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The Malignant Narcissist

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We already have distinguished between a pathological narcissist and a malignant narcissist based on the extent of cruelty, sadism, paranoia and fusion with their objects: how pathological narcissists join with others as a mirror reflection of themselves, whereas the malignant narcissist joins with an external object to project their cruelty and malevolence. Earlier we distinguished between the antisocial narcissist and malignant narcissism based on the degree of superego functioning.

According to Kernberg (1992, 1995), the fusion with a sadistic internal object gives the malignant narcissist a momentary sense of power and superiority: “Now others will experience the pain and torture I feel!” In some delusional way this is an attempt to remove psychic pain from normal states of dependency for fear of being hurt or vulnerable. The malignant narcissist joins with an internal object that colludes with the insanity, private madness of the couple, or the folie à deux. Together, the dance of insanity.

One point that has been grossly overlooked in the treatment of criminals, murderers, torturers and terrorists is the notion of fantasy. Criminals have a much diminished fantasy life, unable to distinguish between reality and fantasy and therefore have to “do it” rather than fantasize about “doing it” (e.g., beheading, bodily mutilations). Melanie Klein’s (1934) contribution Criminal Tendencies in Normal Children showed that through play, children using tiny dolls, men, women, animals, cars and trains in play therapy mutilate, cut, beat, slice and destroy them and repeat the same hostile sadistic acts again and again. She recognized that children have the desire and impulse to destroy, cut up mommy’s breast and mutilate daddy’s penis, and through play therapy the child early on learns the difference between the act of doing and the act of fantasizing about doing it. Basically, Klein was saying that the more guilty and persecuted a child feels the more aggressive he or she becomes. According to Klein (1927), it is this process that leads to the delinquent or the criminal. She concluded that these children who are denied a fantasy life grow up with a lack of a superego that diminishes self-discipline and overpowers the conscience (what I refer to as a reverse superego). This eventually leads to antisocial and criminal behavior. Often this occurs in societies with severe abusive and depriving child-rearing practices (see Chapter 9). Without a container to hold the child’s destructive impulses it gets acted out. Often one finds justification for such acts in retaliation against a frustrating breast

or a manic defense against the feeding breast. The real punishment, however

severe, was still more reassuring in comparison with the murderous attacks they were continuously expecting from imaginative cruel parents.

The malignant narcissist tends to be vile, cruel and malicious. These narcissists are full of self-doubts and self-loathing and constantly need to have others reinforce their beliefs and convictions. Many are pathological liars who often believe their lies are the truth. To highlight the characteristics of a malignant narcissist or to make the dynamics more glaringly apparent, I refer to the psychological make-up of a terrorist (Lachkar, 2006) and to folie à deux in marital and political relationships (Lachkar, 1993a, 1993b). Sadism, hatred and uncontrollable aggression are the most common syndromes of the malignant narcissist, whose paranoid features drive self-serving political aspirations that become the rationale for acting out one’s worse sadistic fantasies through destructive aggression. The malignant narcissist is usually a leader with striking similarities to heads of various dictatorial and tyrannical regimes: for example, someone like Slobodan Milosevic, the Serbian war criminal, who under the guise of religion or “the cause” can act out the most heinous crimes and violations against humanity.

The most pervasive trait of malignant narcissists is that they often enact the role the victims: “It is not me doing something to you; It is you who has done something bad to me!” This is not a far cry from Osama bin Laden claiming the 9/11 attack was in defense of his own people and was the will of Allah (Lachkar, 2002). Typically, individuals within nations often are seduced to collude with leaders who play out the group’s shared collective group fantasies and thus form a powerful, intimate connection with the group. Often these leaders exhibit paranoid and sadistic features that compel them to fulfill self-serving political aspirations and provide the rationale for their own destructive and sadistic acts of aggression: “I swore to the Serbs I would be their leader and would protect them and never would I allow the Albanians to hurt them again.” In addition, the malignant narcissist may be so infused with envy that he will use any possible mode of control and domination to ensure that the other will not succeed: “I’ll do anything to see that he does fail.”

I am reminded of a character in Arthur Golden’s (1997) novel Memoirs of a Geisha. Hatsumomo does all kinds of vile things to a young geisha apprentice, 12-year-old Chiyo-Chan, whom she envies for her beauty, talent and charm. Hatsumomo has a select entourage of enablers who join and feed into her aggression. Each time Hatsumomo passes by Chiyo-Chan she says, “Oh, there is little Miss Stupid.” She and her support system do everything in their power to destroy the younger trainee. On one occasion Hatsumomo makes Chiyo-Chan write in black marker the name of another geisha, her rival Mamecha, on her most expensive and most beautiful kimono, resulting in a severe beating and confinement for Chiyo-Chan. In this way, Hatsumomo “had the power to make my life miserable in any way she wanted. I had no choice but to obey” (p. 81).

Communicating effectively with the malignant narcissist requires that we must always start with praise for the cause espoused or, shall we say, appreciation and understanding, but not acceptance. This would be especially true in extreme cases: “No, you cannot murder and torture prisoners, but given the fact that these prisoners killed your parents during the war, I can understand how you would do anything to seek revenge.”

Folie à Deux

Few authors have made reference to the concept of folie à deux in the psychoanalytic literature. No one does it so eloquently as do Henry Dicks (1967) in Marital Tensions and Albert Mason (1994) in Quick Otto and Slow Leopold, describing the folie à deux relationship between Wilhelm Fleiss and Sigmund Freud (Fleiss coercing Freud to believe in numerology). People who identify with destructive partners, groups and leaders perpetuate certain collective group delusional fantasies and convince their partners or people through fear and terror that their grandiose schemes will lead to some salvation.

Women Who Choose to Stay With Malignant Narcissists

The type of woman who stays with a malignant narcissist is typically someone who exhibits a borderline pathology, who is a dependent type or who assumes a caretaker role—someone who colludes or joins up with this disorder’s pathology. This partner does not have a sense of self and perpetuates feelings of unworthiness by being submissive and compliant to the perpetrator’s every whim. Some partners may share many of the same aggressive attributes as the malignant narcissist. The extreme example is a partner who will fight for a cause at any price, even at the sacrifice of themselves, her family or her children. In some cases, the partner may be someone who needs to enact her own hidden agenda acts of aggression, through forming a strong identification and idealized attachment to the malignant narcissist: “I know my husband tortured thousand of prisoners, but he did it for a good cause. He is a ‘real man’” (confusing aggression and cruelty with strength and honor).

Allegra, a professional opera singer, fit the perfect description of the emotionally abused woman. Even though no one laid a hand on her, she could feel just as violated as a woman who is being physically abused (Lachkar, 1998). Her husband, Bill, continually devalued and put her down, making her feel that she was a nothing and he was everything: “I was a pro football player. How can you compare that to a woman who stands up on a stage and makes all those squeaky sounds come out of her mouth?” Allegra, like many abused women, had lost all sense of self-esteem and self-worth. She felt as if she was not worthy unless she was performing or was on center stage.

Her husband, Bill, the ex-football player, worked as a coach in a local high school. Allegra, the former opera star, had formed a collusive bond with a man who reenacted a familiar scenario, a prescripted role she played with her mother as a child. Allegra was taught from childhood to perform, to sing, to study every possible instrument. The only thing that mattered was for her to become a famous opera soloist. Conditioned from childhood to conform to her mother’s every wish and demand, she was the obedient child who never questioned or challenged but simply did just what she was told.

Allegra described an incident when she was 12 years of age. Despite being sick, cold and hungry, she was forced to get up at 4:00 a.m. to catch an early flight to Europe to meet with a concertmaster at a European opera house. When she arrived, her throat was so sore that she could hardly talk, let alone sing. Her mother went into a complete panic and instantly bought every cough drop available. Allegra was forced into an audition, sitting in a cold room waiting for hours for her name to be called. The concertmaster was so outraged by the mother’s insensitivity that he actually criticized her in front of those in attendance and forced her to get the child to a doctor: “She did and found that I had walking pneumonia. My mother was devastated. All she could think about was the loss of an opportunity, but there was no caring or consideration for me.”


Th: Hi, Allegra …

A: I’m exhausted.

Th: Oh?

A: My husband kept me up all yesterday again, wouldn’t let me sleep. He knows I have a night job and have to sleep during the day, and he gets really pissed.

Th: So he has no consideration for you?

A: None whatsoever. Furthermore, I am the one who runs the house. I pick the kids up from school, help them with their homework, cook, get food and lunch stuff ready, and he thinks I don’t do anything. He makes me feel that I shouldn’t have any needs. More than that, if I come home late he thinks I’m out screwing someone.

Th: So he’s paranoid?

A: Then on top of it all he asks me to massage his back and suck his dick.

Th: Your husband sounds like a very cruel and selfish guy. Why do you stay?

A: That’s a question I have been asking myself all along. My friends tell me to get out. I am so sleep deprived I can’t even function.

Th: You definitely need your sleep.

A: My aunt asked me to come over for a few days just to recuperate, but I’m too scared to leave him.

Th: Scared?

A: I’m afraid that when I get back he won’t be there.

Th: This sounds as though it is not reality based because basically he needs you more than you need him. I guess it goes back to feeling abandoned emotionally by your mother, who lived through you and used you for her own self-serving purposes.

A: You’re right. He is mean, cruel and sadistic, and I stay because I feel it is my duty to obey him.

Th: So you are bringing into your current reality your old childhood fantasies, as if you are a small child again beholden to a stage mother who cared only about how you performed.

A: Now I am always performing. I feel he judges me on how well I perform.

Th: Yes, but to the extent of sabotaging your own needs.

A: I can’t go on like this.

Th: As bad as it was, at least with your mother it led to a successful career. With your husband it leads to nothing but shame, humiliation and guilt.

A: Hmmmm—you’re right about that—never thought of it that way.

Th: I suggest you go to your aunt’s, get some sleep and please be aware there is no indication he will leave you. In fact, he is like glue. [the fused part dependent on the object]

A: I think you’re right. I kind of know that, but it’s good to hear it. It gives me reassurance.

Th: That is the problem. You depend too much on how things feel rather than how things are. Right now we are trying to get your needs met, and it might not feel good, but at least you will be functioning.

A: But how will it look?

Th: This is not a performance. You are not to kill yourself to please maestro, your mother or an audience. This is not a dress rehearsal but a real entrée to having a healthy life. If you keep on being a slave, then you can’t grow, and he will in time become more fused and more aggressive.

A: I think you’re right.

Th: Let’s stop now. See you next week.

A: Would you like to come to my studio? I’ll give you a great massage.

Th: That would be lovely, but if I do that then you would be my caretaker and there wouldn’t be a me here to take care of you.

A: You mean it is okay for me to not take care of you?

(Therapist uses Allegra’s caretaker role as a lead-in to the transparent relationship.)

Th: That’s my role, not yours.

A: Wow! This is a new one for me.

Th: We have to stop now. See you next week.

A: Bye.


Because of the lack of conscience and inability to feel guilt or to show remorse on the part of Allegra’s partner, this case could easily be in the chapter on antisocial narcissism. However, because of the fusion of the couple and how together they do the dance, it has applicability here. Each one becomes an appendage of the other as they join in complicity. Allegra not only feels diminished and denigrated by her partner, but she identifies and internalizes the negative projections, or what Klein (1957) referred to as the introjective–projective process. I have termed this dual projective identification (Lachkar, 1998, 2004, 2008). Although Allegra’s partner made her an appendage to himself, someone to take care of his every whim, he joined up with a woman like Allegra because she made the perfect aim for his cruelty and aggression. Because of her own relational bond with a mother, Allegra had to appease and please; she fantasized that the more she compromised and gave herself over to him, the more he would appreciate and love her.

An examination of depression must also address aspects of emotional and physical abuse. Emotional abuse may be defined as including verbal and behavioral means to undermine someone’s sense of self, resorting to such tactics as ridiculing, shaming, blaming, criticizing, threatening and neglecting the partner’s emotional needs (Lachkar, 1998). It is an ongoing process in which one person, either consciously or unconsciously, psychologically attempts to destroy the will, needs, desires or perceptions of the other. Although emotional abuse has been associated with physical abuse, it embodies different elements. Both forms of abuse epitomize aggression and pent-up rage, but emotional abuse is insidious, lingering and often covert. It can be just as harmful as physical abuse—and in some cases even more so.

The most salient feature of emotional abuse is its insidious nature. It is about power, domination and control and is harder to identify since it is more subtle than physical abuse; there are no obvious signs like broken bones, scars or bruises. However, the emotional scars it leaves can be equally devastating. Physical abuse is generally cyclical and intermittent, whereas emotional abuse often follows a predictable pattern that is continuous and ongoing. Even though these episodes may follow pleas for forgiveness and remorse, as tension builds promises are replaced by threats and the assaults escalates again.

Emotional abuse is a brainwashing method that over time makes the woman into an enabler. It is quite common for the partner to believe that she is responsible for the abuse and thus must adapt and adjust to it. Instead of leaving, she strives to modify her behavior with the hope of de-escalating the aggression. According to Loring (1994), there are two types of psychological abuse: overt and covert. Overt abuse is openly demeaning and defacing (e.g., verbal put-downs, constant criticisms). Covert abuse is subtle and hidden, but no less devastating.

In earlier contributions I focused mainly on the emotional abuse of the high- functioning woman (HFW) (Lachkar, 1998, 2004, 2008). It was aston-ishing to realize that a woman who can function so efficiently in the workplace can return home to an emotionally abusive spouse and suddenly go into a downhill spiral. People often think that only women who have experienced trauma or abuse in early childhood are easy prey for abuse. By and large, all women can be prey. The higher-level HFW was not subjected to early childhood trauma or abuse. However, she stays with the malignant narcissist because she wants to preserve the family unit. She does not identify withthe abuse, nor does she feel deserving of it. The lower-level HFW, a product of early abuse and trauma, does identify with the abuse and does feel she deserves it. The major difference is that the higher-level HFW may fill her life with other interests, outside resources and support whereas the lower-level HFW may dwell in the depression and the paralysis and may live in the depths of the despair (as in case of Sandra later in this chapter).

Why Are Men Often the Aggressors?

Many mental health professionals are beginning to concede the point that men are often the aggressors and predators and that they are more sadistic in nature than women. Men’s aggression appears to be intimately tied to the vicissitudes of identification, the deep-rooted fears and threats to their masculinity. By contrast, women tend to be more masochistic and often assume the role of victim. Men worry that they will become like mother and vigorously defend against this in two ways: (1) through disparagement of women by emphasizing and reemphasizing their own masculinity; and (2) by becoming tough, powerful, aggressive and, for the most part, unemotional. Consistent with this argument is Benjamin’s (1988) idea of identificatory love and Greenson’s (1968) notion of disidentification, affirming that boys disidentify with mother and push her away to take on a male role. Benjamin argued that a women’s identification with mother is the source of her psychological foundation and of her female power.

Kernberg’s (1995) explanation of narcissistic pathology in relationship to love object bonds is in part gender related. He stated that in women there lies a masochistic tendency to attach themselves to unsatisfactory men who cannot sustain a full and intimate relationship with them. Benjamin (1988) noted that masochism in women can be seen as a means for escaping loneliness by allowing the other to be in control. Kernberg claimed that men attach them-selves to unsatisfactory women for fear and insecurity, which takes the form of hostility and resentment toward them—“envy of the pregenital mother” (p. 56).

The following concerns must be communicated to the woman within the context of emotional abuse as a link to depression:

  • Fear that the rage will escalate and move into physical danger to her and

  • her children if they try to leave

  • Fear that leaving will result in something worse

  • Fear of the loss of economic support for herself and the children

  • Fear of being alone, alienated, isolated by society; fear she can’t cope with home and family on her own

  • Fear that the children will feel abandoned

  • Fear of losing custody battles and long, drawn-out court battles

  • Fear of finding work, housing, child care

  • Fear of recrimination from friends, family and social community

In terms of communication, the therapist has an opportunity to justify and validate all of these as legitimate, realistic concerns. The therapist must then immediately “attack” the defenses with incisive laser sharpness: “Yes, all these concerns and fears are true. But if you live in a state of despair, feel you are deserving of the abuse, identify with the abuse, become the depression or the paralysis, then you make it harder to use your mind and resources to know what to do.”

The following is an example of a man so emotionally abused he went into a complete depression to the point where he actually became emotionally and physically paralyzed.

I couldn’t sleep, eat, or work. I cried all the time, was lethargic, a textbook model of depression. I was so low, and Sophia offered no caring or sympathy. We were having major financial difficulties, but instead of being a partner and discussing with me what we could do she went to New York and went on a wild shopping spree. Never a concern about me. She was only concerned with her own image—trips, clothes and with what others think of her.

Let us examine the impact a malicious narcissistic pathological liar has on a woman’s self-esteem and impaired ego functioning.

Sandra was continually hoping to have a relationship with a man who promised that someday he would get his act together and that they would be together as a real couple. She would wait and wait and wait. Endless days and weekends would go by with nothing more than an XOXO e-mail. When she did call she would discover he was out of town, usually with another woman, whom he claimed meant nothing to him. The patient was paralyzed and could not move out of her house. Reality was not soothing; the more reality she was faced with, the greater the denial.

I know it happened. I saw it happen. But still when he tells me his lies for some reason I lose my reality. I knew he was staying at the Ritz Carlton Hotel. I could not help myself and was determined to enter his room. I begged the housekeeper to let me in under the guise of forgetting my key. When I entered I was in complete shock. There on the bed lay a black negligee, Victoria’s Secret underwear, and two bottles of Cabernet Sauvignon with used wine glasses. When I confronted him, he said, “It’s not true. You are imagining things again.”

In the following example we see how a son regarded his clingy, overly possessive mother. The fusion was so suffocating that his only recourse was to disidentify with her. In an effort to separate from her he attached himself to a woman whom he then made into a caricature of his mother.

Mrs. L: Mother as Caricature

I was walking on eggshells, anxious and fearful about having to make a very difficult interpretation to Mrs. L, a 60-year-old, once-famous movie star with severe narcissistic personality traits and strong histrionic features. Mrs. L called for a last-minute session, very upset about her adult son’s choice of a new female partner. Although Mrs. L was predominantly narcissistic, she crossed over to other disorders—including borderline and dependent-histrionic pathology. Her exhibitionism, for example, was a wild part of herself that produced an outer shell to allure and seduce.

Despite her loneliness and loss of fame, her grandiose, omnipotent self made it difficult for her to reach out and forge new relationships. She thought she was as young and beautiful as she had been when she was 20: “There just isn’t anyone out there who is suitable for me.” Because of her attachment to an internal depriving–rejecting object, she guarded against her healthy emotional vulnerability and dependency needs, misconstruing my attempt to help her as criticism or a way to control her. She already knew everything and had all the answers.

Mrs. L began by describing all her son’s prior girlfriends as inappropriate, rude, ill-mannered and very distastefully dressed: “I cannot tolerate Joel’s new girlfriend.” Unbeknownst to Mrs. L, her son had chosen a woman who was an object replica of herself. He then made a symbolic caricature of her—a mother who looked completely ridiculous in stilt-like heels in which she could hardly walk, skirts so short she could hardly cross her legs and a harsh voice that constantly demanded and complained. Thus, at the same time he repudiated his mother he also recreated her.

This presented a real therapeutic dilemma. How does a therapist convey such a thing to a patient so vulnerable without creating a huge narcissistic-histrionic flare-up? One cannot merely say, “Your son’s girlfriend is a mockery of you.” The therapist must find a way to transform the son’s projection of a cartoon-like mother as having more to do with her son’s internal world than his “real mother.”

From a theoretical perspective, again we see the blend of self-psychology and object relations to be a perfect match, taking the focus away from the mother’s narcissistic involvement to the part of the self the son long ago abandoned, the splitting off of his real, legitimate needs. Ironically, both mother and son were joined in complicity, whereby both poked fun and devalued their own needs, making them into something ridiculous: “What? Join a dating service and make an utter fool of myself? What do you think I am? Some kind of a desperate woman?”

Drawing from Heinz Kohut’s work on empathy and mirroring offers invaluable methods for handling such sensitive issues. In addition, Melanie Klein’s work has been most influential—mainly her article “On Identification” (1929). It describes the infant’s sadistic fantasies toward the mother’s breast as it was being deprived; because it is so needed, the breast becomes an object of denial, the lost part never to be regained because it is trapped in the mother’s body. In other words, to make up for the missing part instead of mourning for the object, one becomes it. Klein’s article is invaluable, showing how patients not only project unwanted or missing parts onto external objects but also how they form an identification with them.

Otto Kernberg took this a step further by noting that a certain segment of homosexual men act like funny little women, first by identifying with them, then becoming them and, finally, making them into comic characters. He noted that this is quite different from the norm in the gay population (O. Kernberg, personal communication, 10/28/2001). The following example is a description of a son (not gay) who unconsciously enacted his sadistic malicious fantasies toward his mother through choosing a mate he knew his mother would despise, yet in an exaggerated format created a mate who almost in a comical way shared many of the same characteristic as his mother. Mrs. L showed up dressed in a leopard-print skin-tight skirt, very high heels, a black low-cut sweater that revealed her newly implanted breasts, long blond extensions and thick plum lipstick to display her Botoxed lips. Using the empathic mode to assuage persecutory anxieties, I opened a new space, showing how I under-stood Mrs. L’s pain, how upsetting it must be that her son had chosen a most inappropriate partner. This eventually segued into the discussion of Mrs. L’s needs and how she disregarded and mocked me. Wherever I tried to help her with her emotional needs, she responded, “What are you talking about? I’ve already done that, tried that.” I plugged along until I eventually got Mrs. L to understand that in the same way she made a mockery of me by ignoring her own needs, her son was doing the same thing “by symbolically choosing the most absurd woman he can imagine because he, like you, thinks his needs are ludicrous.” Suddenly, I leapt from the external object (her son) to her depriving, internal object, showing her that by her disregarding her own internal needs she unwittingly joined in a collusive bond with her son (folie à deux).

Case of Mrs. L

Mrs. L: I just have to talk to you. My son did it again. He invited a horrible woman who he calls his new girlfriend to my birthday dinner. Even though I said I would prefer for her not to come, he brought her anyway. They picked me up and put me in the back seat of the car next to her mother who I couldn’t stand. I complained that I was hot and uncomfortable and asked the girlfriend if she would change places with me. “Oh,” she blurts out, “I hate sitting in the back seat, and I thought you and my mother would get along.” We finally arrive at the restaurant, and, of course, she picks the worst restaurant. When I got out of the car I got a good look at her. She was very tall, skinny/bony, and dressed very weird. Her high heels were like stilts, as if she weren’t tall enough.

Therapist (Th): Then what happened?

Mrs. L: Well, I didn’t want to sit in the corner. You know how claustrophobic I get. So we sat by the window. The waiter came over. Everyone knows I am on a diet and my son is a vegetarian and also I don’t drink alcohol, so she [the girlfriend] deliberately yells out, “They have great desserts, and also steak and chicken. Oh cool. I just love steak.” At that moment I wanted to puke. I did not raise my son to become a neurosurgeon to end up with a piece of crap like her. She had no manners. Would you believe that when the food came she started to wipe her wet hands on her clothes? I tell you I felt disgusted and wondered why in the world my son would choose a woman like that!

Th: (I gather up my courage to finally confront Mrs. L, wondering how I convey that the girlfriend is an exaggerated version of her. Should I just let it pass? How do I say, “The girlfriend may have no manners but you have no boundaries.” I can’t say that, but I can find another way in. Okay, Joan, I say to myself. Go for it.) Mrs. L, I hope you’ll take what I am about to say to you in the spirit of the analytic work we’re doing. Please do not take it as anything personal against you.

Mrs. L: No, of course. I am very interested in what have to say; otherwise I wouldn’t be here.

Th: You know how children exaggerate and make fun of their parents?

Mrs. L: Go on.

Th: Well, this is what your son is doing,

Mrs. L: What in the world are you getting at?

Th: I believe your son has a distorted image of you. He takes your good intentions, the desire to take care of your health and beauty needs, and distorts and twists them around. So instead of seeing you as someone attempting to take care of her health and attractiveness, he sees you as fussy and picky.

Mrs. L: Are you saying I’m fussy and picky?

Th: I didn’t say that you are fussy and picky. That’s not for me to judge. I’m saying that your son may misinterpret your good intentions and efforts as an exaggeration or as a distortion.

Mrs. L: So what’s wrong with that?

Th: For me, nothing. These traits are admirable. But, again, I am not your son. He has his own issues and desires to separate from you. However, instead of doing it in a healthy way, he is retaliating and has to make fun of you by displaying this ridiculous girlfriend in your face as you describe. Just to reassure you, I think you’re right. This woman won’t last, and I believe he is merely acting something out.

Mrs. L: This makes me feel better, to know this is just temporary and that he won’t end up with her.

Th: She is a caricature of you. It is a hostile act, something in him that he does not have words for (the unmentalized experience).

Mrs. L: This makes some sense. No, I am not offended, and I think you have explained something I couldn’t make sense of before. So it’s nothing I’ve done wrong?

Th: No. At this point your son is an adult and has to be responsible for his own inner world, his own unconscious enactments and behavior. In fact, it is because he is so attached to you that he has to pull away. You’re been a great mom. Look at all the things your son and your daughter have accomplished. Not too many kids have had the love and opportunities you have offered them.

Mrs. L: I just can’t stand this woman. So what should I do?

Th: At this point, nothing. Stay out of it. (I decide to go into transference mode, a very touchy matter at this point). But you have also been very fussy and demanding here. You have changed our appointments many times at the last minute and often cancel at the last minute, acting as if routine beauty appointments (massage, Botox, hair and nail appointments) are more important than taking care of your legitimate emotional needs. By putting your needs aside, you are not getting the proper attention you require and deserve.

Mrs. L: Yes, and I appreciate that, that you don’t make those kinds of judgments.

Th: I’m not your son. I’m here to understand you, not to distort your image but to be direct and up front with you. You do not have the same compassion as a therapist. Apparently your son feels very hostile and is acting something out that is completely separate from you.


I began to lay the groundwork, moving gently into transference mode and showing Mrs. L how, just like her son, she did not deal with her own legitimate needs. She made a caricature of them by putting her beauty appointments before her emotional needs in the same way her son made fun of his own emotional needs by choosing an inappropriate woman. Whether the therapist was accurate or not in the interpretation of how her son was using the girlfriend to present a caricature image of Mrs. L, this case, nevertheless, displays the kinds of sensitivity and empathy needed to deal with such delicate conflicts. The way to address the narcissistic Mrs. L is to begin by being nonjudgmental and noncritical, even to the extent of showing appreciation for her desire to take care of her health and beauty needs. This kind of interpretative work gradually helped move her away from false needs to real ones—for example, finding her own mate, transforming the preoccupation with her son to living more within her own psychic space. Communicating with Mrs. L required me first to be empathic and nonjudgmental, to show appreciation for her development and makeover job. Then I could address the subject of Mrs. L’s becoming more attentive to her own emotional needs.

People who are particularly vulnerable to abandonment, anxiety and depression need constant reassurance from the therapist to remind them of reality. The patient will take great satisfaction in learning to evaluate his or her own perceptions by constantly referring back to the experience, replaying it again and again.

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