So in the video below, Jennifer Sweeton, PsyD gets into one rapport-building strategy that can help increase your effectiveness when working with narcissism.
Have a look.
So for these clients, you may need a whole other strategy. For these clients, a lot of times they may be seeing you as the clinician, as someone who’s a threat in terms of a power differential or the power struggle. If inferiority underlies their narcissism or their grandiosity, they don’t want to go to a clinician who they feel has power over them. That’s going to make them feel inferior. In fact, you may be seeing these narcissistic traits even more so than some of the other people in their lives. You’re going to see it in full force because of the nature of this relationship. So you trying to address it directly, or you even trying to validate it, it’s almost like you’re pulling yourself at their level and this is going to make them uncomfortable, some clients at least, uncomfortable. So with these clients, it can be a very tricky thing, but you may want to watch trying to take over the session.
So sometimes I’ll talk to clinicians. I do a lot of consultation with clinicians and they’ll say, “Well, I feel like session after session is just the same thing. And if I try to say, ‘Hey, can we work on this? Or can we do CBT? Or can we do EMDR?’ I get immense pushback right away. It’s like, they don’t want me. They’ve hired me to be the professional, the expert. And yet they don’t want me in this role.” So what you may have to do is first of all, accept at the outset that this may be a fairly long process. And to also know that they may insist on guiding the session and what you’re trying to do is follow them. And every now and then take a little bit of a detour slightly toward a slightly different place. So for instance, they may be talking, again, about how they were successful and someone at work just didn’t see it.
And this person is obviously just not very intelligent. What you might try to begin doing, slowly over time, is ask them to engage in mentalization. So what I mean by that is taking another person’s perspective and it’s not important that this perspective is accurate at all, but you might just insert the question. “What do you think that coworker was thinking in that moment? What’d you think that coworker was feeling in that moment?” That, in a small way, is beginning to take them out of that narcissistic space, where everything is about them and revolving around them, and putting them in someone else’s mindset. So you can begin to do this over time, when you see that the validating is actually maybe making them worse.
For more expert strategies on working with narcissism, check out this course featuring Bessel van der Kolk, MD; Peter Levine, PhD; Pat Ogden, PhD; Terry Real, MSW, LICSW; and more.
Now we’d like to hear from you. What strategies have been helpful in your work with grandiose clients? Leave a comment below.
I have a question: what do you do when the client answers the question (what could coworker think/feel) with ‘he’s just jealous’. That’s an answer I hear once in a while. How can we know if it’s right or not? I had a client who indeed had experiences of jealousy in childhood (he was mother’s favorite child, it was a bright child and a smart adult later etc..) and this triggered jealousy in his siblings and even father.
This is a general observation and not a critique to anything said.
It is ineffective, even counterproductive that a therapist has a fixing approach. This is so obvious and yet most therapists act like “the one who knows” which immediately creates a power relation (“I am the one who knows what works with ‘this type’ of client”)
In my opinion, a view of the client as someone who needs fixing (“what tool and strategy should I apply with this client right now?) may interfere with the deep humane connection and comprehension necessary to penetrate the client’s reality.
To keep humble and open, we as therapists need to remember that our choice to help others says something about ourselves too. So the therapist constantly works on our own ego to truly focus on the fact that the only way to understand and help the client is through our own sincere empathy.
It is the therapist who has to think “if I behaved in the way my client is doing at the moment, what would I be unconsciously trying to do? And what is the lack, the missing link hidden behind this “trying to do”?
Then the deep humane connection miraculously occurs and the perfect healing interaction (with long lasting results) begins to occur.
Really helpful
Needing to remain in control in a therapeutic session is not necessarily NPD, but the modus to survive or else totally loose one’s empowerment. A therapist is not there in daily life, cannot take over control. And Mentalization about why a nasty person does things is not very useful. Introspection not a given. Just one way to survive Trauma,s, whilst the other way is trying to control others and manipulate situations, lacking Introspection. In some cases lacking Empathy. According to research not present in the genes of many men. Leading to an inability to read others, read their Narcissistic ex spouse or their daughter. Just a talk with two female neighbours triggered trauma. One saying all negatives land on my plate, whilst i am suffering a bad CPTSD/DID day, and the other telling me to stop feeling that way and to look at the future. With all the suffering in the world i never understand where these kind of people are coming from. I found building tools to work the best. But when i Collapse/submit i do neither take my supplements, nor do my daily practices and acutely become suicidal. This pit lasting for a few days and after decades of experience taking my supplements, using my tools, surface again. I was very disappointed the other day hearing a therapist say to a client she could not fix the issues. Is that not what a client pays a therapist for? Heard this paradigm claimed before in a large conference about Child trauma. When traumatized Inutero it is what you need. the therapist, the other to fix certain things as you never learned to Live but only to Survive, needing a mother’s brain to learn, to grow, being denied that Inutero and in Early Childhood. At 4 i dissociated in becoming my Mother’s Mother and remained that until the day she died. Never a daughter, never a child. It was the only available option for me as a very unwanted, calendar accident, failed abortion child.
People telling others‘ ‘not to feel that way’ is called chronic invalidation. DBT founder Dr Marsha Linehan writes about the deep and long-lasting emotional damage done by such intolerant, toxic and frankly gaslighting comments.
Excellent strategy and it works for me as well with that type of client.
It seems there is an assumption that one can teach self-reflection.
In my life of experience and observation of a personal nature as well as professional, a tiger doesn’t change its stripes.
That May be true but you can give relational
Reflection of worthiness- Which in itself is healing for the often underlying trauma of deep emotional neglect in a narcissist. And therefore lead the way to self reflection as it naturally gripes with relational healing.
“What do you think that coworker was thinking/feeling at that moment.” Great cue!