Why I Love to Treat Narcissists

I love to treat Narcissists. This fact is often met with surprise by folks who inquire about my professional life. These bogeymen and women of the 2020s, their idealization so seductive, their devaluation so destructive, take us on a ride that is at once thrilling and agonizing. Of course, my professional orientation with them provides me the distance to not be so rocked by their shenanigans with me. In my personal life, I do my best to avoid them and I advise non-Narcissistic clients on how to cope with those who are unavoidable*. But what is it about working with Narcissistic folks that is so professionally compelling for me?

By way of answering that, let’s first start with how I frame Narcissism and Narcissistic Personality Disorder. One of the ways to define any personality disorder is that it is a hyper-rigid set of defenses that developed within adverse childhood environments. Problematically, these defenses make less sense as we grow older, when the world calls for more flexibility and more ability to empathize with and cooperate with others. If all personality disorders have this in common, what distinguishes them is the particular defenses used and, most crucially, what is being defended against. In her masterwork Psychoanalytic Diagnosis (2011), Nancy McWilliams posits that the narcissistic individual is defending against the diabolically disempowering emotions of shame and envy. In an attempt to scramble away from the powerlessness that shame and envy engender, Narcissists invest in a drive to power, often taking the form of idealization and devaluation.

This leaves the question of what adverse childhood environments are likely to give rise to core experiences of shame/envy and the consummate defenses. Strikingly, these environments can run the gamut from caregivers who are hyper-attentive, showering of praise and encouragement to caregivers who are benignly neglectful or caregivers who are outright abusive, hyper-critical and even sadistic. All of these caregiver presentations have two things in common. One is that there is a set of expectations, implicit or explicit, that the child is to meet in order to feel worthy of love. Digging underneath this we hit the more crucial adversity; the internal emotional experience of the child is neglected in favor of external markers of achievement or failure. Either way, the child learns, at worst, “I am not worthy of love” (shame) or, at best, “I am not worthy of love unless I…” (and the correlated, "That person is worthy of love because she..." and attendant envy). As the child's internal experience is neglected and thus awareness of even having an internal emotional experience withers on the vine, they have no choice but to look for external markers of worth to orient themselves in a scary world.

Awareness of this process has led to an immense shift for me as I have moved through my professional life. When meeting a Narcissistic individual, we are most keenly aware initially of their defenses, and their defenses often illicit our own. However, using these defenses as indicators of where vulnerability lies, what I become most aware of is the suffering child underneath the bluster. And so I say to my Narcissistic clients, directly and indirectly through where I put my focus, “your internal experience matters.” Not your bluster, not your distorted perceptions of yourself and other people, but the emotions driving these things and the intense need for a sense of safety and self worth. So, I ignore the bullshit and go for what is real in their experience, i.e. their emotional needs, primary among them the need for safety . And they resist it. And they resist it again. Their internal eyes have been blindfolded and their external eyes are hyper attuned to approval and disapproval. They don’t know how to see their vulnerable inner yearnings. So I am their seeing eye dog, and I am dogged in my pursuit of their emotional truth. Compassionate, humorous, curious and dogged. When they begin to step forward into their vulnerability, they are met with the interest, acceptance and openness that was lacking in their caregivers.

The process that I described above is by no means the end of the therapy. It is a necessary and hard fought step for the process that follows, a process that incudes learning emotional regulation skills, empathy training, communication skills, and more. Teaching the neglected inner children of Narcissists that their emotional experience matters is the process that allows my work with Narcissistic individuals to be so gratifying.

*Please do not take what follows as an endorsement of the idea that somebody in relationship to a Narcissist, especially a romantic relationship, can heal or “fix” them. That is not true. If you are being subjected to Narcissistic abuse, it is highly unlikely that this dynamic will substantially change.