The Narcissist in Therapy

The narcissist regards therapy as a competitive sport. In therapy the narcissist usually immediately insists that he (or she) is equal to the psychotherapist in knowledge, in experience, or in social status. To substantiate this claim and "level the playing field", the narcissist in the therapeutic session spices his speech with professional terms and lingo.

The narcissist sends a message to his psychotherapist: there is nothing you can teach me, I am as intelligent as you are, you are not superior to me, actually, we should both collaborate as equals in this unfortunate state of things in which we, inadvertently, find ourselves involved.

The narcissist at first idealizes and then devalues the therapist. His internal dialogue is:

"I know best, I know it all, the therapist is less intelligent than I, I can't afford the top level therapists who are the only ones qualified to treat me (as my equals, needless to say), I am actually as good as a therapist myself…"

"He (my therapist) should be my colleague, in certain respects it is he who should accept my professional authority, why won't he be my friend, after all I can use the lingo (psycho-babble) even better than he does? It's us (him and me) against a hostile and ignorant world (shared psychosis, folie a deux)…".

"Just who does he think he is, asking me all these questions? What are his professional credentials? I am a success and he is a nobody therapist in a dingy office, he is trying to negate my uniqueness, he is an authority figure, I hate him, I will show him, I will humiliate him, prove him ignorant, have his licence revoked (transference). Actually, he is pitiable, a zero, a failure…"

These self-delusions and fantastic grandiosity are, really, the narcissist's defences and resistance to treatment. This abusive internal exchange becomes more vituperative and pejorative as therapy progresses.

The narcissist distances himself from his painful emotions by generalising and analyzing them, by slicing his life and hurt into neat packages of what he thinks are "professional insights".

The narcissist has a dilapidated and dysfunctional True Self, overtaken and suppressed by a False Self. In therapy, the general idea is to create the conditions for the True Self to resume its growth: safety, predictability, justice, love and acceptance. To achieve this ambience, the therapist tries to establish a mirroring, re-parenting, and holding environment.

From my book "Malignant Self Love - Narcissism Revisited":

"Therapy is supposed to provide these conditions of nurturance and guidance (through transference, cognitive re-labelling or other methods). The narcissist must learn that his past experiences are not laws of nature, that not all adults are abusive, that relationships can be nurturing and supportive.

Most therapists try to co-opt the narcissist's inflated ego (False Self) and defences. They compliment the narcissist, challenging him to prove his omnipotence by overcoming his disorder. They appeal to his quest for perfection, brilliance, and eternal love - and his paranoid tendencies - in an attempt to get rid of counterproductive, self-defeating, and dysfunctional behaviour patterns."

Some therapists try to stroke the narcissist's grandiosity. By doing so, they hope to modify or counter cognitive deficits, thinking errors, and the narcissist's victim-stance. They contract with the narcissist to alter his conduct. Psychiatrists tend to medicalize the disorder by attributing it to genetic or biochemical causes. Narcissists like this approach as it absolves them from responsibility for their actions.

Therapists with unresolved issues and narcissistic defenses of their own sometimes feel compelled to confront the narcissist head on and to engage in power politics, for instance by instituting disciplinary measures. They compete with the narcissist and try to establish their superiority: "I am cleverer than you are", "My will should prevail", and so on. This form of immaturity is decidedly unhelpful and could lead to rage attacks and a deepening of the narcissist's persecutory delusions, bred by his humiliation in the therapeutic setting.

Narcissists generally are averse to being medicated as this amounts to an admission that something is, indeed, wrong and "needs fixing". Narcissists are control freaks and hate to be "under the influence" of "mind altering" drugs prescribed to them by others.

From my book "Malignant Self Love - Narcissism Revisited":

"Many (narcissists) believe that medication is the "great equaliser": it will make them lose their uniqueness, superiority and so on. That is unless they can convincingly present the act of taking their medicines as "heroism", a daring enterprise of self-exploration, part of a breakthrough clinical trial, and so on.

(Narcissists) often claim that the medicine affects them differently than it does other people, or that they have discovered a new, exciting way of using it, or that they are part of someone's (usually themselves) learning curve ("part of a new approach to dosage", "part of a new cocktail which holds great promise"). Narcissists must dramatise their lives to feel worthy and special. Aut nihil aut unique – either be special or don't be at all. Narcissists are drama queens.

Very much like in the physical world, change is brought about only through incredible powers of torsion and breakage. Only when the narcissist's elasticity gives way, only when he is wounded by his own intransigence – only then is there hope.

It takes nothing less than a real crisis. Ennui is not enough."