In this paper, the author revisits the problem of ‘premature ego development’ first introduced by Melanie Klein in 1930. She also highlights several developments in post‐Kleinian thinking since the publication of that paper, which can be seen as offshoots of or complements to Klein's work. The author proposes a link between this category of precocious development and the absence of the experience of what Bion termed the ‘containing object.’ She puts forward several technical considerations relevant to analytic work with patients who suffer as a result of early developmental failures and presents various clinical vignettes in order to demonstrate the ways in which these considerations take shape in the analytic setting.

The report by a member of the Brazilian parliament that the rejection of physical deformity is natural and instinctive, and the Muslim reaction to the publication in the Western press of cartoons considered to be offensive to their religion, serve as an introduction to the examination of conflicts in human relations. The two episodes may be classified as representing the sense of the ‘uncanny’, attributed by Freud to the narcissism that remained from primitive cultures, in which the shadow cast by the body and the mirrored reflection of the latter probably generated the idea of soul‐which would be the narcissistic phenomenon causing the illusion of immortality. The presence of this illusion as a support for the beliefs of present‐day civilized peoples makes clear the inopportune influence of primitive mental states in areas where more developed ones should prevail. The persistence of the omnipotent thinking derived from these states provides the possibility of drawing a parallel between the development of the ego‐evolution from narcissism to object relation‐and the progress of civilization. In this context, the majority of social conflicts can be attributed to the deficient object relation resulting from the strength of primary narcissism, which generates a tendency to reject that which is different and to facilitate the emergence of destructive aggressiveness. The progress of civilization would then occur by means of a development of the ego compatible with object relations that lead to a drastic reduction in destructiveness.

There has been a long, ongoing discussion of goals in psychoanalytic treatment. Some analysts are even of the opinion that psychoanalysis ought to be goalless (‘just analysing’). The growing number of outcome studies, however, is in need of a generally accepted set of criteria by which treatment results can be judged. The author proposes a definition of the goals of psychoanalysis that covers four areas: the alleviation of symptoms and complaints, changes in life adjustment, changes in personality structure, and procedural goals such as the resolution of the transference neurosis. She illustrates the relevance of this conceptualization by an empirical study that considers the assessments of 19 psychoanalysts discussing statements made by a former patient about her analytic treatment. On the basis of this case, which comes from the follow‐up study of the DPV (German Psychoanalytical Society), reported by Leuzinger‐Bohleber et al. in 2002, the author demonstrates that psychoanalysts use the criteria defined above implicitly in forming their opinions. Moreover, they arrived at similar judgements regarding the treatment's outcome.

The author highlights self‐observation as an important goal of psychoanalysis, separate from other concepts with which it is often confounded. To support this position, he presents clinical and developmental data, as well as observations by psychoanalysts on recent findings by cognitive neuroscientists. He introduces the term ‘pathological attractor sites’ to capture the challenge in moving from the belief in the reality of one's own thoughts to self‐observation. Clinical techniques to deal with this specific challenge are presented.

In this paper the author addresses the problem of framing an interpretation that properly takes account of the degree of splitting and projection the analyst encounters in a patient at a particular time. If the patient has needed to split off and project unacceptable parts of the self, the analyst has to consider how useful it is to describe this situation to the patient, who may no longer be in contact with the disavowed parts. The disadvantage of this situation is that an interpretation that refers to different parts of the personality may make sense intellectually, but may in fact reinforce the patient's defensive structure. The author describes one case in which such a situation prevailed, and contrasts this with a second case in which a greater degree of integration had developed, with accompanying internal conflict and pain. In this latter case it seems paradoxically more appropriate for the analyst to include, in his interpretations, references to the struggle between different parts of the personality.