Run-of-the-Mill Narcissist Behavior in the Context of Psychotherapy and How It May Impact 'Outside'

In the framework of psychotherapy sessions, narcissistic behavior by the patient would seem to be normal. After all, one of the stipulations of the patient-therapist agreement is that each session will key exclusively on the client and his or her needs, rather than those of the therapist. In this sense, deciding to embark on psychotherapy is in itself a kind of narcissistic behavior. Some theorists such as Heinz Kohut feel that therapy functions in a redeeming way, to make up for the noticeable lack of sufficient parental empathy and mirroring that leads to narcissism; narcissistic behavior by patients in treatment is as a result not only to be expected but should be encouraged.

While we expect our patients to be self-absorbed during sessions, such narcissistic behavior outside the context of psychotherapy would be improper. One of the potentially deleterious side effects of treatment, with its emotional satisfaction of long-unmet needs, is that patients come to ache 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 communications; in effect, it's a 24/7 sort of psychotherapy, where patients try to feel as if they were in session all the time. One of our aims as therapists is to aid clients to learn to accept that only in session is their narcissistic behavior acceptable. "Outside" relationships must be reciprocal; for each person to have his or her needs met, all relationships must yield gratification for each person.

Now and then in the practice of psychotherapy, one meets the patient who seems unable to feel any type of empathy for anyone, including the therapist, and can only view him or her in an idealized fashion. These people usually come from seriously inferior backgrounds; their extreme narcissistic behavior reveals a desperate need for mirroring and empathic support because nobody else in their lives has ever been able to supply it. These clients can be quite arduous to work with as they have little tolerance for the ordinary interruptions in treatment: weekends and vacations, the periodic personal emergency. They may make recurrent "emergency" phone calls; they may want to have constant contact with the therapist in between sessions and can't tolerate any feeling of separation.

If they are even capable of continuing personal relationships, this sort of client will also prove severely exacting and possessive of their friends and mates. Narcissistic behavior is prevalent in many forms: an intolerance for separateness, a desire to dominate the other person, and self-absorption so severe that they may be heedless of their friend's or partner's suffering, needs and wishes. A juvenile type of rage may be the reaction to mental upset or slights.

As an efficacious treatment gains ground, the client will learn to cope with separateness; obtaining the sort of empathy and mirroring that were lacking in their upbringing will help decrease narcissistic behavior and advance a new faculty for empathy. This may start in relation to the therapist: emotional lessons learned in the framework of psychotherapy sessions will in future generalize. Development in the therapeutic relationship then generates growth in outside relationships as well. In this way, psychotherapy is a microcosm of the client's larger world; Change within that microcosm begets "outside" growth as well.

Joseph Burgo PhD writes a psychotherapy blog for people who want to continue to grow after the end of psychotherapy, with the kind of relationship advice you won't find elsewhere on the Internet