This study compares the effects of exploratory, insight-oriented (EIO) and reality-adaptive, supportive (RAS) forms of psychotherapy on a sample of 95 schizophrenic patients. Analyses of 2-year outcomes revealed a complex interaction between the type of psychotherapy provided and the domain of psychopathology affected. RAS psychotherapy exerted clear preferential effects in the areas of recidivism and role performance. The EIO psychotherapy exerted preferential, albeit more modest, action in the areas of ego functioning and cognition. Overall, however, the magnitude of the differences was low. The results highlighted the need for more focused studies of subgroups, and of process and contextual influences on outcome.

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Near the end of The Public Enemy (Wellman: 1931), luck runs out on the mobster played by Jimmy Cagney as he falls in a rain of police bullets. There is a fleeting moment between his realization of what is happening to him and his death. It is a moment of confrontation between his grandiose sense of invulnerability and the reality of his mortality. With a look of disbelief on his face he mutters: ''I ain't so tough'', and falls into the gutter. Like most Mafia movies, The Public Enemy is a morality play. It tells the story, repeated in so many other Mafia films, of a protagonist whose lust for power and belief in his own invincibility fuel his rise from the street to the top of the mob world. Then, as in Greek myth, the anti-hero overreaches and commits the classical sin of hubris: believing in his own divinity. He perishes, the victim of his own manic denial.While there are countless dramas that recount the rise and fall of the overreaching hero, Mafia films have a special twist. They focus on destructive narcissism and depict the seductiveness of a fantasy in which a person is so powerful and untouchable that he is beyond the rules of law and retribution. In this fantasy, a person can indulge his desire to dominate and humiliate others, especially others who have insulted him. In real life, we are all forced to tolerate slights, disrespect, and continual reminders that we are not at the center of the universe. The celluloid mobster lives out the universal desire to retaliate for narcissistic injury, to retaliate totally and brutally, destroying the offender. He exists in a universe of libidinized hatred, where the pleasures of omnipotent destructiveness are so sweet that eventually the hero cannot resist them, even if it means that he is destroyed as he is destroying others.In the psychoanalytic literature, Rosenfeld (1964Rosenfeld ( , 1971) developed the concept of destructive narcissism and, in recent years, Steiner (1993) and Kernberg (2007) have refined and elaborated it. Steiner writes of a world of inner objects that is like a Mafia gang. Within this world:Reality is based on a retreat from the truth to omnipotence … The retreat is one in which reality is dismissed and the organization on which it is based peopled with omnipotent figures who claim respect from their divinity and power. The truth does not have to be argued or justified and shame and guilt are inappropriate. It is indeed the lack of shame which makes these alliances with omnipotent figures so dangerous since normal restraints on destructiveness and cruelty are rendered inoperative.

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