Narcissists often only present themselves in therapy in a late stage of desperation or disintegration. They finally are gazing deep into the relationship abyss caused by their narcissism. The fact of being in therapy means that they are vulnerable and in crisis and more open than they normally would be. The therapist can and should exploit the crisis by consistently referencing the breakdown when the narcissist gets stuck being defensively offensive. On the other hand, when clients may not be true narcissists, but have narcissist tendencies they may be more readily and effectively addressed because of their willingness to defer to the therapist's expertise and their critical circumstances. The therapist must have sufficient confidence and conceptual clarity to assert expertise. The therapist, rather than holding this stance however is vulnerable to getting caught up in trying to prove him or herself to the narcissist. The narcissist has well-practiced skills in a superiority-inferiority battle. The therapist needs to have ready responses to the enticements to engage.
The therapist may be most effective by being a virtual narcissist or through becoming a psuedo-narcissistic therapist. The therapist may be most effective if he or she can connect to personal narcissistic instincts. Being aware of and connected to ones own narcissistic desires enables the therapist to identify with the narcissistic client. Humanistic orientations of therapy are based on the therapist identifying within oneself the comparable humanity of the client. Some therapists however might consider any narcissistic tendencies to be among the dark side of human emotions and psychology to be avoided. They would subsequently be averse to their own narcissism and fail to own it. Recognizing and honoring ones narcissistic feelings while managing self to avoid behavioral manifestations of such feelings can be a powerful entry into the narcissistic client's world. Being on the precipice of narcissistic reactions and responses allows the therapist to empathize honestly with the narcissist's existential world. The therapist who gazes down yet steps back from the precipice may be best able to offer alternatives to the narcissist's compulsive dive into the abyss.
The intense counter-transference ignited by narcissists may come from the therapist seeing his or her darker instincts blatantly manifested by another. The therapist wants to be the best therapist in the community. He or she seeks to be and may be extremely knowledgeable and skilled compared to more mediocre and even relatively good therapists. He or she wants to be acclaimed as outstanding and special among fellow professionals. Getting criticism of clinical and professional choices is threatening. Annihilating or punishing his or her critics is desirable and satisfying. He or she is tempted to cross over into ethically deficient or morally reprehensible behaviors to be successful. The therapist's accumulation of skills, achievements, and personal and professional qualities should entitle him or her to special consideration and treatment. The scorpion within the therapist feels entitled to sting those that threaten him or her. Accepting ones narcissistic energy may be the therapist's key to effective work with the narcissist in individual and couple therapy. Perhaps, the "almost" narcissistic therapist is best suited to provide effective therapy for a narcissist. Such a therapist best knows the narcissist inside and out from almost living the narcissist's emotional, psychological, intellectual, spiritual, and social life… but only almost.
The healthy and ethical therapist can experience versions of virtually all the narcissist's internal processes, but does not behaviorally express them. It is essential that the therapist especially not act out narcissist instincts under the guise of clinical strategy or interventions. The likelihood is that the effective therapist's narcissist energy is less intense, and subsequently more manageable. He or she has sufficient mental, emotional, and psychological stability to be secure enough to have integrated narcissistic energy into a healthy self. While he or she has a stinger or the capacity to be cruel, vicious, self-righteous, and vindictive, the effective therapist knows it is a destructive weapon best kept sheathed. If the therapist is a narcissist, he or she will allow him or herself destructive behaviors by justifying them using some theoretical rationalization. This therapist, however may be very effective with non-narcissistic clients since they would defer to his or her expertise and role. However the narcissistic therapist would tend to be enticed into the omnipotence, grandiosity, superiority, and entitlement competition with a narcissistic client. As with other narcissists, such a therapist would sub-consciously compulsively dismiss or ignore relationship realities and experience a cognitive distortion to satisfy deep narcissistic energies. His or her clinical judgments will be self-righteous and arrogant to justify clinical decisions no matter how poorly therapy turns out. He or she would label the client or clients as incorrigible, not amenable to therapy, or resistant, rather than take professional responsibility.
The effective therapist must be highly skilled, knowledgeable, very intelligent, and mentally agile and willing to take on the challenge of working with the narcissist. Many therapists, with significant skills, knowledge, and intelligence may be not sufficiently mentally agile to "dance" with narcissist, and thus may be overwhelmed by the challenge. Many therapists fail to disprove the narcissist's assertion of superiority. Only the "virtual or almost" narcissistic therapist- that is the therapist who is in touch with his or her "inner narcissist," and is emotionally healthy and psychologically stable and secure may have a chance to work successfully with the narcissist, especially in couple therapy. Perhaps, it takes a virtual scorpion to deal effectively with a scorpion. Extending the metaphor, work with a scorpion must differ from work with a ladybug, earthworm, or puppy dog. The therapist should likewise think and feel, so to speak like a ladybug to work effectively with a ladybug. And so on and so forth, in joining the existential world of each client.
The individual with narcissistic personality disorder constantly acts entitled to all manner of privileges and deference. The narcissist insists on being special. And, he or she is special- an exceptionally disturbed and exceptionally damaged person. He or she is exceptionally defended and exceptionally skilled in aggression and abuse in order to have survived psychically. The couple with a narcissistic member as a result, presents a special exceptionally difficult challenge in therapy. The seven deadly habits: criticizing, blaming, complaining, nagging, threatening, punishing, and bribing or rewarding to control often reverberate in the relationship. The scorpion stings frequently and habitually. The seven caring habits: supporting, encouraging, listening, accepting, trusting, respecting, and negotiating are inconsistent in the relationship. Ironically, the narcissist may be highly skillful practicing the seven caring habits when it suits him or her. And when narcissist rage is not triggered. Both partners may acknowledge the harm of the deadly habits but they persist nevertheless. Roadblocks, eruptions, and ambushes are intrinsic to the therapy. The therapist experiences a version of the regular pattern of the toxic relationship between the partners in the couple. The partners recognize the benefits of the caring habits and often practice them sporadically, but they get lost in the midst of narcissistic energy. Couple therapy that includes a narcissistic partner requires the special- the exceptional therapist: exceptionally knowledgeable, exceptionally skilled, exceptionally psychologically healthy, exceptionally self-aware and secure, and exceptionally mentally agile to conduct exceptional therapy. There may be no exception to this special requirement for work with this special individual, and in this special couple. This book has sought to facilitate development of such exceptional and special knowledge and skills for the therapist the narcissist and the couple desperately need. Beware and be prepared for the scorpion's sting!