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Treatment: The Integration of Mirroring and the Dissolution of the Mask

Before addressing the above question in the context of pathological narcissism, it might be useful to first consider my approach to the same question as it pertains to the general interpersonal model of psychoanalytic treatment (see also chapters 3 and 4). W hat makes the patient "tru st" the analyst sufficiently to engage in a joint dism antling of his protective system with the same person who transferentially is the source of m ost im m ediate danger? Su lliv an 's answ er (1953, pp. 152-154; 1954, pp. 217-239) was that the analyst works much like a sensitive musician; responsive to where the patient is on a gradient of anxiety, and trying to maintain it at an optimally minimal level-low enough so that the patient's defenses do not foreclose analytic inquiry, but high enough so that the defensive structure itself can be identified and explored.