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In this paper, the authors present an overview of a range of psychoanalytic understandings of narcissistic pathology with an emphasis on the model and system of classification described by Kernberg. They discuss how the concept of a fundamental split between object relations dyads can contribute to major pathology of superego development and functioning and to the defensive establishment of the false grandiose self that are central to pathological narcissism. The authors also review therapeutic modifications that can help clinicians effectively treat patients with narcissistic pathology and describe distinctions in levels of narcissism that influence both how to approach treatment and prognosis.

This paper illustrates the centrality of attachment issues in a manualized psychodynamic psychotherapy for BPD, Transference-focused psychotherapy (TFP). The focus is on how the psychotherapist's awareness of these issues may advance the understanding of psychopathological processes mediated by attachment disorganization, and in particular how the patient-therapist match may foster or impede disorganized attachment.