For Richard, developing a more intimate relationship with his wife meant opening himself up to his emotions—which he’d learned at an early age were signs of weakness. At age 6, for instance, he’d had a fight with his best friend, Steven, who’d said he’d never play with Richard again. When Richard ran home crying, devastated at the prospect of losing his friend, his father disdainfully admonished him, saying, “Don’t be such a wuss!” His mother told him, “You’re much better than Steven anyway. You’re making a big fuss about nothing. He’s not worth your time.” The message was loud and clear: Richard should be above silly things like hurt feelings and lost friendships.
The Art of Empathic Confrontation
Narcissists will rarely initiate therapy, except in the case of debilitating depression or anxiety that’s interfering with their performance. More typically, they show up only because their partners have said they’re leaving them, their adult children won’t speak to them, or their employers have threatened some disciplinary action unless they start therapy. Sometimes they come because of a court order involving illegal substance abuse, sexual misconduct, or domestic violence. And when they do come in, they’re usually seeking the “magic wand” cure and blaming the world for their misfortunes.
Since the narcissist isn’t motivated to do the necessary work of exposing his vulnerability, the only leverage that allows therapy to succeed is usually the prospect of losing the people in his life who care for him. So to make what happens in my office matter, I need to connect our moment-to-moment encounter continually with what’s going on between the client and the important people in his life. And to accomplish that, I need to show up in the treatment room as a “real” person, someone who can acknowledge the sting of insults and cutting remarks, as well as the decidedly nontherapeutic urge to withdraw or even attack in the face of continual provocations. Calling attention to my reactions to off-putting behaviors as they occur forces the client to confront how that same behavior affects others.
For example, a client recently responded to my attempt to empathize with his struggles with his wife by saying, “Stop acting like you care about what happens to me. You probably think I’m a piece of shit, just like my wife. You’re a woman after all. I may not be perfect, but I’ve seen a lot more of life than you have in your cozy little therapeutic bubble.”
Taking a deep breath, I said, “My hunch is that right now you’re feeling uncomfortable about being here, and that your put-downs about me are your way of handling that. But I have to tell you that what you just said was not only inaccurate, but insulting. Is this what you do with your wife when you’re feeling uncomfortable? If that’s right, I can understand why she keeps saying she’s so fed up with your marriage. I think what you’re really saying is that it’s hard for you to accept that anyone can care for you when you expect to be seen with contempt. So you play the bully to protect yourself.”
This isn’t the kind of warm, supportive exchange that most of us associate with therapeutic conversation, but with narcissists, this sort of self-disclosure and limit-setting is necessary if a bond of honesty and trust is to be established. The truth is that narcissists are particularly adept at ferreting out weaknesses in others and triggering feelings of inadequacy and intimidation in the therapist. For a therapeutic bond to develop, it’s important to establish firm ground rules as well as acknowledge your own triggers and vulnerabilities that can get in the way of treatment.
When I began working with this population many years ago, one of my narcissistic clients launched into an eloquent discourse on some esoteric feature of Shakespeare’s Hamlet. I was momentarily caught up in trying to understand his references and admiring how incredibly smart he sounded. Noticing what he perceived to be a dumbfounded look on my part, he said, “Wendy, do you ever read anything other than psychology books?” I can’t recall how I responded to him, but I’m certain I wasn’t empathetic. What I do remember is that I felt both exposed and furious.
I went home and began feverishly searching for a copy of Hamlet to refresh my memory and show Mr. Larger-Than-Life a thing or two! Then I caught myself: What am I doing? What’s happening to me? With the help of my own therapist, I was able to root out what had triggered me and get a grasp on my own wildly competitive reaction.
In the next session, I decided to tell him that I’d felt the impulse to outdo and impress him. I then wondered out loud about whether he had this effect on others who might have felt simultaneously captivated by his intellect and wounded by his careless air of superiority. While he dismissed me at first as being “too sensitive,” he’d been caught off guard: he wasn’t used to having people express their uneasy reaction to him this directly. This moment became a turning point in our therapy. He realized that he could trust me to tell him how I was actually feeling about him in the moment, without being completely critical of all the parts of him that were human—an experience he’d never had before.