The Last Psychiatrist is an Id Analyst Disguised as a Self Psychologist.

While I greatly enjoy The Last Psychiatrist, I’ve come to see his work as a good foil for my own perspective.  Here’s a criticism of a vignette he posted some time ago about transference.

TLP relates the story of a man going through some relationship troubles and notes who at one point flattered him with the following:

4.a. I had noticed narcissistic behavior in me before several times and I’ve been trying to change. For instance, somehow I thought I’d look ridiculous giving someone a gift so I didn’t usually did that, no matter the circumstance. I originally thought giving a gift was about me, a reflection on me, not about the person receiving the gift. When I came back from Denver I brought a Broncos jersey for my little brother, but I was worried about what my father would think of me and about my choice of a gift, and stuff like that, but I focused on how my brother would feel receiving the gift. It may sound silly but for me that was a big deal. It pisses me off that I forgot to pay attention to her feelings in this situation.

This is obviously self critical.  Perhaps TLP would identify the superego effects in play with all this negative self talk?  Perhaps he could point out that giving gifts is always partially self interested (See The Gift, Mauss,  or Derrida, Given Time or The Gift of Death).  Furthermore, he could point out that it’s natural to worry about how other people will react to a gift, and similarly to feel like you shouldn’t be so worried about it.

Instead of offering any of these TLP offers a developmental explanation which I will summarize “You want my approval, just like your fathers, and are tricking me into giving it to you with this story, and in general, by the way you are acting it out in your life.”

This is a developmental explanation tinged with the assumptions of Id analysis and commonsense moralizing.  Patients are seen as crafty adversaries, childishly trying to get one over on their analysts.  Or, at best, to be stuck at a developmental stage.

TLP rightly did not give his full scooby-doo explanation (why you’re really doing what you’re doing) because it would be taken as a confrontation.  The analysand would be left with either:

  • Denying that he is looking for approval.
  • Feeling shame about looking for approval.

To see the super-ego effects you should look for what both TLP and the analysand don’t bother to question:  It’s bad/wrong/evil/childish/immature to want approval, and worse to try and get it indirectly from others.

Given that we can assume they both agree on this point, it is doubtless that the client was already dealing with repressed shame about wanting approval – and thus acting it out in the transference and his life.  The key to this distinction is that TLP felt disapproving.  That is how I look at this.  It is not in the words.  The words are the content.  It is in the relationship someone has to the content that you will find transference feelings, which are a clue to how the client relates to the content.  Something is standing between TLP and his ability to be empathic with his client.  What that is, in this case, is his client.

Not only do I think approval from important others is an ordinary adult need, I think it is normal to feel bad about wanting it.  What might help this client experience some relief would be  to become able to experience and talk about how he feels ashamed about wanting approval from TLP.  

The traditional path to this kind of insight is to withhold response – in the old days they would call this intensifying the transfer neurosis.  This is, unfortunately, a long a troublesome process.  It eventually infuriates narcissists and makes borderlines feel abandoned.

Objectivity from the standpoint of the analyst/analysand dyad is not possible, as TLP correctly notes.  However, an interpretation that is neutral from the standpoint of the client is possible to the extent it is ego analytical (identifies and relieves superego tension).  It is never easy to arrive at this kind of thinking, but it might eventually look something like:

  • “It seems like you’ve noticed some changes but are still disappointed by what seem like setbacks.  You’d like to feel like you are making improvement but are undone by doubts that are subtle and difficult to dispel.  It would be natural for anyone dealing with this to want some reassurance, and they would probably find it hard to imagine they could enjoy asking for it.

Even this may still just enrage or shame the client, who couldn’t help but feel accused of being childish.  Then again, perhaps the client would feel this way naturally because it is exactly what TLP actually believes.  TLP prevents TLP from being neutral from the standpoint of the client because of his explanatory framework and the transference effect of the clients unspoken shame about his dependency needs.

8 thoughts on “The Last Psychiatrist is an Id Analyst Disguised as a Self Psychologist.”

  1. Your writings are insightful. Do you think that there is a way to help someone else who falls into Alone’s type of narcissism?

    And by that i mean a person who is in a permanent state of mental masturbation, avoiding obstacles (and change), constantly adjusting the narrative to justify their stagnation – instead of taking practical action.

    The only thing i partially regret in life are the years that i was that person, in the beginning of adulthood (i’m in my 30’s now). I had a shot and i missed by lack of action and other people suffered because of it (indirectly, because i could’ve help them if i wasn’t stuck looking at the pool). And now i have a young friend (recent welcomed to adulthood) and i see the same pattern. Bright guy, pretty ideals, zero action.

    1. Thanks for the encouragement. The long version – I would recommend therapy. For minor attitude adjustments try this: Narcissism looks like an obsession with self but can also be seen as an obsession with others. The way out of this is to find people you sincerely admire and try to emulate their ethics and values, not personality and achievements. This is easier when your role models at at a bit of distance to you, instead of right in your face where it is easy to either get competitive or fall into a cycle of worship/disappointment.

      If you can’t find people to admire, or can’t enjoy taking on their ethics, then you’re probably suffering from an excess of shame and resentment and that’s where to start. Hope that helps.

  2. ”This is a classic clue to being around people we’d call narcissistic – they challenge your narcissism. ”

    Might I ask what you mean by this? Are you saying that the commentor you were replying to is narcissistic, and he feels pushed away by his therapist because his narcissism is activating the therapist’s narcissistic defenses – or that his therapist is narcissistic and that is challenging the patient?

    Also, ”It’s hard not to hear this as a criticism – but therapists especially do indeed want to help. The patient of course often picks up on this and finds it unbearable to deal with or handle other people’s narcissism. ” seems hard to follow as well?

    Thanks if you can reply (and really great blog!)

    1. What I meant is that the desire to help or be significant on the part of the therapist can be challenged by the client. Hope that helps – thanks.

  3. Tough call, though my objections are that (A) TLP’s writing style suggests we shouldn’t read the father thing as anything other than an opportunity to throw a curveball for emotional effect, and (B)
    sex workers tend to separate business and pleasure when it comes to sex, and professional empaths frequently do the same thing with empathy. To even suggest that something is standing between TLP and his client is making a massive (and strange, if you’re a clinician yourself) leap to identifying “a random commenter on the internet” as “TLP’s paying client.” This is not a practitioner-client relationship. This is a blog about sex and media. The guy gets off on seeing things in ways that other people don’t, and I think he’s done a good job of offering that to this kid.

    1. Thanks for the comment – I think you’re right on many counts. Critique of therapeutic technique is probably best accomplished under observation, but theoretically all we have to go on is case books and writeups.

      In this case (admittedly made up to make a point) TLP was making a few points (1) that his clients are really trying to trick him, (2) that you can’t analyze the transference, and I strongly infer that TLP thinks (3) people shouldn’t have narcissistic needs like the need for approval from their therapist.

      My contention is that if he were himself were less attached to the assumptions of drive theory he might interpret the failure of long term therapy more emphatically – perhaps his clients have to hide their narcissistic needs from him because they can tell he thinks they are weak, immature or bad to express them more directly.

      To call the transference imaginary leaves TLP with the difficult position of defining what part of what we call relationships are not imaginary.

      The failure of interpretation and the negative therapeutic reaction are real phenomena. If one explains those through the traditional line of thinking you are left with the conclusion people are bad, instead of concluding that the act of interpreting drives (telling someone they want your approval) is shame inducing. What I’m saying is that if you can relieve the shame one can choose more freely and connect the dots in broad daylight of something like getting approval and answer how much they really need that after all.

      TLP leans towards the “bitter pill to swallow” type of thinking about therapy. In my view, an effective interpretation is one which produces relief, i.e. feels good.

      All speculation, but then again – this is just a blog too and I enjoy a good spar with an intellectual figure I admire. Thanks again for the comment.

  4. This is very interesting. I really like many of TLPs analyses and I find they’ve deepened my understanding of human behaviour and motivations, though I began to feel that TLP was very critical and judging in a way that made some of the analyses self-defeating. I didn’t really know how to characterize it though.

    Part of my dilemma came from my own experience. Being a very analytical individual, I’ve experienced many times where my judgement of a conversation, or someone’s words, made it feel like there was a gap between us that was unbridgeable – despite never pointing it out verbally. The natural questions that come up are “Is it me or is it them?”, “Am I looking at this wrong?”, “How should I be acting/responding and is there a disconnect in my thought process that is leading to this disconnect?”.

    I felt uncomfortable with the analysis you are referencing specifically because it felt like it was unhelpful. The way I understood it, if I were in TLP’s shoes I wouldn’t feel any closer to helping the client – and if anything I’d feel I was pushing them away. Sure, it may validate TLP’s diagnosis within his/her analytical framework, but what does it do for the client who now surely feels the divide between them and the silence which is characterized more by judgement than by empathy.

    1. Thanks for commenting David. In your last passage you mention how you’d feel pushed away and unhelpful. This is a classic clue to being around people we’d call narcissistic – they challenge your narcissism. It’s hard not to hear this as a criticism – but therapists especially do indeed want to help. The patient of course often picks up on this and finds it unbearable to deal with or handle other people’s narcissism. This is close to the developmental genesis of the experience (early caregiver objectification) and makes their behavior compulsive – avoiding dealing with the contact of another ego. Kohout’s analysis of the self is seminal here (The Analysis of the Self, 1971).

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