Jake, a 34-year-old, white software engineer, called me in a panic one day, voice trembling, because his relationship of two years was falling apart, pummeled by daily fights. Slumping into my couch, he tearfully let an armful of papers spill around him.
“Can I share some of these emails with you?” he blurted out before even saying hello. As I paused to let some air move between us, he glanced around my office and scowled at a blue abstract painting on my wall. “She doesn’t get how hard it is for me at work,” he said, suddenly looking sad again. “She inundates me with emails about how I don’t listen. She doesn’t understand because she’s never had a job like mine.” His fists clenched as he spoke.
And that’s how we began. Jake shared his story in bits and pieces, punctuated by fits of tears. His job sounded stable enough—his boss often applauded his work—and he had friends, though his circle seemed to have dwindled over the years. But as he described his life, one theme stood out: “No one has ever really understood how I feel,” he kept repeating, and each time, the statement seemed almost too much for him to bear.
We’d clearly jumped right into the work, or so it seemed, but something felt missing. Throughout it all, I noticed that despite all the tears—despite the trembling and beseeching glances—his story didn’t resonate emotionally the way other clients’ pain usually did. It was as if I was hearing a melancholy ballad, but the instruments were off-key.
And there was something else. I had a familiar sense of invisibility in his presence. I felt, in fact, quite irrelevant.
Granted, there was nothing pompous about Jake. He didn’t even seem to feel especially proud of himself, either his looks or his job or his accomplishments—quite the opposite, in fact. His story was one of failure; of feeling unrecognized, disappointed, and misunderstood; and above all, of feeling a deep and abiding sense of aloneness in his misery.
That sense of aloneness seemed accurate, given that his girlfriend, friends, and even some coworkers had all but faded from his life, turning away from his suffering. He was in deep pain—that was clear. But the way he carried and conveyed it never seemed to elicit the kind of support he longed for. If I’d been honest, I myself wasn’t yet feeling compassion for him.
I knew his problem: Jake was a narcissist. He just wasn’t the kind we’re used to hearing about.
Most of us, when asked to picture a narcissist, rarely conjure visions of someone like Jake—mournful, shy, and self-doubting. Instead, we imagine a loud, vain, preening, braggart; reality TV stars often come to mind. This vision of narcissism that we all know and loathe doesn’t stray far from the mythological figure who inspired the term. Many therapists dread the client who monologues about their talents, shrugs off all efforts to help, and vehemently denies even fleeting moments of fear or grief—and with good reason. It can be nearly impossible to help this type of narcissist because their entire sense of self is based on never needing someone’s help in the first place.
Sometimes people with extreme narcissism can’t engage in therapy at all—a sad truth we all have to accept. It’s a humbling experience when clients remain so rigidly rooted in defense that their message in the room is essentially: you have no impact, and you never will. Impasses like this confront psychotherapists with a harsh reality: we can’t help everyone. Regardless, the extraverted, grandiose narcissist is just one version of narcissism, and it turns out, there are several others.
Narcissism, at its core, isn’t simply about feeling handsome or rich or brilliant; it’s about feeling special, exceptional, or unique, standing out from the other nearly 8 billion people on the planet. Contrary to what we might expect, all human beings, if they’re happy and healthy, show some degree of this tendency—a fact proven time and time again when narcissism is measured as a trait.
Indeed, across the world—from the most collectivist cultures, like those in China and India, where the health and happiness of the group is prioritized, to the most individualistic Western cultures, where autonomy and individual ambition are valorized as the pinnacle of personhood—everyone falls somewhere on the narcissism spectrum. What’s more, research shows that a slight overestimation of oneself, a moderate dose of feeling special, helps people maintain ambition, overcome obstacles, and deepen relationships. It’s a personality asset my colleagues and I call healthy narcissism.
Picture a line from 0 to 10, moving from left to right. As someone’s narcissism grows well above average (around 7), they climb high enough in the trait to earn the label narcissist. (At 0, we find the opposite problem, echoism, where people fear or don’t believe they deserve special attention—or any attention at all.) In extreme narcissism, people slip into pathology at the highest end of the spectrum, around 8 to 10, meeting criteria for narcissistic personality disorder (NPD). Here’s where we find the core of pathological narcissism, The Triple E: exploitation, doing whatever it takes to feel special, even if it hurts others; entitlement, acting as if the world should bend to our will; and empathy-impairment, becoming so driven to feel special that we lose sight of the needs and feelings of others.
Working with clients high on the narcissistic spectrum may mean accepting that some people don’t want to be reached at all—yet. But we can still retain faith that we offer something unique that makes us suited to helping people, whatever that quality is—warmth, wit, commitment, generosity, flexibility, honesty. Succumbing to the idea that helping a client is all there is to us as clinicians—this alone is what makes me worthwhile—is what drives narcissism in the first place. If we want to help people with NPD and remain healthy, we have to resist the temptation to fall prey ourselves to this belief.
It wasn’t obvious, but Jake was living at the upper end of the spectrum as what we’d call a covert narcissist. Other qualifiers that are sometimes used to describe this type of narcissism include introverted, vulnerable, and hypersensitive. Rather than feeling special by virtue of positive traits, Jake believed it was his emotional pain that made him unique. Covert narcissists like Jake agree in self-report with statements like “I’m temperamentally sensitive compared to most people” and “Few people understand my problems.” Their grandiosity is hidden—hence covert.
And that’s what’s so incredibly vexing for clinicians. Covert narcissists, because of their willingness to admit to problems, are far likelier to show up to therapy than the extraverted narcissists of reality TV—and their eagerness to share their struggle can make them feel like ideal clients. On the surface, they often long for help, care, or closeness. Unfortunately, at a deeper level, their need to feel special eclipses their ability to receive help. Feeling truly supported and understood raises the specter that their pain might actually be understandable, perhaps even ordinary, leading to a continual push–pull between client and therapist: covert narcissists demand we attend to their suffering, but as soon as we make contact with their wounds, they find ways to erase our efforts to meet them. They ignore our words, bristle as if attacked, or simply change the subject.
Their grandiosity also blinds them to their own growth potential. Covert narcissists often feel failed, lonely, and misunderstood, but dream of being great and recognized one day—a metric by which they relentlessly and silently measure their failures. This, in their minds, makes every success trivial, even therapeutic ones. They harbor an inflated sense of the importance of their problems—as if no one else has ever experienced their depth of suffering, making it that much harder to relinquish. And they appear vulnerable in a way we seldom equate with narcissism: open tearfulness. Their sadness is often mixed with aggrieved rage. This inflated emotionality hides progress, making it hard for both therapist and client to recognize and build on genuine moments of change.
In reality, Jake’s emotion wasn’t vulnerable at all. It was angry, insistent, and demanding. It was more display than expression—hence the feeling that it was striking the wrong chord with me. If he was to repair his relationships and move to a healthier place in the middle of the spectrum, he’d have to learn to depend on others in a way he’d come to fear. His insistence on the specialness of his suffering was a defense—a way of bypassing the vulnerable state of asking for attention, requesting help, or seeking comfort.
His tossing about of email printouts, covering the sofa with them, was a reified metaphor for his problem. He filled every room with himself. With his girlfriend, he’d launch into complaints of work as soon he arrived home to her. With me, he’d obsessively present proof of how he’d been hurt—instead of greeting me or even maintaining minimal eye contact. He took space instead of asking for it or sharing it, or even inviting me to share in it with him.
To treat Jake, I’d have to show him how healthy relationships allow room for two people to feel and have a presence in the room. And I’d have to help him grasp that he does in fact matter to others for reasons that go beyond his pain. Covert narcissists haven’t developed the faith that people can see all of who they are while still recognizing they suffer, which blinds them to the feelings of others around them.
Moving from Me to We
Jake started our third session as he had the first two: with papers strewn across his lap. “Can I read you a few of these? I think it’ll give you a sense of how she’s been acting with me.” He began reading before I could answer.
“Actually,” I interrupted, “can we try something different?” I met his eyes—which had narrowed with impatience. I knew I had a small window within which to reach him, empathically, in a different way than he’d come to expect or invite in his relationships.
“I can see you’re in pain,” I continued. “And I really want to help you through it. My gut tells me we can start that by beginning in a different place today. It’s up to you, but I wanted to run it by you.”
This kind of intervention is both a change in the conversation and in the relationship. I’d just insisted on having a presence—but I’d also given him a choice. In a way, we’d already broken the reenactment where special attention for him meant literally showing all the ways he’d been hurt, without deeply feeling, authentically, the emotions emerging in him—and without pausing to feel or even see how I might be receiving what he shared. It’s this kind of one-sided interaction that had alienated his girlfriend, so it was crucial for us to discover what was driving it.
“Okay, but I really want you to hear these,” he replied.
“I want to hear them, too.” I gestured to the papers, underscoring that I saw what he wanted me to. “And I want to help you with all the feelings you need help with, and I worry they get left out, stranded, when we go straight to the emails.”
“I’ve been telling you my feelings,” he whispered, with more than a hint of exasperation.
“To truly help you, we need to change how old emotional patterns drive what you say and do, and the kinds of interactions they invite. That requires moving from content—the emails, the details of what happens, the actions you’re taking—to process: what happens internally that fuels all that. How does that sound?”
“How does it work?” he asked. He leaned forward, brow furrowed, his whole body asking, How in the hell will this help me?
“It begins,” I explained, “by just tracking what your body is feeling as closely as you can. That will tell us exactly what’s happening inside that leads to any given choice in any given moment.”
“I feel my stomach tensing up and my chest is tight,” he told me.
In this single conversation, Jake and I had begun changing how he handles his feelings. He’d already begun moving from displaying to experiencing—and what’s most important is that he and I were in conversation together about what he was experiencing. By focusing on process, we had just moved from me and you, to we.
Shifting from Content to Process. The more narcissistic someone is, the more uncomfortable they are with genuine feelings of sadness or fear or loneliness—in fact, any of the more vulnerable feelings puts them on edge. The reason is straightforward enough. As psychologist Phebe Cramer had shown in a longitudinal study, narcissists often have the kind of parenting—whether coldly neglectful or critically controlling—that makes them afraid to turn to others when they’re in need of care, comfort, or understanding, for fear that once again they’ll be rejected or criticized or—more often than not—deeply shamed for normal needs and feelings. In other words, the more narcissistic clients are, the more insecure their attachment style. Defensively, they cope with their fear of depending on others by maintaining a strong sense of specialness. That way, they needn’t ever risk asking for, or vulnerably inviting, support or attention and hearing no; they can just expect their needs to be met.
I draw from Diana Fosha’s Accelerated Experiential Dynamic Psychotherapy (AEDP) which emphasizes viscerally experiencing change to help clients relate in a more mutual fashion. Unconscious defenses like Jake’s covert grandiosity are softened and set aside, giving him a chance to fully express all the feelings and needs he’d been shamed into hiding behind his curated sense of exceptionalism.
“So it’s tightness in your chest, is that correct? That’s what you feel as you begin to share the emails.”
“Yes,” he replied a little more slowly.
“Just keep tracking those feelings, and let’s see what happens.”
Reducing Anxiety. I invite clients to track anxiety in their body for the simple reason that defenses always soften when we’re less anxious. Just tracking the sensation of anxiety often lessens it, making room for emotions to surface in ways that help change the strategies that keep clients stuck. Choice and flexibility can emerge from a calmer state, and the more entrenched defenses are, as with narcissism, the more crucial it is to lower anxiety before beginning deeper work.
Sometimes I ask a simple question: what would you be feeling if you weren’t anxious? Other times I ask if there’s a part of their body we could focus on that feels less anxious. There are many ways to help a client feel more regulated in the moment. For Jake, just tracking the bodily sensations of anxiety reduced his fight-or-flight state.
“My chest is feeling more open, looser,” Jake replied after a few minutes.
“Is it okay to just stay with that calmer feeling?” I asked.
He nodded, settling a little more deeply into the couch.
Distancing from the Defense. Jake’s whole demeanor had shifted. He swept his bangs from his forehead and wiped his glasses. As he gazed at me, his eyes appeared softer, less insistent.
“Just stay in the calmness, the openness in your stomach and chest. Get an image of when you first viscerally felt that tightening. Don’t go into it. Just see it. Without overthinking it, let it emerge. What image comes to you?” I asked.
“I can see myself at six, on the kitchen floor.” It’s not unusual for covert narcissists to easily retrieve painful memories. It’s what sets them apart from the more outgoing, obnoxious versions of NPD. Keeping them there productively is the challenge, and when they veer away from such work, it’s usually because the memories are laced with a sense of danger: that to be truly seen is to be attacked, abandoned, or shamed. The danger has to be addressed and healed in the present.
Indeed, a feeling of danger often sets people up to depend on feeling special, and this was certainly true for Jake. His mother was a bitter, controlling woman, who once berated him for crying when his best friend moved away. “Don’t be so selfish!” she’d admonished. “He needs to be with his family!” Finally, when he’d thrown himself on the floor, she’d reluctantly offered him comfort, patting his back. But his father—who’d drummed into Jake’s head that “real men stand on their own two feet”—had crossed his arms and glared.
As with most moments that shape character, this wasn’t a single traumatic event: it was emblematic of the way that, in order to reach his mother, he’d learned to collapse into a state of fragility and helplessness she couldn’t ignore. For Jake, to be seen was to be helpless and suffering—loudly. His defenses reduced people from potentially caring listeners to captive audiences—witnesses to his misery monologues and pain performances. To change his alienating behaviors, I’d have to help him view his narcissism as a part of him, not all of him: something he does, not who he is.
This is the key to engaging people with NPD: helping them see that their defenses aren’t all there is to them. For this reason, I rarely tell clients they have NPD, because I think of them as a person first. Language like “you’re a narcissist” does little except make people more defensive; even the least narcissistic among us bristles when labeled. Little wonder, then, that it leads to spectacular treatment failures when slung at personality-disordered clients, whose defenses are deeply imprinted and reflexive. Instead, I strive to name and transform defenses. (Perhaps because of this, my clients often freely talk about having narcissistic defenses.)
In Jake’s case, I worked with a vivid memory, locating the behavior in the past. But I might also invite a client to get an image of themselves engaging in the behavior—which could be any narcissistic defense, like behaving contemptuously, launching attacks, controlling interactions. The key is to help the client separate the person from the behavior. Because defenses are, by definition, unconscious, and we tend to see them as a fundamental part of who we are, this can take time. But once clients have developed awareness of their defensive behaviors, we can move to the central transformative experience: creating attachment security.
Creating Attachment Security. The lesson of Cramer’s research is clear: to the extent that we can depend on people, we won’t depend on feeling special. We’ll find other ways to matter in the world and in relationships, besides presenting ourselves as the smartest, strongest, or most deeply suffering person around. Narcissistic clients need a deeply felt experience of being cared for and seen when they turn to others with their genuine feelings, without having to resort to grandiose defenses. Few experiences create that more intensely than when the client can provide a more compassionate response to a younger version of themselves than the one they received from caregivers in the past.
“Can you see that six-year-old?” I prompted. “Is he lying on the floor or standing?”
“See it in detail, as vividly as possible, and help me see with you.”
“His mother’s standing over him. ‘What’s wrong with you?’ she’s shouting.”
I continued, “As an adult, sitting with me now, in this calm state, how are you feeling toward the six-year-old who believes he has to scream and cry and kick to be seen—when he just feels sad about his friend leaving?”
Here, Jake and I were bringing his memory to life in a portrayal, another AEDP tool. I take my time setting up portrayals, encouraging the recall of sights, sounds, smells—of any sense memories that come. The more richly textured and alive these imagined interactions are, the more powerful the emotional responses they evoke and the greater the healing impact.
This is just one way in. However one gets there, the goal is to create an experience where genuine feelings are experienced, expressed, and seen in relationship. If the client can’t get there fully, I often model the attachment response for them, saying something like, “That poor little boy, he’s just sad. He should never have been attacked for that; no child should be.”
Jake teared up, dabbing his eyes. His hands were relaxed at his side, glasses next to him. Now he wasn’t showing me sadness—he was feeling it. “I feel so terrible for him,” he sniffled softly. His affect felt inviting instead of angry, and I had an impulse to comfort him.
“Can you imagine being with him, letting him see your sadness for him?”
Tears streamed down Jake’s face. “Yes,” he said softly.
“Let the sadness guide you to any words or gestures you’d like to share with him.”
This is a moment of key change. In working with narcissistic clients, we’re trying to replace judgment and shame with healthier responses. These clients carry internalized judgment toward themselves and others: you’re nothing if you’re not everything; your pain is unimportant unless it’s loud; needs are weakness. The side effect of their defenses is to leave us feeling as insignificant, humiliated, or powerless as they once did in the face of the shame they’ve come to expect when they have ordinary, healthy feelings of sadness, fear, or anger.
Jake’s genuine sadness for himself replaces the insistent, angry reactions that took over when he feared that feeling sad or scared would once again earn him criticism or contempt. Until now, he hadn’t even left himself any room to see what else was possible.
“What happens next?” I asked.
“I’m holding him,” he continued. Then, to the six-year-old, he said, “I can tell you’re feeling sad about your friend. I’m sorry you’re losing him.” He sighed, still sad, but calmer than before.
“What happens inside the boy hearing you and feeling your arms around him?”
Jake looked up, briefly. “He feels strong.”
This is the ideal outcome. Shame and attack are replaced with caring and attunement, freeing up a new, undefended response: sadness without demand, pain that matters but isn’t everything; fear that invites solace and safety. Unhealthy narcissism’s steepest price is that it turns a person into a performance. Therapy lowers the curtain on the performance, inviting the narcissist off the stage and into the seat next to us.
Of course, with many NPD clients, treatment doesn’t always go as well as it did for Jake. It can take months to inch forward from me to we. And some clients’ defenses won’t budge. Although therapists know we can’t save our clients, particularly those with NPD, we may deny this reality. We clinicians often have our own brand of narcissism: the feeling that we’re special enough, in our capacity to help and heal, to reach anyone if we work hard. Communal narcissism, as it’s called, is all about feeling especially or uniquely capable of helping. Therapists need some of this, but we’re better off holding this illusion loosely, rather than clinging to it like a talisman.
Michelle, 35, a Latinx life coach, arrived in lime green joggers and a white T-shirt, emblazoned with REACH!—the signature style of the coaching organization to which she belonged.
“I love my job,” she said, “but I feel sick all the time. I’m afraid of disappointing my clients, my boss—everyone.” Failure, it became clear, was Michelle’s deepest fear, but not in any grand sense of the word, as it clearly was for Trudy, her mentor and the cultish leader who started REACH! to save the world. Michelle feared failing to help in all her close relationships: with her friends, her partner—also a coach—and of course her clients.
Michelle’s defense, though milder than Jake’s, was equally destructive. If I’m not the most helpful person, I’m no one. Like all communal narcissists, her insistence that she be helpful above all else led to anger toward herself (and often those she was helping), and shame when she fell short of transforming her clients—which, not surprisingly, proved to be an elusive outcome.
When Michelle was seven, her mother had become deeply depressed, lying in bed in the dark for much of the day. The gloom and shadow that surrounded her mom had terrified Michelle. “I was scared she’d disappear into the darkness,” she explained. “I’d sit with her in bed or bring her food or offer to raise the shades.” Occasionally, her efforts would elicit a smile and praise. “She’d hug me and say I was her little angel,” Michelle recalled, smiling to herself as the memory returned. “My father told me I’d be a doctor one day.”
This is how Michelle had learned that the only way she mattered—or could be seen—was as a helper. She had no faith that anyone cared about her beyond her ability to lift spirits, so much so that she rarely shared when she felt upset with her friends. This led to superficial connections, where she related to people more as judges than as sources of mutual comfort, humor, or fun. Rather than enjoying any of these other ways of being and connecting, she stepped up her efforts to help. It was, in fact, a frenzied effort to help a stubbornly distant coaching client that led her to share with me the depth of her fear that she was failing—and I had a chance to offer her a new response.
“My stomach is in knots, I can’t let this woman down,” she said, somewhat angrily.
“What are you feeling inside when you say that?” I inquired, moving her from content to process.
“That sinking feeling,” she answered. “I don’t want you to think I don’t care about her.”
This was the same visceral feeling she’d had whenever she’d seen her mother retreat to the bedroom, but now, here, in the present, she expected me to judge her the same way her family had. Opportunities like this are a gold mine of change with narcissistic clients—they open a moment where defensive judgment can be set aside, and the client can simply be seen.
“And what do you feel from me as you tell me about your client? Do you see or feel anything that suggests I think less of you?” I was creating an attachment experience by inviting her to take in and feel my actual response, rather than the judgment she feared. Michelle looked away, but after several invitations to pay attention to how she was experiencing my response, she relaxed and made room for what she was noticing.
“Your face looks kind. Like you want to help me.”
I nodded, asking her to tune into her body as I told her, “I don’t think any less of you because you haven’t been able to help your client. I know you want to help. Even if you’re not helping, I enjoy hearing your adventures. Your sadness touches me, and I admire your willingness to share your fears. You’re so much more than your ability to help.”
She smiled and began to cry. This was the beginning of Michelle allowing herself to be known as more than someone who helps.
We know from research that narcissists may not be more prevalent these days, but they certainly are louder. They can stand out and broadcast their specialness to hundreds of thousands or even millions of followers on Instagram, Facebook, or Twitter.
Narcissism can be benevolent, inspiring people to change, grow, and learn—certainly, this is true of inspirational leaders at their best. It can also be destructive and dangerous, promoting orthodoxy within a group and hatred for outsiders who deny the magnificence of the group’s chosen guru.
In many ways, understanding and treating narcissism in the individual and culture at large is a process of intentional complication. The narcissistic self is a simple one, reductive and predictable. It operates from a belief that to be a self at all means to be seen as special, usually in very few ways: to be the smartest, the most giving, or the most misunderstood self in the room. The narrowness of that view forecloses the many rich, multifaceted versions of self we’re all privy to that have nothing to do with being special.
So many self-states are ordinary and nuanced, yet powerful. The parent who moves seamlessly between quiet caretaker and warm authority fosters far greater security in children than one who needs to be the most powerful person around. A leader who can also be a follower is bound to be more successful than one who insists on calling all the shots. A partner who enjoys giving and receiving provides greater security than one who plays the martyr. We can support narcissistic clients in authentically feeling and being many things at once: a helper and a student, exceptional and average, high-achieving and calm, ambitiously striving and capable of just being; and in doing so, we can help them have closer relationships.
The true lesson of understanding and treating narcissism is that everyone around us suffers when we come to believe we can only matter in one way. And everyone benefits when we can also just be—and be connected at the same time.
Want to know more about the narcissism spectrum? Download this excerpt from Craig’s book, Rethinking Narcissism.
ILLUSTRATION © ILLUSTRATION SOURCE/LUDVIK GLAZER-NAUDÉ
Craig Malkin, PhD, author of the internationally acclaimed book Rethinking Narcissism, is a clinical psychologist and lecturer for Harvard Medical School with more than 30 years of experience. His articles, advice, and insights on relationships have appeared nationally and internationally in outlets like Time, and he’s been a featured guest on many TV, radio, and podcasts, such as NPR, The Oprah Winfrey Network, and Rick Hanson’s Being Well Podcast. He’s president and director of the Cambridge Massachusetts–based YM Psychotherapy and Consultation, Inc. Recently, Oprah Daily named Rethinking Narcissism in their article “The Best Books to Read If You Have a Narcissist in Your Life.” Visit Craig’s website at drcraigmalkin.com.