Pathological narcissism in an eight-year-old boy: An example of Bellak's TAT and CAT diagnostic system.

Abstract

Narcissistic pathology is difficult to assess in psychological testing of children and adults. Contemporary psychoanalytic diagnosis is based on Freud's (1915) metapsychological points of view and A. Freud's (1965) developmental profile, as in Schafer's (1954) Rorschach approach and Bellak's (1986) system for the Thematic Apperception Test and Children's Apperception Test. Bellak (1986) provided an analysis of the relation of the ego (self-concept characteristics of the main hero, conception of the world, interpersonal object relations, defense mechanisms, and 12 ego functions), id (thematic analysis, needs, anxieties, and significant conflicts), and superego. A case example of narcissistic pathology in a young child's Children's Apperception Test demonstrates this method of psychoanalytic diagnosis. Neurotic conditions have been extensively studied in the projective test literature. The past decade has witnessed a revival of psychoanalytic studies of Rorschach test characteristics of patients with the preoedipal condition of borderline pathology (

My perceptions of the Thematic Apperception Test in psychodiagnosis and psychotherapy.

“…This perspective is very useful in studying responses to the TAT and is not in conflict with basic psychoanalytic theory or the way I have always interpreted responses to these stimuli. Those who like Kohut's (1971Kohut's ( , 1974 contributions to self-psychology may find it useful to read a case study that my colleague Abrams (1993) illustrated with a thematic test protocol of narcissistic pathology. I believe that the field of TAT assessment needs more such clinical case protocols, which include multiple diagnostic perspectives from different schools of psychotherapy.…”

Six decades of the Bellak scoring system, among others.

“…However, pioneering adult TAT case presentations of narcissistic patients have been published by Francoise Brelet-Foulard (Brelet, 198 l , 1983(Brelet, 198 l , , 1986Brelet-Foulard, 1994) in France and Shulman, McGarthy, and Ferguson (1988) in the United States. I (Abrams, 1993(Abrams, /1995 have published narcissistic child and adolescent Children's Apperception Test (CAT) and TAT case presentations.…”

“…Other developments in the last 2 decades of TAT research have been the extension of the TAT into diagnostic studies of borderline disorders (Rogoff, 1985;Rosoff, 1988;Westen, Klepser, et al, 1991;Westen, Lohr, et al, 1990;Westen, Ludolph, Block, Wixom, & Wiss, 1991;Westen, Ludolph, et al, 1990), the aforementioned work on narcissistic disorders (Abrams, 1993(Abrams, /1995Brelet, 1981Brelet, , 1983Brelet, , 1986Brelet-Foulard, 1994Harder, 1979;Shulman et al, 1988), attention deficit disorder (Bellak & Abrams, 1997;Costantino, Colon-Malgady, Malgady, & Perez, 19911, mental retardation (Hurley & Sovner, 19851, substance abuse (Brelet, 1988;Cabal Bravo et al, 1990;Fassino et al, 1992;Wilson, Passik, Faude, Abrams, & Gordon, 19891, eating disorders (Williams, 1986), and trauma (Henderson, 1990;Hoffman & Kuperman, 1990;Stovall & Craig, 1990).…”

“…Most notably there is Cramer's (1991aCramer's ( , 1991bCramer's ( , 1996 scoring of defenses and the scoring of Bellak's interpersonal object relations category. Although any one of Bellak's 10 scoring dimensions may provide a fairly good clinical assessment of TAT responses (Abrams, 1993), psychologists should question whether even a 4-part purely object relations approach, such as that of Westen, is too one sided for clinical use.…”