The following is an outline for a clinical presentation I gave on Heinz Kohut’s (1979) Two Analyses of Mr. Z:

In this 1979 paper, Heinz Kohut recounts the case of Mr. Z, a young man analyzed in two separate periods—first under classical technique and interpretation, and later through Kohut’s self-psychology lens. This paper documents the change in Kohut’s theoretical outlook through a clinical case presentation.

Self Psychology is focused on the vitality of the Self—its cohesion, continuity, and sense of worth. Kohut argues that treating narcissistic or self-disorders requires an emphasis on empathic responsiveness to the patient’s selfobject needs.

The central thesis Kohut presents is that his method of self-psychology enabled access to parts of the patient’s personality that had not been reached by classical oeidpal or preoedipal interpretations.

Side note: Kohut’s biographer, Charles Strozier, claims that Kohut himself was Mr. Z, suggesting that the first analysis was his training analysis with Ruth Eissler, and the second analysis was essentially Kohut’s self-analysis after arriving at his insights about narcissistic disorders—making the second analysis a possible work of fiction. Whether this is true or not remains uncertain.

Case History

• Mr. Z: early 20’s, only child; father died four years prior.

• Presenting Problems: mild somatic symptoms, social isolation; main social contacts were one friend and his mother.

• Family Background: At around 3.5 years old, Mr. Z’s father became seriously ill, stayed in the hospital for several months, and fell in love with a nurse. After recovery, the father stayed with that nurse for 1.5 years, rarely visiting Mr. Z. No divorce ensued. When the patient was 5, the father returned to the family.

• According to Kohut: “Every indication, both from external evidence and from the overall flavor of Mr. Z’s personality, that the unremembered earliest part of his life, perhaps the first year or year and a half, had been a happy one.”

First Analysis

Interpretations and Reconstructions

• Regressive Mother Transference & Narcissism: “unrealistic, deluded grandiosity and his demands that the psychoanalytic situation should reinstate the position of exclusive control...catered to by a doting mother.”

• Patient’s Reactions: He opposed these interpretations, erupting in rages at weekend interruptions, schedule changes, and the analyst’s vacations, often experiencing depression and fleeting suicidal thoughts.

• Shift After 1.5 Years: Abrupt calmness arrived when the analyst remarked, “Of course, it hurts when one is not given what one assumes to be one’s due.” Kohut later viewed this as a mirroring response to the grandiose self.

• Main Resistances: defensive narcissism and denial.

• Oedipal Rival: Mr. Z’s delusion that he had no oedipal rival masked his father’s actual role as a powerful figure possessing his mother sexually. This kept unconscious castration anxiety at bay.

• Primal Scene: Mr. Z recalled witnessing parental quarrels and intercourse interpreted as a fight.

• Masochistic Masturbation: Rooted in pre-oedipal, pregenital fixations with oral and anal elements, not simple regression.

Kohut attempted oedipal interpretations, linking the fantasies to fear of competition with the father and castration anxiety. He also explained Mr. Z’s masochistic fantasies as sexualized guilt regarding pre-oedipal possession of his mother.

Importantly, Kohut later concluded these Oedipal and preoedipal explanations were secondary to a deeper narcissistic self-deficit.

Course of the First Analysis

• Social and Sexual Impact: After a two-year period of relative happiness, when the father returned from his affair with his nurse, Mr. Z’s social isolation returned, and he became more tied to his mother. The father remained emotionally distant.

• Homosexual Friendship: By age 11, Mr. Z had a two-year affectionate (possibly sexual) relationship with a 30-year-old counselor, but no subsequent homosexual fantasies were observed.

• Purported Success:

• Masochistic preoccupations faded in the second half.

• Mr. Z moved out of his mother’s home.

• He began dating and had brief sexual relationships with age-appropriate women.

Late in the analysis, Kohut increasingly confronted Mr. Z’s narcissistic features as resistances against deeper fears of masculine competition. Mr. Z apparently responded favorably, showing more assertiveness.

A Key Dream (half a year before termination): Mr. Z is inside a house, door slightly ajar, father stands outside with gift-wrapped packages. Mr. Z is frightened, tries to keep him out. Kohut initially linked this to castration fear and anxiety about competitiveness with a strong male figure.

Limitations of the First Analysis

Kohut realized near termination that the emotional tone was surprisingly shallow, despite Mr. Z’s capacity for strong feelings. Mr. Z’s deepest emotionality seemed directed only at the prospect of losing the analyst, rather than at the material interpreted (Oedipal conflicts, etc.). Thus, the classical approach failed to address the relational, self-deficit aspect of Mr. Z.

Mr. Z eventually returned to therapy 4.5 years later, with little lasting change in his overall sense of well-being. Kohut suspected that the original analysis suppressed symptoms without creating deeper structural change.

Second Analysis

By the time Mr. Z returned, his life had not improved meaningfully, suggesting unresolved internal issues.

Idealizing Transference

Early in the second analysis, Mr. Z dreamed of a strong, confidence-inspiring dark-haired man—part father, part counselor, part analyst—indicating an idealizing longing. This linked directly to the final phase of the first analysis, signaling that the second analysis would resume where the first had left off.

Mirror Transference of the Merger-Type

Soon, the idealizing transference faded, replaced by self-centered demands for perfect empathy and rage at any perceived misunderstanding. But this time Kohut recognized these narcissistic reactions not as mere defenses but as vital clues to Mr. Z’s unmet developmental needs.

“Formulated in the traditional terms of early object relations, we would say that this phase of the analysis revived the conditions for the period when, in early childhood, he had been alone with his mother...” (p. 12).

Method Shift: Kohut relinquished the moralizing stance of “health and maturity,” instead reconstructing early childhood experiences tied to Mr. Z’s mother’s pathological domination.

Recognizing Pathological Maternal Enmeshment

Kohut claims that Mr. Z’s mother bestowed total attention only under conditions of absolute submission. She was “intensely and pathologically jealous,” dominating father, son, and even servants.

“The father had tried to save himself, and in doing so, he had sacrificed the son.”

Mr. Z vacillated between acknowledging his mother’s serious pathology and doubting it—typical of disintegration anxiety tied to losing the archaic selfobject (the pathogenic mother-self).

The Archaic Selfobject and Disintegration Anxiety

As Mr. Z re-examined this enmeshment, it threatened him with dissolution: if the mother was pathologically domineering, what did that imply for his sense of self? Kohut notes that transient transference distortions quickly gave way to memories, indicating progress rather than defensiveness.

The task of self-psychology was to perceive and address the serious pathology of the childhood selfobject.

“He began to recognize that she had by no means been in empathic contact with the needs of his self...she had always taken totally for granted that...he would never leave her” (p. 14).

Mr. Z, often haltingly, began discussing overtly abnormal maternal behaviors—her obsession with his feces, possessions, and bodily blemishes. These revelations underlined the mother’s “unmodifiable need” to keep him as a permanent selfobject.

Specific Maternal Fixations

• Feces: Intense maternal inspection until he was about six. Then, she abruptly shifted to preoccupation with his skin.

• Classical vs. Self-Psychological Interpretation:

• Classical: It explains his oversensitivity to shortcomings and overvaluation of his “productions.”

• Self: It illuminates the mother’s lack of genuine interest in him as a separate self, only in controlling aspects of him.

Similar patterns emerged in her obsession with furniture, objects, and blackhead removals. Kohut frames this as part of a psychotic core in the mother, a “central hollowness” covered by rigid control over her selfobjects.

 

Kohut observes that his earlier classical lens had reproduced the mother’s rigid worldview, leading Mr. Z to comply with the analyst’s convictions. This compliance fueled what Kohut calls a transference cure—seemingly successful but superficial.

Evolving Self Psychology Perspective

Self: The individual’s core identity, cohesion, and continuity.

• Idealization (Defensive vs. Non-Defensive)

• Grandiose Self

• Mirror Transference

• Disintegration Anxiety: “Which reality was real—his mother’s, the first analysis, or the present one?”

• Masturbation Reexamined: Not simply a drive-based act; it became a way of staying connected to a sense of aliveness.

• Nondefensively Idealized Father: Mr. Z’s increasing curiosity about the analyst’s personal life signaled a longing for a strong father figure. When the analyst interpreted this need, Mr. Z felt relief and began recalling positive attributes of his father for the first time.

Kohut notes this was the crucial turning point, eventually leading to the reactivation of an independent nuclear self, previously overshadowed by the mother’s domination.

Late Stages of the Second Analysis

• Reclaiming Father Imago: Step by step, each new father memory surfaced amidst renewed anxiety.

• Idealization of Kohut accompanied the rediscovery of father’s positive features. Mr. Z realized his father was “by no means as distorted as the much more powerful mother.”

• Revisiting the Key Dream: The father loaded with packages trying to enter. In the second analysis, it became a dream about a boy’s longing for a father, rather than a child’s castration fear.

• Termination Phase: Kohut observes less resistance and more recognition of the father’s independent life. Mr. Z finally dismantled the “archaic self” that had merged with the pathological mother, replacing it with a newly cohesive sense of self.

Outcome and Selfobject Needs

Mr. Z’s biggest achievement was breaking the deep merger ties with his mother. Still, he retained skills, ambitions, and ideals formed under that merger, yet now with more freedom and genuine selfhood.

Mirroring, Idealization, and Twinship remain core needs. Through “transmuting internalizations” of the analyst as a good selfobject in an empathic setting, Kohut says Mr. Z finally integrated these essential selfobject experiences.

Vertical Splitting in self psychology differs from repression (horizontal splitting): multiple self-states can coexist, switching between grandiose and depressed stances rather than burying them entirely.

Critical Analysis and Epistemology

• Kohut wonders if the first analysis’ resolution was a “transference cure” (i.e., compliance), whereas the second analysis offered deeper emotional engagement.

• Historical vs. Narrative Truth

One major criticism that I have of this case is how in-depth Kohut goes into diagnosing Mr. Z’s mother. By what evidence can he make such diagnoses as ‘borderline with a psychotic core’ without ever having met her? Does this go against our code of ethics to not diagnose someone whom we have not assessed? Additionally, did he tell his patient his working diagnosis of the mother? And what was the result?

Core Dilemmas:

Do you think it is important that we know the historical truth of a patient’s developmental experiences? What about the historical truth of their recollections of childhood? Are these important? If so, in what way? How do we verify these truth claims? Does it even matter if they are true? If not, what does?