰当地利用这种分析。他不断地把他的问题投射到他的妻子或其他人身上，包括分析师，却完全不能把这些问题看作是属于他自己的。他喜欢详细解释自己的梦，解释自己的想法和感受，但任何冲突、焦虑或沮丧都很快消失，几乎无法体验。他不怨恨解释，相反地，他迅速地接受它们，并以自己的方式谈论它们，对自己的知识感到非常满意，因为他不认为分析师做出了任何贡献。他的态度使他很极难改变自己的人格，所以在某种程度上让人想起弗洛伊德的描述——就像面对着一堵石墙。在这堵石墙的后面，似乎有全能的力量隐藏着敌意和嫉羡，病人完全否认，也很难在分析材料中表现出来。在我一次又一次地向他展示他在回避和我产生任何的关联，也在回避和自己的感受，尤其是对我的敌意，之后有一节分析，他说，他现在想更接近他的问题。然后他告诉我一个梦，在梦里，他和其他人乘坐一辆高速的火车上去旅行。他突然看到一种超现实主义的机器在火车附近着陆，并向它发射了一束非常危险的火焰。幸运的是，火车迅速开走，躲过了这次袭击，但人们感觉袭击还会重演。病人觉得这台机器是由一个似乎以前住在英国的人从俄国送过来的，但他认为自己受到了某种虐待，因此感到痛苦，想报复。在梦里，他有一种感觉，一些大范围的攻击将在英格兰的各个地方进行，主要是酒店的名字，如皇家，皇室，宏伟，宫殿，等等，但这些攻击是针对他父母的。似乎还有食物短缺。两个女孩和他一起在火车上。在梦的另一部分，因为食物短缺，有许多女孩靠在石墙上卖淫。他走到其中一个人面前说：“你想要个顾客吗?”但她只是笑了笑，他感到很失望，因为他是很认真地走近她的。在他的联想中，他认为俄国人必然和他自己有关，因为他同情俄国人，仿佛俄国人有权发动这些攻击似的。他想他一定是讨厌他的父母如此重要，因此感到被他们轻视了。他认为俄国人一定是想自己成为最重要的人物，而这些攻击是他感到屈辱和怨恨的结果。病人对这个梦几乎没有什么情绪反应。
The dream shows very clearly the omnipotent virulence of an extremely hostile omnipotent part of his personality which makes attacks both on the important superior parents and on a part of himself. The reason for the attacks is obviously derived from his babyhood envy of the important grown-ups because the parents, in his association^, are accused of humiliating him and making him feel small. It is also clear in the dream that the Russian has a paranoid grudge, which is an admission of his own paranoid attitude which is consciously denied. The train moving quickly to avoid any contact with the destructive rays is related to his train of thought and his own self containing the two breasts (girls). In fact he prides himself on being able to move extremely quickly and cleverly, and so in his thoughts being able to avoid any contact with his destructive self. The dream implies that making contact with the analyst as an important parentalfigure arouses dangerous, envious, paranoid impulses. It is interesting in the dream, that the envious paranoid Russian is placed in the distance, while the destructiveness emanating from him influences the patient's train of thought, his contacts and relations to his parents and women. The dream shows clearly how in narcissistic relationships envy is split off and kept away from self-awareness, and at the same time the patient's destructiveness keeps his object relations devalued and so enables him to by-pass his difficulties. An interesting feature in the dream is the food shortage which makes the girls into prostitutes. This implies that the importance of the breast is denied, and women are devalued into prostitutes, who, lacking food or breasts cannot feed themselves and therefore have to come to the patient to get money for food: this would also indicate a projection of the dependence into the prostitutes.
这个梦非常清楚地显示了他人格中充满敌意的全能部分的全能毒性，它攻击了重要的、优越的父母和他自己的一部分。攻击的原因显然来自于他童年时对重要的成年人的嫉羡，因为在他的联想中，他指责父母羞辱他，让他觉得自己很渺小。在梦里也可以清楚地看到，这个俄罗斯人有一种偏执的怨恨，这是对他自己偏执态度的承认，但在意识层面上被否认了。为了避免与破坏性射线接触而快速移动的列车，与他的思想列车以及包含两个乳房（女孩）的自我有关。事实上，他为自己能够非常迅速和聪明地移动而自豪，因此在他的思想中能够避免与他的破坏性自我有任何接触。这个梦暗示着，和分析师这样一个重要的家长意象产生里联系，会引起危险、嫉羡和偏执的冲动。有趣的是，这个充满嫉羡的、偏执的俄国人被放在远处，而从他身上散发出的破坏性影响了病人的思路、他与父母和女人的联系和关系。这个梦清楚地表明，在自恋性关系中，嫉羡是如何被分裂，并远离自我意识的，与此同时，病人的破坏性使他的客体关系贬值，从而使他能够绕过他的困难。梦中的一个有趣的重要意象是食物短缺，使得女孩们成为妓女。这意味着乳房的重要性被否定了，女性被贬低为妓女，她们缺乏食物和乳房，无法养活自己，因此不得不去找病人去赚钱买食物：这也表明了他把依赖投射到了妓女身上。
As the patient had started the session by saying that he had made up his mind to get on with the analysis, in other words wanted to come closer to me, it is clear that the dream reveals not only his attitude to women but to the analyst also. He deals with his fear of being rejected by me by approaching me-in a superior way turning me into a prostitute. It is interesting that the prostitutes lean against a stone wall, which would confirm that the stone wall of the narcissistic transference has to be linked with narcissistic object relations, which are emerging in the analysis.
在这节分析开始时，他说他已经下定决心继续进行分析，换句话说，他想接近我，很明显，这个梦不仅揭示了他对女性的态度，也揭示了他对分析师的态度。为了应对被我拒绝的恐惧，他以一种高高在上的方式接近我，把我变成了一个妓女。有趣的是，妓女靠在石墙上，这将证实自恋性移情的石墙与自恋性客体关系有关，这也在分析中出现了。
Following this dream the patient's aggressive superiority towards the analyst was more openly admitted in dreams and associations, but his desire to possess the analysis and feel that it was his own creation was only admitted openly after the following dream. The patient was shopping, and was offered a special kind of salt packed in self-made containers. It was much cheaper than ordinary salt, only ninepence for four pounds. He asked the storekeeper whether it was as good as ordinary salt. In spite of the storekeeper's assurance that it was perfectly all right, the patient himself did not believe it. On leaving the shop it took him about two hours to get home, and he felt guilty because he was afraid that his wife would be waiting anxiously for him. The patient remarked that he had had to buy salt the day before because they had run out of it. He felt sure that the salt must have something to do with the analysis, as four pounds reminded him of coming four times a week to his sessions. He stressed that the salt was so much cheaper because obviously the people had made it up themselves. I could show the patient in this dream that ostensibly he comes to me to have analysis, but he maintains that what he gets from me is his own self-made version of the analysis which he pretends to himself is as good as the ordinary analysis. He obviously tries in the dream to get reassurance from the shopkeeper/analyst that this is right and normal, but he admits that he does not really believe this himself. Staying out late implies a projection into his wife of his feelings of dependence and the anxiety about having to wait. The dream illustrates that the patient has not as yet admitted to himself his dependence on me; it is denied and projected, and this continuously leads to acting out. I would like to add here the general meaning of the self-made version of the analysis, which is clearly represented in this dream, because it plays a very important part in the analysis of many narcissistic patients. While ostensibly the narcissistic patient maintains that he has a superior and sometimes more creative breast in his possession, which gives him better analysis and food than the mother-analyst could ever produce, careful analysis reveals that this highly valued possession of the patient represents his own faeces which have always been highly idealized, a fact carefully concealed by the patient. The unmasking of the situation, while it may temporarily lead to the patient's feeling severely deflated, is essential if real relations to external and internal objects are ever to be established.
在这个梦之后，病人对分析师的攻击性的优越感在梦和联想中被更坦率地承认，但他想拥有分析并感觉这是他自己创造的欲望，只有在接下来的梦之后才被开放地承认——这位病人正在购物，店家给他提供了一种自制容器包装的特殊的盐。这种盐比普通盐便宜得多，四磅只要九便士。他问店主它是否和普通的盐一样好。尽管店主保证说一切正常，病人自己还是不相信。离开商店时，他花了大约两个小时才回到家。他感到内疚，因为他担心妻子会焦急地等着他。病人说前一天他不得不去买盐，因为他们的盐用完了。他确信盐一定与分析有关，因为四磅让他想起了每周他来做四次分析。他强调，盐之所以这么便宜，显然是因为这是他们自己做的。我可以告诉病人，在这个梦里，表面上他是来找我做分析的，但他坚持说，他从我这里得到的是他自己做的分析，他假装自己的分析和普通的分析一样好。显然，他在梦里试图从店主-分析师那里得到安慰，让他相信这是正确和正常的，但他承认，他自己并不真的相信这一点。在外面呆到很晚暗示着他将依赖和不得不等待的焦虑投射到了妻子身上。这个梦说明病人还没有承认他自己依赖我; 它被否定和投射，而这持续地导致他见诸行动。我想在这里补充一下自制分析的一般性含义，因为它在很多自恋患者的分析中起着非常重要的作用，这在这个梦中得到了清晰的体现。虽然从表面上看，这位自恋的病人坚称，他拥有一个更优秀、有时更有创造力的乳房，这给了他比母亲-分析师更好的分析能力和食物， 进一步的分析表明，这种高度珍贵的粪便代表了他自己的粪便，这一直是被高度理想化的，一个精心隐藏的事实。如果要建立与外部和内部客体的真实关系，揭露这些是至关重要的，虽然它可能暂时导致患者感到严重泄气。
In a later dream the patient illustrates how he entirely reverses the relationship to the analyst by omnipotent projective identifications. In the dream the patient was a doctor holding a surgery. He had a cake, and four women were coming to see him. He suspected that these women were only pretending that they were ill in order to get attention. There was some trouble on the roof of the house and he was starting to repair it. A noise was heard of something falling down, or of hammering, and at the first sound the women quickly withdrew, afraid that something might fall on them. In his associations the patient described the women as fat and greedy. The dream shows in an undisguised way that the patient has put himself in the role of the analyst who not only possesses the cake-the breast-but also does the reparative work. His own greedy attitude of simply wanting to get food from the analysis without really admitting that he is ill, and withdrawing from me quickly whenever I make an interpretation which might touch him, is projected on to the four women who, as often before, represent the analysis or the analyst (cf. the four pounds of salt). We notice that in the dream the patient has become more appreciative of the analyst and the reparative work of the analysis, and feels critical of his own greedy demands on the analyst and of his constant withdrawals whenever he hears an interpretation which he feels is good. However, he evacuates entirely his unsatisfactory attitude into the analyst, who in the dream is changed into the patient's unsatisfactory self, while he takes over the role of the analyst whom he admires.
在后来的一个梦中，病人说明了他如何通过全能的投射性认同，完全逆转了与分析师的关系。在梦里，病人是一个主持手术的医生。他吃了一块蛋糕，四个女人来看他。他怀疑这些妇女只是为了引起关注而假装生病。房子的屋顶上出了点毛病，他开始修理。他听到有什么东西掉下来的声音，或者是敲击声，她们一听到响声就赶紧退了出去，担心会有什么东西砸到她们身上。在他的联想中，病人描述这些女人又胖又贪婪。这个梦以一种毫不掩饰的方式表明，病人把自己置于分析师的角色中，他不仅拥有蛋糕——乳房，而且还做着修复工作。只是想从分析中获取食物却不真的承认他病了，每当我做出一个可能触动他的解释，他就迅速撤退——他把自己这种贪婪的态度投射到了那四个女性身上，和之前一样，这四个女性代表着分析或分析师（就像那四磅盐）。我们注意到，在梦中，病人变得更加感激分析师和分析的修复工作，每当他听到一个他认为是好的解释，就会让他意识到自己对分析师的贪婪需求，以及他的不断回避，这让他感到被批评，然而，他将自己不满的态度完全转移到了分析师身上，后者在梦中变成了病人不满意的自我，而他则取代了自己钦佩的分析师的角色。
I shall now go on to discuss some of the more practical considerations in the analysis of narcissistic patients. A powerful resistance in their analysis is derived from their superior omnipotent attitude, which denies any need for dependence and the anxieties related to it. This behaviour is often extremely repetitive, and there are many alternative versions which are used by the narcissistic patient. The intelligent narcissist often uses his intellectual insight to agree verbally with the analyst and recapitulates in his own words what has been analysed in previous sessions. This behaviour not only blocks any contact and progress, but is an example of the narcissistic object relation I have been describing. The patient uses the analytic interpretations but deprives them quickly of life and meaning, so that only meaningless words are left. These words are then felt to be the patient's own possession, which he idealizes and which gives him a sense of superiority. An alternative method is shown by patients who never really accept the analyst's interpretations, but constantly develop theories, which they regard as superior versions of analysis.
现在，我将继续讨论分析自恋患者时的一些更实际的考虑。在他们的分析中，一种强烈的阻抗来自于他们优越的全能态度，这种态度否认任何依赖的需要和与之相关的焦虑。这种行为往往会不断重复，自恋患者会采用许多不同版本的方式去重复。聪明的自恋者经常使用自身的智慧洞察力，在口头上与分析师达成一致，并用他自己的语言概括在前几次分析中分析的内容。这种行为不仅阻碍了任何连接和进展，也是我所描述的自恋性客体关系的一个例子。病人使用分析性的诠释，但很快就剥夺了它们的生命和意义，所以只剩下无意义的词语。这些词被认为是病人自己的财产，他将其理想化，并给予自己一种优越感。还有一些病人从未真正接受分析师的诠释，但他们会不断发展出理论，他们会认为这些理论才是更好的分析版本，这是他们使用的另一种方法。
In thefirst case the patient steals the interpretations representing the breast from the analyst /mother, turning them into faeces; he then idealizes them and feeds them back to the analyst. In the second case the patient's own theories are produced as if there were idealized faeces, which are presented as food superior to the breast, which the analyst /mother provides. The main source of this resistance and behaviour comes from the narcissistic patient's denial of envy, which is only forced into the open when he has to recognize the analyst's superiority as a feeding mother. The patient whose dreams I have discussed here gradually admitted that he had to keep vague and uncertain that it was I who actually gave him the analysis, because any real clarity about my role led to unbearable feelings of his being small, hungry, and humiliated, which he deeply resented even when I was available. Occasionally resentment broke through, and the patient felt that I had all the answers and gave him only some. Why should he listen to me or depend on me if what I gave him was not complete? This resentment was derived from envious feelings against the analyst/mother who, possessing the breast, only feeds the child, instead of handing over the breast to him completely. Atfirst such a break-through was only fleeting and the patient guarded against such feelings by quickly putting himself into a superior position to me by thinking of something at which he excelled. There was a powerful resistance also from his ideal self-image which he was slowly able to describe in the following way: 'I want to feel good and have a perfect relation to you. Why should I admit anything bad which would spoil the good picture I have of myself which I feel you must admire too?'
在第一种情况下，病人从分析师/母亲那里窃取了代表乳房的诠释，把它们变成了粪便；然后他将它们理想化并返还给分析师。在第二种情况下，病人制造了自己的理论，就像有理想化的粪便一样，这些粪便作为优于母乳的食物呈现出来，而母乳是分析师/母亲提供的。这种阻抗和行为主要源于自恋病人对嫉羡的否认，只有当他不得不承认分析师作为哺乳母亲的优越性时，这种否认才被迫公开。前面我讨论的那个病人，在讨论过那些梦之后，逐渐承认他必须保持模糊和不确定，不能明确是我给他提供分析，因为任何真正明确我的角色的事情将导致无法忍受的感觉——他是那么渺小、饥饿及丢脸，他痛恨这些，即使我是可用的。偶尔他会爆发怨恨，他觉得我知道所有的答案，却只给了他一些。若我所给他的不是全部，他凭什么听我的话，倚靠我呢?这种怨恨源于对拥有乳房的分析师/母亲的嫉羡，她只是喂养孩子，而不是把乳房完全给他。起初，这种突破只是转瞬即逝的，病人为了防止这种感觉，迅速地把自己置于比我优越的位置，想到他擅长的事情。他的理想自我意象也会产生一种强烈的阻抗，他慢慢地可以用以下方式来描述：“我想感觉良好，想和你有一种完美的关系。我为什么要承认任何不好的东西，破坏我对自己的好印象呢？我觉得你一定也会喜欢我好的样子的。“
The rigid preservation of the ideal self-image blocks any progress in the analysis of narcissistic patients, because it is felt to be endangered by any insight and contact with psychic reality. The ideal self-image of the narcissistic patient may be thought of as a highly pathological structure based on the patient's omnipotence and denial of reality.
对理想的自我意象的严格保护，阻碍了对自恋患者进行分析的任何进展，因为任何与心理现实有关的领悟和接触都被会认为是危险的。自恋患者的理想自我意象可以被视为一种高度病态的结构，其基础是患者的全能感和对现实的否认。
Only very slowly was the patient able to admit that the keeping up of the ideal self-image meant an elimination of all my interpretations which might endanger the perfect image of himself. He began to notice that he constantly lost contact with everything which had been discussed during the sessions. This was painful to him, but the pain was again quickly eliminated, despite the fact, that it meant expulsion of the good experience with the analyst, which had led to the painful insight. This attitude is very characteristic of the narcissistic patient, and not only pain but insight is expelled again and again. For example, when my patient's need to be dependent came more to the surface, he at first projected the dependence into his wife and acted it out with her by creating a situation where she was depressed and in need. He then explained to her the reasons why she was depressed, and became angry when she did not immediately understand his interpretations and behave properly. However, he gradually became aware that this expulsion of his dependence, and thus insight, constantly created more difficulties and frustrations in his life. We discovered that whenever the patient acknowledged any real understanding about himself and tried not to project his feelings, he became anxious and depressed. At that moment he became confused and he heard himself saying, 'This is dangerous', in response to which he again expelled the anxiety, depression, and insight. I then showed him that what was endangered in such a situation was not his sane or good self but his omnipotent mad self. This struck him very forcibly, and he said it felt to him like driving in his car and coming up against a red light. This of course was a danger signal to stop, but he felt that his danger signal made him feel that he wanted merely to accelerate to get through the red light without stopping, in other words to get through the danger of being confronted with sanity and reality and back into his idealized omnipotent position.
病人慢慢地才承认，保持理想自我意象意味着消除我所有可能危及他完美意象的诠释。他开始注意到，他经常与分析期间讨论的一切失去联系。这对他来说是痛苦的，但这种痛苦又很快被消除了，尽管这意味着与分析师的良好体验——带来痛苦领悟的体验被驱逐。这种态度是自恋患者的典型特征，不仅痛苦，而且领悟会被一次又一次地驱逐。例如，当我的病人对依赖的需求越来越明显时，他首先将这种依赖投射到他的妻子身上，并通过创造一个让她感到抑郁和需要帮助的环境来和她一起表现出来。然后，他向她解释了她抑郁的原因，当她没有立即理解他的解释并恰当反应时，他就生气了。然而，他逐渐意识到，这种对他的依赖和领悟的驱逐，不断地给他的生活带来更多的困难和挫折。我们发现，每当病人意识到对自己的真正理解，并尽量不把自己的感受投射出去时，他就会变得焦虑和抑郁。在那一刻，他变得困惑起来，他听到自己在说，“这很危险”，然后他的反应是再次驱逐了焦虑、抑郁和领悟。然后我告诉他，在这种情况下，危险的不是他的理智或好的自我，而是他的全能疯狂的自我。这当然是一个危险的停止信号，但他觉得危险信号使他觉得，他就想加速通过红灯而没有停止，换句话说，跳过面对理智和现实的危险，直接回到他理想化的全能位置。
Clinical Prognosis.The clinical result of the analysis of a narcissistic patient depends on the degree to which he is gradually able to acknowledge the relationship to the analyst, representing the mother in the feeding situation. This implies an overcoming of some of the problems I have been describing and therefore a recognition of separation and frustration and a working through of what Melanie Klein has called the depressive position. We have also to take into account that some narcissistic patients have often a less narcissistic, a more normal object-directed part of the personality, and improvement has to be measured in terms of the integration of the narcissistic parts of the personality with this. To bring about an improvement, the omnipotent narcissism of the patient and all the aspects related to it have to be laid bare in detail during the analytic process and to be integrated with the more normally concerned part of the patient. It is this part of the analysis which seems to be so unbearable. Splitting results again and again when either the normal or the omnipotent parts of the self are denied. Often the attempt at integration fails because mechanisms related to the omnipotent narcissistic self suddenly take over control of the normal self in an attempt to divert or expel the painful recognition. However, there are patients who gradually succeed in their struggles against narcissistic omnipotence, and this should encourage us as analysts to continue our research into the clinical and theoretical problems of narcissism.
临床预后。自恋患者的分析的临床结果，取决于他逐渐能够承认与分析师的关系的程度，分析师就代表着喂养情境下的母亲。这意味着克服了我所描述的一些问题，从而意识到分离和挫折以及修通了梅兰妮·克莱因所说的抑郁心位。我们还必须考虑到一些自恋患者通常没那么自恋，人格中有更正常的客体导向的部分，那么他们的改善必须通过人格中的自恋部分与这部分的整合来衡量。为了使病情得到改善，在分析过程中必须详细地揭露病人的全能自恋以及与之相关的所有方面，并与病人更关心的正常部分相结合。这部分分析似乎是如此难以忍受。当自我的正常部分或全能部分被否定时，分裂的结果一次又一次地出现。通常，整合的尝试失败是因为与全能自恋自我相关的机制突然接管了正常自我的控制，试图转移或驱逐痛苦的认知。然而，有一些患者在与自恋的全能感的斗争中逐渐取得了成功，这应该鼓励我们作为分析师继续研究自恋的临床和理论问题。
1964 Rosenfeld, H. 'On the psychopathology of narcissism: A clinical approach', International Journal of Psychoanalysis. 45: 332-337; republished in Psychotic States. Hogarth Press (1965).
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