Narcissistic Patients and New Therapists

Book excerpt: Patients that have significant narcissistic personality pathology are challenging to most therapists. Student therapists often find that treating such patients is particularly difficult. Not only do such patients challenge the therapist's conceptualization and empathic skills, but they also evoke strong feelings toward the patient, a phenomenon known as countertransference, which can be personally unnerving. However, countertransference can be used as a tool in better understanding one's patient and how to best intervene with him or her. This book sets out to accomplish three major objectives. First, it describes narcissistic pathology from a psychoanalytic and psychodynamic perspective, which allows therapists to have a meaningful framework from which to think about their patients' problems and work with them. Second, it discusses how countertransference can be understood as a useful therapeutic tool. Third, it presents four case studies from doctoral students in various stages of their clinical training and how they came to understand and work with their patients in therapeutically effective ways by managing and understanding their countertransference reactions. In the end, it is hoped that the reader will see that, while they may be challenging at times, narcissistic patients can be effectively treated if therapists have a meaningful theoretical framework from which to think about their patients and can become comfortable with their own inner lives as they relate to their patients.