Run-of-the-Mill Narcissist Behavior in the Context of Psychotherapy and the Implications for 'Outside' Relationships for the Patient

Run-of-the-Mill Narcissist Behavior in the Context of Psychotherapy and the Implications for 'Outside' Relationships for the Patient

In the framework of psychotherapy sessions, narcissistic behavior by the patient would seem to be common. After all, one of the provisions of the client-therapist agreement is that each session will focus exclusively on the patient and his or her needs, rather than those of the therapist. In this light, deciding to enter on psychotherapy is in itself a sort of narcissistic behavior. Some theorists such as Heinz Kohut presume that therapy functions in a compensative fashion, to make up for the considerable lack of adequate parental empathy and mirroring that begets narcissism; narcissistic behavior by clients in treatment is accordingly not only to be expected but should be encouraged.

While we expect our clients to be self-absorbed during sessions, such narcissistic behavior outside the context of psychotherapy would be inappropriate. One of the potentially adverse side effects of treatment, with its emotional gratification of long-unmet needs, is that clients come to thirst for similar satisfaction outside the session. Their interchange with other people may then become pseudo-therapeutic. Emotional needs and psychological problems become the focus of their interchanges; in effect, it's a 24/7 form of psychotherapy, where clients try to feel as if they were in session all the time. One of our goals as therapists is to encourage patients to learn to accept that only in session is their narcissistic behavior befitting. "Outside" relationships ought to be reciprocal; for each individual to have his or her needs met, all relationships must yield gratification for each party.

Sometimes in the practice of psychotherapy, one meets the patient who seems unable to feel any kind of empathy for anyone, including the therapist, and can only view him or her in an idealized fashion. These people usually come from extremely inferior backgrounds; their extreme narcissistic behavior demonstrates a desperate need for mirroring and empathic support as nobody else in their lives has ever been able to give it. These clients can be quite arduous to work with as they have very little tolerance for the everyday interruptions in treatment: weekends and vacations, the random personal emergency. They may make repeated "emergency" phone calls; they may wish to have continuous contact with the therapist in between sessions and can't bear any feeling of separation.

If they are even capable of keeping up personal relationships, this type of patient will also prove intensely exacting and possessive of their friends and partners. Narcissistic behavior is pervasive in several forms: an intolerance for separateness, a wish to control the other person, and self-absorption so severe that they may be unaware of their friend's or partner's suffering, needs and desires. A childish kind of rage may be the response to disappointment or slights.

As an efficacious treatment continues, the patient will learn to bear separateness; getting the kind of empathy and mirroring that were deficient in their upbringing will help moderate narcissistic behavior and encourage a new faculty for empathy. This may start in relation to the therapist: emotional lessons learned in the framework of treatment will in future generalize. Development in the therapeutic relationship then creates growth in outside relationships as well. In this sense, psychotherapy is a microcosm of the client's larger world; Growth within that microcosm gives birth to "outside" progress as well.

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