The Narcissist in Therapy: A Complex Challenge

Understanding the Narcissistic Mindset in Therapy

Narcissists typically enter therapy with a grandiose sense of self-importance and a preconceived notion that they are on par with, if not superior to, the therapist in terms of intelligence and insight. This attitude can significantly hinder the therapeutic process, as the narcissist might see the sessions as a competitive arena rather than a space for introspection and healing.

Initial Interaction Dynamics

• Equality with the Therapist: Narcissists often insist they are equals to the therapist in knowledge and status.
• Use of Jargon: To demonstrate their supposed equality, they frequently pepper their language with professional terms, attempting to 'level the playing field'.

The Narcissist's Internal Dialogue

According to Sam Vaknin, author of "Malignant Self Love - Narcissism Revisited," the narcissist's internal dialogue may include thoughts of superiority over the therapist, a belief that only top-level therapists are worthy of treating them, and a desire to be seen as a colleague rather than a patient. This mindset can lead to a devaluation of the therapist's credentials and abilities, further complicating the therapeutic alliance.

Challenges in Narcissistic Therapy

The treatment of narcissism is fraught with specific challenges that stem from the narcissist's self-perception and defense mechanisms. These include:

• Idealization and Devaluation: Narcissists may initially idealize the therapist, only to subsequently devalue them when their expectations are not met.
• Resistance to Treatment: The grandiose self-view and vulnerability aversion lead to a strong resistance to traditional therapeutic approaches.
• Manipulation: Narcissists might attempt to manipulate the therapy sessions to maintain a sense of superiority and control.

Therapeutic Strategies for NPD

Therapists employ various strategies to break through the narcissistic defenses, often focusing on leveraging the narcissist's need for admiration and fear of inferiority:

• Ego Stroking: By complimenting the narcissist, therapists might encourage them to demonstrate their 'omnipotence' by engaging in the therapy process.
• Challenging Perfectionism: Therapists might appeal to the narcissist's quest for perfection to motivate change in behavior and thought patterns.
• Medicalization: Some psychiatrists opt to explain the disorder through genetic or biochemical abnormalities, which narcissists might prefer as it absolves them from blame for their behaviors.

The Role of Medication in Treating NPD

Narcissists often resist medication, viewing it as an acknowledgment of a flaw or weakness. However, when they do agree to medication, they might treat it as a badge of honor or a unique aspect of their identity, as noted in Vaknin's discussions on narcissistic responses to treatment.

Conclusion: The Path Forward in Treating NPD

Treating narcissistic personality disorder requires a nuanced approach that balances empathy with firm boundaries. Therapists must navigate the complex landscape of narcissistic defenses with a strategy that often involves complimenting the narcissist's ego while subtly guiding them towards self-awareness and change. The ultimate goal is to foster a safe environment where the true self of the narcissist can begin to emerge and grow, moving away from the dysfunctional patterns upheld by their false self.

For further reading on therapy for personality disorders and specific treatment modalities for NPD, consider exploring resources like Sam Vaknin's work on narcissism or the detailed FAQs on narcissistic-abuse.com.