Given their arrogance, condescension, and lack of empathy, narcissists are notoriously difficult clients. The key to working with them is being direct and transparent about the roiling emotions they trigger in us.

As the morning sun warms your kitchen, you put on coffee, feed the dog, and glance at your calendar for the day’s schedule. There he is: your 3 p.m. appointment. Your heart sinks, and you begin longing for a power outage in your office building today—anything to force you to cancel on this client, Mr. I’m-Right-and-Everyone-Else-Is-Wrong.

Although you consider yourself well trained and capable of handling the challenges of working with even your most depressed, anxious, and angry clients, this one reinforces your worst fear: maybe you aren’t cut out to do therapy after all. But what exactly makes this pompous, narcissistic puff-dragon so tough? Who gave him the power to trigger you like that?

One reason narcissistic clients are so hard to treat is that they’re adept at taking charge of a session and steering the conversation off course again and again, until you feel sorely tempted to give up and let them take the wheel. Richard, one of my clients, fit the classic profile. He often shifted into self-aggrandizing monologues on his latest brilliant investment, his newly purchased, one-of-a-kind this or that, his powerful business connections, his to-die-for wine collection. Whenever I hazarded an insight into his…