Peeking into the complexities of the narcissistic client can arouse our curiosity. Treating them individually or in the context of couple’s work can arouse our sense of inadequacy and frustration.
Maintaining a firm and flexible posture, understanding our own personal triggers along with the narcissist’s makeup – helps us to bypass obstacles when dealing with them, promoting a sturdy stance for (empathically) holding the narcissist accountable. In so doing, we can sustain the necessary leverage for healing, and for lasting change. But how can we summon up the courage, maintain an empathically attuned state of mind, and effectively engage these clients when they’re more likely to defend, deny, demean, devalue, attack, distract, and charm us rather than cooperate with us and comply with treatment?
Exploring the critical content related to early life experience and unmet needs is essential to the formulation of a robust conceptualization and the implementation of treatment but can be a triggering endeavor for many therapists when facing the belligerence, self-righteous entitlement, denial, neurotic victimization, and arrogance, of a narcissistic client.
Treating the narcissistic client – overt and covert – involves meeting early unmet needs such as, unconditional love and acceptance, empathy, and tolerance for frustration and limits. This comes with the challenge of confronting bullying, critical, passive-aggressive, detached, martyrish, and approval-seeking modes.
These clients sometimes default into hypersexual activity such as pornography, cyber-sexual relationships, prostitutes, affairs, or other erotic preoccupation. Intimacy is fractured and the refurbishing of trust is challenging due to the “betrayal trauma” of offended partners and the entitled stance of the narcissist. Healing is possible when leverage is high enough and partners are willing to engage in the treatment process individually and together.
At the heart of schema therapy, we have an approach capable of weakening narcissistic coping modes, and internal demanding critic modes. Adaptive responses replace unhelpful ones as schemas heal. Using effective strategies grounded in emotional engagement and the therapy relationship, therapists are poised to correct the biased early emotional experiences typically linked with high demands for extraordinary performance, confusing messages of over-indulgence alongside inferiority and insecure attachments, devalued emotional experiences, and poor limit setting.
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