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Pathological narcissists are extreme in their narcissistic defenses and behavior. They engage in almost a narcissist feast or frenzy, are totally self-absorbed, lack empathy and display indifference or apathy to the emotional needs of others. Pathological narcissists have a highly exaggerated sense of self and are dominated by such primitive defense mechanisms as guilt, shame, envy, control, domination, splitting, projection, projective identification and paranoid anxiety—including many unresolved Oedipal issues. The major defense is in allowing themselves to be dependent: “I’m quitting this treatment, haven’t learned a damn thing and can get more out of reading a book. Nothing has changed.” To this the therapist might reply, “I understand your frustration, and because you are so very bright and educated it has been difficult for me to help you. Of course you can get it out of a book, but every time I offer you something, you’ve already been there, done it, have it all and know it all. So if you can’t take anything in from that, what then can I offer?”
In addition to showing little or no regard for the feelings or sentiments of others, pathological narcissists believe the world centers solely around them. Some refer to these narcissistic personalities as “users”: “She only calls when she needs something; otherwise I never hear from her;” “When I am in a room with her, she hardly knows I exist!” A patient who was at a cocktail party with a narcissist had a dream that night that she was a perfume bottle and that after speaking with the narcissist she evaporated into the bottle and disappeared.
Pathological narcissists share the common narcissistic desire to attain power, fame, wealth and beauty and are in need of constant praise and admiration from others. The desire to maintain a healthy relationship becomes overshadowed by these defenses. In other words, love and intimacy are replaced by primitive defenses such as the need to dominate, to control and to compete, as well as Oedipal rivalry. Pathological narcissists see the object merely as an appendage of themselves: “You will be a doctor no matter what it takes, and your success will be my success: my son the doctor.“ In essence, many narcissists have a fear of intimacy, which can cause a great deal of suffering for partners involved with them. The narcissist’s greatest fear is “the womb of intimacy.”
Typically, pathological narcissists choose someone like a borderline per-sonality type, a person who has a thwarted sense of self, who suffers from abandonment anxiety. Because the chosen partner frequently has an exquisite false self, she can for a short while pose at being the perfect mirroring self-object for the narcissist: “I will do whatever you want, just don’t abandon me” (Lachkar, 1992, 1998, 2008).
Mirabel and Jake had experienced an on and off relationship for the previous five years when they first began therapy. Mirabel was 35 years old, had never been married and was a teacher; Jake was a 42-year-old lawyer. They entered treatment with much frustration after being referred to numerous previous therapists and counselors. Mirabel realized her biological clock was running out, and Jake seemed to take the position that her biological clock had very little importance. What is more important is that Mirabel was a shopaholic, was obsessed with beauty and appearance and had little regard for Jake’s time or space. She could think about one thing and one thing only: marriage.
Therapist (Th):Greetings. Nice to meet you both. Who would like to start?
Mirabel (M):I’d like to start. I am so frustrated, feel depressed, cry all the time and don’t feel that Jake pays attention to any of my needs.
Jake (J):How can I when all she does is cry and make demands?
M:I’m 35 years old. Jake promised that eventually we would live together and get married. I want so much to have a baby and scared I won’t be able to if we wait too long.
Th:Jake, what are you waiting for?
J: (angrily) Waiting for her to stop spending so much money on her looks, Botox, hair extensions, breast implants, clothes, nails and stuff.
Th:Jake, where do you live?
J:Live? I live in Bel Air Estates, and Mirabel lives in a not-so-posh area. She lives in the city of Torrance.
Th:That’s a pretty upscale community. Do you see Mirabel any differently than the people in your community?
J:No, she’s not as bad as some of my neighbors who live at the Spa, and Barney’s, but I hate materialistic women.
Th:So why do you live in a materialistic area, and why are you with Mirabel?
J:Because I love the peace and quiet. My home in Bel Air is large and spacey, gives me room for my art collection. And I’m with Mirabel because I love her. But she will have to change her ways before I even consider marriage.
M:See how he puts me down and keeps me on hold. It’s okay for him to spend thousands of dollars on art, but he complains bitterly when I shop or spend money on my things.
J:My money is spent on art objects, hers on Prada purses, Chanel suits and stuff.
M:He loves his vases and art objects more than he loves me. He collects Fabergé eggs, among other porcelain eggs. They cost a fortune. I don’t know why he needs so many eggs. Does he expect they will reproduce themselves?
Th:Mirabel. I see you have a sense of humor and are very clever and clear about what you need and what the issues are.
J: Okay, what are the issues?
Th: (decides to go into communication–empathology mode) Jake, I really admire your taste. You are a man of class and culture with an appreciation of the finer things in life. I’m sure that must be one of the things Mirabel appreciates about you.
J: Thank you. Sometimes I don’t think Mirabel cares about my art objects and that I am a connoisseur of such pieces as Cloisonné, Glocina and Netsuke.
M: I do appreciate that side, but I don’t think it is fair for him to put down my looks and my appreciation for wanting to maintain myself.
Th: In the same way, I am sure that you, Jake, do appreciate how she looks. She is a rather stunning woman, but you don’t appreciate what it takes to maintain herself. She is also working quite hard. School teachers don’t have an easy task these days.
J: Don’t think you really understand the issues.
Th: Jake, in all due respect, if I came to your house, I would have the utmost respect for your expertise—the value and quality of your pieces. [mirroring his true self] But here I would appreciate if you could do the same and appreciate my area of expertise.
J: What is your area of expertise?
Th: Thought you knew (kind of tongue-in-cheek).
J: (laughs for the first time)
Th: Couple therapy and marital conflict.
M: Tell him. He thinks he knows it all. He is so narcissistic and into himself.
Th: Well, I don’t know everything, but I do know something. However, if you showed me an authentic Fabergé egg, I wouldn’t know a real one from a fake one.
J: (warming up slowly)
Th: (starting to confront Jake but a bit uneasy about doing it too soon) What I do know is that as beautiful as these pieces are they are objects—material ones at that.
J: So what’s wrong with that?
Th: Nothing. It is a beautiful thing to be an art collector and connoisseur, but first we bond with people, not objects (therapist holds her breath).
J: Are you putting down my art?
Th: Quite the contrary. I’m putting it up.
M: (remains silent)
Th: Because the power you have in selecting these eggs is the same power you have to produce them for real reproduction. If you keep putting down Mirabel’s needs by not committing to her after being together for five years, you are killing off her eggs. There is also a value in what you two can reproduce together that cannot be bought in a store.
M: (tearful) I have never had this kind of support before.
J: (fumbling around) I never thought of it that way. My dad always put down the fact that he had me. He always told me having a child was a big mistake and a waste of his time.
Th: So his sperm was useless, as were Mom’s eggs.
J: Guess so.
Th: Thank you, Jake, for that wonderful information. It shows you have insights that can be of value here.
M: So are you saying that the reason Jake puts me down is because the more I look like the “fertile egg” the more threatened he feels?
Th: Mirabel, again that is an amazing connection. So you are showing us your mind goes beyond hair extensions.
Th: We have to stop. In closing I would like say that my job is to keep you both healthy to deal with the “real” issues—the authentic ones and not the fake ones.
J and M: Thank you, doctor. See you next week. We would like to continue.
It might have been rather precipitous and quite a risky thing for the therapist to confront Jake early on in the session. In fact, one might criticize her for doing this, but she felt as if the material was ripe, fertile and timely enough to move Jake away from his disingenuous self to his real self and gradually to the real needs that an intimate relationship requires. Throughout the session the therapist began mirroring both Jake and Mirabel, making it clear she was aware of their strengths and good qualities. In addition, she stayed with the thematic motif—using the patients’ words (e.g., eggs, extensions, value, real/authenticity). The therapeutic effort was to keep the treatment real and authentic, away from pretense and falsities (battling about who is more materialistic, who is right or wrong) with the focus on the actual needs of the relationship. Here we also see a budding relationship with the therapist, the emergence of a couple transference (e.g., the therapist as the real and authentic helping, nurturing object).
So much has been written in the psychoanalytic literature on transference and countertransference that it would be folly to delve into it here. In couple therapy, we needed another approach to viewing transference and counter-transference reactions since now instead of two people there are now three involved. Thus, I devised the term couple transference (Lachkar, 1998, 2004) to encompass transference and countertransference issues between partners. However, couple transference is somewhat more complex than individual transference. In couple transference, interpretations are derived from the analyst’s experience and insights and are designed to produce a transformation within the dyadic relationship. Couple transference refers to the mutual projections, delusions, distortions and shared couple fantasies that become displaced onto the therapist. The notion of “couple/therapist” transference opens up an entirely new therapeutic vista or transitional space in which to work. It is within this space that real issues come to life (Lachkar, 1998, 2004, 2008). For example, in the previous case Jake was doing the same thing with the therapist as he was with Mirabel. With Mirabel he was diminishing the importance of her fertility, and for the therapist he was diminishing her capacity to provide “fertile,” meaningful insights.
Transference and countertransference issues take on a different shape when we take include ego functioning in the mix. One supervisee told me he was enraged every time his patients were late because they reminded him of his ex-wife, who took three hours to get dressed and was late to every function they attended, including missing an airplane.
The characteristics of the pathological narcissist overlap those of many of the narcissists described in this book, but there are distinct differences. Whereas the pathological narcissist is dominated by many severe primitive defense mechanisms, he is not necessarily cruel and sadistic, as is the malignant narcissist. He still answers to a restrictive and punitive superego or internal voice as opposed to the antisocial narcissist, who has no conscience. Kernberg, more than anyone, helps us define more clearly pathological narcissism within the context of relationships (Lachkar, 1998, 2004, 2008). Let us briefly review these various love bonds.
In Aggression in Personality Disorders and Perversions, Kernberg (1995) reminded us of the complexities of relationships as he distinguished among four different kinds of love relationships: (1) normal; (2) pathological; (3) perverse; and (4) mature (Table 2.1). Kernberg’s descriptions are both provocative and useful in the treatment of couples and add greatly to determining the most effective communication style. He examined the success and failure of love, taking into consideration the roles of narcissism, masochism and aggression. His premise was that even though partners may fight, abuse and hate one other, if the desire to maintain a loving relationship is the ultimate goal, the partnership is considered healthy (Lachkar, 1998, 2004, 2008).
In normal love, “love conquers all.” The desire to love and have a loving relationship overcomes conflict. Internal strivings and aggression do not interfere with the capacity to maintain a long-range, intimate, passionate, loving relationship. In a normal relationship, individuals are able to face reality. They do not live in denial and are not threatened by the other person’s emotions or truth. Erotic desire is linked to the Oedipal object and is not obliterated by the failing of internal objects. One has a strong desire for symbiotic fusion with one’s mate. Normal love means the relinquishing of Oedipal rivals to the realization that one can settle down with one’s partner. The desire to love one’s sexual partner becomes more pervasive than the desire to possess, to own or to control the Oedipal or rival object. One now can live side by side with father without having to compete with him. Couples who experience a problem within a normal love relationship will benefit from short-term psychotherapy.
As an example, a man and his wife entered couple therapy presenting with the problem of the husband’s habit of wearing his wife’s underwear. At times, he even dressed up in her clothes, sometimes going so far as to wear her makeup. Not only did this peculiar habit enrage his wife, but she also felt humiliated and shamed. From the outside looking in, his behavior seemed quite bizarre and perverse and out of the realm of what might be considered normalcy. Yet they had a rich family life, were well respected in the community and had two successful married children. The strange fetish did not inter-fere with the couple’s capacity to maintain a close and intimate relationship.
As we explored further, we discovered that the husband’s behavior represented an identification with his absent mother, who abandoned him during his early years. The only way he could maintain any kind of object constancy was to momentarily act out this loss by “becoming” her. The treatment consisted mainly of helping the husband control his fantasy life so that he could enjoy these fantasies while recognizing the difference between fantasy life and reality. It is okay to fantasize, but it is not okay to act on these fantasies; this can be a turn-off for his wife.
In pathological love, conflict overcomes the desire to love or to have an intimate relationship. Pathological relations encourage the tendency to repeat the trauma again and again. This is also known as traumatic bonding (Dutton & Painter, 1981). In this relationship, aggression and internal conflicts interfere with the desire to maintain a loving relationship. In pathological love, emotions run high. The relationship is steamy and explosive and alters and falters between states of distress and discontinuity to moments of harmony and bliss. It is a part-object tie, in which such primitive defenses as envy, control, sadomasochism, aggression and cruelty fester. We see this in obsessive love, in addictive love and in love that goes in the wrong direction. In severe pathological relations, love gets directed to sadomasochism and perversion, envy, greed, control, domination and self-destruction. Reality testing does not offer relief; instead, reality is denied, split off and projected. Couples in pathological love relationships are in need of more intensive psychotherapy.
In perverse love, excitement becomes the replacement for love. Because pain is often linked to the love object, the relationship becomes highly charged and eroticized. Many narcissistic/borderline relationships teeter on the fringes of perversity, using excitement and eroticism as surrogates for a loving relationship. These couples cannot tolerate true intimacy and instead turn to excitement. What kills or destroys a perverse relationship is, in fact, love itself. The confusion between good and bad is used to shield oneself from getting too close to the good thing. Perversion goes beyond whips and chains. It connotes confusion around one’s symbolic love objects. For example, a breast may be viewed as bad because it represents a hunger, whereas an anus is viewed as good because it represents withholding qualities (the unavailable object highly charged with libidinal energy). Eroticism then becomes the emotional insurance policy against vulnerability.
One example of perverse love involved a woman, described by one of my supervisees as a nymphomaniac, who hooked up with a man who avoided contact and intimacy. They never had couple sex, yet together they went to swinger groups and indulged in wild sex. Or, as another example, a man might rationalize, “This woman isn’t right for me, but I feel excited. I’m with someone who torments me, someone who is unavailable, just like my mother.”
In mature love, partners share common goals, values and traditions. They are aware of each other’s vulnerabilities and share a willingness to work things through. Mature love implies a total commitment within the province of sex, emotions and shared couple values (Kernberg, 1995). The desire for erotic and emotional attachment is not obliterated by the world of internal objects. Desire is an outcome of need fulfillment and does not result from part-object erotic desires or Oedipal conflict and does not interfere with the couple’s capacity to maintain a close and intimate relationship. The case history that appears later in this chapter encompasses many of the theoretical perspectives outlined previously. A couple may not have the same passion they once shared, but the desires for harmony, mutuality, common interest, raising a family, compassion and being part of a community become the predominant feature of their relationship.
The type of woman or man who chooses to stay with a pathological narcissist is often someone with a borderline, histrionic, depressive or dependent personality. These individuals frequently have been traumatized in childhood and feel deserving of the mistreatment they receive. They are characterized by low self-esteem, have no sense of self and often hook up with pathological narcissists because they stir up many unresolved developmental issues. Because of early deprivation and severe abandonment anxieties, they have become preprogrammed and prescripted to bond with pain.
Typically, borderline women make perfect prey for the negative projections of the pathological narcissist. Fairbairn (1940) especially helps us understand why certain people with traumatic childhoods stay forever loyal to a bad internal object (see Table1 in Introduction). I am reminded of a borderline woman who reported waiting and waiting for her boyfriend to take her out somewhere. Each week he promised something—dinner in a nice restaurant, a trip to a nice spa, a weekend getaway—only to end it with disappointment: “Honey, something came up and I have to go away on business. I’ll call you . I promise next weekend we’ll be together.” Next weekend never came.
The following vignette describes a partner who refuses to pay for any-thing when out on a date.
Borderline Girlfriend: How come you never pay for anything? I am always the one paying when we go to dinner. I buy the tickets, you sleep with me and what do you offer? I’m getting sick of it.
Narcissistic Partner: She actually thinks I should pay? Doesn’t she realize she should be lucky to have a guy like me in her life?
Therapist: I think your girlfriend is telling you that she would like you to feedher. When you don’t pay, she feels unworthy and undeserving. Not paying may momentarily make you feel big and important, but then you will end up feeling small because you are not living up to your responsibilities as a love partner. Of course, I can understand this because you were deprived of your feeding when your little brother came along. So now, you’re letting us know what it feels like to be deprived.
The following case is an example of a pathologically disturbed narcissistic wife in dire need of empathy from her husband. When she gets it, she rebuffs and sabotages it because it stirs up too many issues of vulnerability. Instead, she acts like Miss Superiority or Miss Know-It-All, when in fact she has very little capacity for introspection or self awareness.
A colleague referred Mr. and Mrs. A to me. I was warned that Mrs. A had a severe narcissistic personality with many borderline features, marked by uncontrolled aggression. Mrs. A was depressed and expressed dissatisfaction in her marriage because her husband was making “unrealistic” demands of her. Mrs. A had withdrawn from all sexual contact with her husband; she felt that he was mean and cruel and had not earned sex. Mr. A was extremely anxious, was shaky and was both sexually and emotionally frustrated and exhausted. Mrs. A was a product of Hollywood producer/actor parents—a mother who was unavailable and a physically and emotionally abusive father. Mr. A grew up in the Midwest with two elder sisters. His parents divorced, leaving him with a depressed mother, while the sisters were sent to live with the father and his new wife. Feeling very deprived of a “normal” childhood, Mr. A described a very restricted home environment, empty and depressing, void of play and things all kids just do to have fun while growing up.
During several sessions to help Mrs. A realize that sex and love are not earned but are part of a healthy, functioning marriage, she split off into, “Well, then maybe we should get a divorce.” Mr. A, spurned on by Mrs. A’s threat, then responded in kind, “That’s what I really want, a divorce. I don’t want to live with a woman who deprives me of sex, fun and play. I had enough of that in my childhood. I have the means to enjoy my life, and if not with her then with someone else.” Mrs. A’s response was, “I just don’t feel like it.” I confronted Mrs. A by letting her know that withdrawing sex and love is not a feeling. She argumentatively responded, “Well, if it is not a feeling, then what is it?” I calmly explained to her that it is a defense.
Mrs. A, feeling threatened by the talk of divorce, said, “What? You are going to leave me with two small kids and two dogs?” Mr. A responded, “I’m not the one bringing this up. You are.” Mrs. A then looked at me and said, “You see how mean he is and what I have to put up with?” Mr. A gave a tit-for-tat retort: “I’m being mean. You’re the one being mean to me. If you’re saying you are not going to give me sex, I will leave. This is why I’m here: to decide what to do about our relationship. I am not happy. I want a REAL wife.” To which Mrs. A responded, “Shut up and keep your mouth shut!”
Mrs. A then turned to me and said, “We’re just wasting our time. You are not helping us, and this is just a waste of time and money. As a marriage therapist you should have been helping us and you’re not.” Through couple transference (Lachkar, 1998, 2002, 2004), I was now getting a taste of Mrs. A’s narcissism. She feel entitled not only to yell, to scream and to attack her husband but also to put me down. To this I replied, “Mrs. A, that was not very nice. You just attacked me. In fact, that was mean. You know what I would have said to me if I were you?” Mr. A jokingly asked, “Okay, what would you have said if you were her?” “I would have said, “You know, we have been coming here a long time, and I don’t feel as though you have been helping us and I feel very disappointed.” This led to her husband’s realization of his passivity—how he tolerated his wife’s aggression and had not taken a firm stance.
There is considerable overlap between a pathological and malignant narcissist. Mrs. A could be very sadistic and cruel. At times she reminded me of a terrorist, out to attack, blame and punish. Her behavior was toxic and vindictive, and in spite of all the attempts to help her she continued to blame and shame and was unable to take any responsibility for how her actions and behavior contributed to the shortcomings in the relationship. Mrs. A always had to be right and would do anything to find justification for her actions. Furthermore, she was unfair. If she took all the time in the session to express her woes, and her husband wanted a few minutes to express his sentiments, she told him to shut up—that it was her turn to talk. Then she would turn to me and ask, “How come you don’t pick on him and see what he is doing?”
It was not easy to confront Mrs. A’s confusion about her withdrawal from intimacy with her husband’s being a defense rather than a feeling. Many patients confuse feelings with withdrawal, and it is crucial that the therapist make these distinctions: “Can you imagine if we all did what we feel like?” Mrs. A did not have a clue how she unconsciously coerced her husband to attack or how she criticized him, making him out to be the abusive, attacking, mean, cruel father. Nor did she understand how she set me up to be the useless, helpless, unavailable mother, someone who was just “wasting her time.”
Mrs. A’s inability to observe and visualize herself realistically was a symptom of severe ego pathology. As soon as she got some of the empathy and kindness she craved from her husband, she repudiated or sabotaged it. Where was her empathy for him? Mr. A set himself up for a punitive parent who deprived him of fun and pleasure, a reenactment of the deprivation of his suffocating, restrictive childhood. In Mr. A’s own passive-aggressive way, he enacted his rage through his wife’s volatility, providing affirmation for his stuck position in the marriage: “I am stuck with this mother, while my siblings are off with dad, having a nice life with family and friends.”
Why does someone like Mrs. A choose someone like Mr. A? Because of Mr. A’s passive-aggressive behavior and developmentally arrested, thwarted childhood, Mrs. A got a lot of mileage on her unleashed aggressive. Mr. A made a perfect container in which to project all her negativity, mainly because Mrs. A stirred up many of his unconscious fears. Having a father who continually called him a loser and someone who would never amount to anything made him a perfect receptacle for Mrs. A’s attacks and offered an invitation to express his own repressed rage.
From a theoretical perspective, although Mrs. A did not meet the exact criteria of a pathological narcissist, which is not a clear-cut entity in any case, there is clearly a cross-over between narcissistic and borderline pathology. Her lack of empathy and sense of entitlement to attack (e.g., yell, scream, interrupt) had a severe narcissistic base, but her enactments of aggression, retaliation, revenge and boundary violations appeared to have more borderline features.
Although Mr. A had many passive-aggressive aspects to his personality, he also had many borderline features, including his tendency to fuse with his wife’s projections (e.g., “You are nothing but a loser”), his tendency to get revenge and retaliate (e.g., taking sides with the kids and the in-laws, refusing to give her the support and empathy she desperately needed).
It is imperative to point out that not everyone described in this book is a full-blown narcissist, nor do they react to a personal injury in the same way. There is a distinction between a momentary state of narcissistic injury and someone with a narcissistic disorder. According to Kohut (1971, 1977), a narcissistic injury arises originally as the result of the failure of the self-object environment and early caretakers to meet the child’s need for optimal attunement and empathic responses. Kohut (1971) viewed the child’s early grandiose self as a significant developmental phenomenon and reminded us of the importance of the patient’s ability to maintain this part of the psyche throughout life. He contrasted this with the psychotic delusions of grandiosity, grandeur and omnipotence formed by patients with prevailing narcissistic personality dis-turbances. The archaic injury is linked to an emotional area of overwhelming vulnerability in which highly charged emotions and sensitivities originating in infancy and childhood remain raw and unhealed (i.e., the V-spot). These experiences might include the parent who abandoned the child at an early age, who smothered the child with too much affection or who neglected, deprived or never touched the child or was not able to comfort or soothe.
As the child goes through his so-called normal phase of development, he develops a grandiose omnipotent self. Discontinuity between how the child views himself and how others perceive him stirs up early traumatic empathy failures in childhood. The child grows up with a misperception of self as all-powerful, as self-acclaimed through fame, power and money and as in constant need of approval and reassurance. This often results from a parent, caretaker or mother who repeats a certain mantra, such as, “You’re not good enough,” or “You don’t deserve that,” or “You’re too demanding.” These children attach themselves to a mythical belief system. Whenever they are at variance with their false perception of self, a narcissistic injury can occur. The following is an example of the defensiveness that ensues when the V-spot (Lachkar, 2008) of an actor-patient is aroused.
In terms of communication style, it is always a struggle to determine when to confront, when to empathize, when to say nothing or when to just sit and wait for the right moment to speak. Masterson’s (1981) guideline is very helpful: With the borderline personality it is necessary to confront, whereas with the narcissist it is necessary to interpret. However, what Masterson failed to mention is what the object of our empathy should be: certainly not the aggression. We empathize with the patient’s vulnerability, not the aggression: “No, it is not okay for you to attack and deprive your wife of sex, money, time, and attention, but I certainly understand why you do it. As a child you were deprived, and now you are letting us know what this feels like.”
An actor-patient was having a great deal of conflict around dependency issues and vulnerability. He had been going to auditions, only to find himself rejected again and again. The bitter paradox is that at issue were the very things an actor needs to perform—a sense of vulnerability, deep feelings and the ability to emote to move an audience at a meaningful level.
Even though this patient knew I had many years of experience in the performing arts, he took whatever help I offered him as an attack: “What do you know about acting? Why don’t you just stick to being a psychotherapist?” I tried to convince him that if he could not be vulnerable on stage, he could not make an emotional connection with his audience, let alone with the director auditioning him. To this he responded quite angrily: “What are you saying? Are you telling me I have not been credible? How dare you put down my acting?” My response was, “What I intended to say and what you heard were two different things. You heard me say that you were not credible. My intention was to help you make use of your vulnerable feelings instead of withdrawing from them so you can get the parts you have worked so very hard for—parts that meet and match your talents.” The ongoing struggle of this patient is quite different from that of someone having a fleeting narcissistic moment.