Kohut argued that interpreting the transference and confronting clients’ defenses risk being experienced as deeply wounding. This may cause more defensiveness and suppress the transference necessary for positive change. Kernberg also recommends a supportive, empathic approach, but in contrast, he maintains that both positive and negative aspects of the transference should be interpreted; rage in treatment must be confronted in order to preserve the therapy and contain patients’ fears of destroying it and any hope of receiving love (Russell, 1985).
Masterson employs a “mirroring interpretation of narcissistic vulnerability” only when the patient is acting-out in the transference.
It’s a three-step process to interrupt narcissistic defenses in order to bring to the surface the patient’s underlying painful affect (Masterson, 2004):
- Identify and acknowledge the patient’s painful affect with empathy and understanding.
- Emphasize the impact on the patient’s self to indicate understanding of his or her experience.
- Identify and explain the defense or resistance, which can be tied to step 1, by observing how it protects, calms, and soothes the patient from experiencing the painful affect. Care must be taken to avoid a narcissistic injury.
Ideally, interpretations focus on the patient’s need to restore strength after feeling injured. With a grandiose narcissist, the therapist focuses on the failure to mirror the patient’s grandiose self. With a Closet Narcissist, the therapist focuses on failures in the idealized object (Masterson, 2004).
Over time, continued mirroring and working through manageable disturbances in the therapy build trust in the therapist, so that the patient is now better able to participate in self-reflection and tolerate and ingest interpretations (McClean, 2007).
Other therapies for treating narcissism include transference-focused therapy and Jeffrey Young’s Schema Therapy, which integrates psychodynamic, cognitive, and behavioral approaches. Stephen M. Johnson also advocates an integrative strategy to include affective therapies, such as Gestalt, Reichian, and bio-energetics.
The goals of conjoint therapy are that partners attain more realistic and empathic perceptions of one another and that they can tolerate each other’s failure to meet their needs (similar to Kohut’s “transmuting internalization”) (Solomon, 1989).
Usually, underlying vulnerability and shame provokes escalating cycles of defensive maneuvers involving forms of attack and withdrawal (Lancer, 2014). These destructive defenses further deteriorate representations of one another and make therapy unsafe. However, couples can be educated that such tactics erode good feelings and damage their relationship.
To build self-awareness and mutual empathy, the therapist can ask them to each talk about how they protect themselves when they’re hurt, what they need and want from each other, and the effects of their current strategies. This can open an empathic dialogue between them about feelings, wishes, and needs, the way communicate, and its impact on one another.
When a defense is employed, the therapist should interrupt the issues at hand, stating something like, “I think we’re getting to the heart of something that hurts you both a great deal” (Solomon, 1989, p. 159). Then he or she can mirror the underlying hurt, emotions, and needs as suggested by Masterson, above, and guide the partner to assertively express them in a nonthreatening way.
Connecting the couple’s pain to their individual past provides space between them and mutual empathy. It allows projections to be detoxified, retrieved by the projector, and not taken personally by the recipient. They also need help to take responsibility for their individual self-soothing and finding other means of support for their needs.
Individual therapy with a Spouse/Partner
When narcissists won’t join counseling, their partners may enter individual therapy. The therapist can help the partner de-idealize his or her spouse and build self-esteem, autonomy, and resources outside the relationship. It’s helpful to connect the narcissist’s interactions to the partner’s yearnings and pain to childhood abandonment depression. Past trauma and shame can be worked through to increase self-worth and self-compassion.
Supporting the partner to stop reacting to the narcissist is the first step. Teaching the client to speak assertively is important. Partners need to learn to effectively ask the narcissist for what they want and to set boundaries on abusive behavior. This empowers the client and builds self-esteem. It also reduces denial and awakens the partner to the reality of the narcissist’s limitations. Intervening this way intrapsychically and systemically in individual therapy often substantially improves the couples’ interpersonal dynamics.