ABSTRACT
The title of this chapter refers to the—sometimes insurmountable—technical difficulties faced by the therapist in the treatment of patients with severe disorders, particularly narcissistic or self-centred patients. The chapter presents clinical material on the analysis of a perverse self-centred patient to whom he will refer as Matias, by means of which he attempts to illustrate the dilemma of interpretive technique. It presents clinical material intended to illustrate both the difficulties that hindered my attempts to apply a technique based exclusively on transference interpretations, and the specific modifications he was forced to introduce. The problem of modifications to a supposedly standard technique, which, incidentally, is defined differently by different psychoanalytic schools and approaches, emerges particularly in relation to cases of serious pathology. The problem of modifications to a supposedly standard technique, which, incidentally, is defined differently by different psychoanalytic schools and approaches, emerges particularly in relation to cases of serious pathology.
