Narcissism and the Psychotherapist

Narcissism per se has received much attention in the literature, but the focus has primarily been on patients. This fascinating book explores the narcissism of therapists--both its negative aspects and the creative potential it can offer the therapist-patient relationship. Although narcissism is often considered a psychoanalytic term, its scope is not limited to any school of therapy. By illuminating this misunderstood, neglected, even actively avoided aspect of the therapeutic process, this volume gives clinicians significant insight into how to bring about effective change in themselves and their patients. The book opens with a consideration of narcissism as a general concern for all psychotherapists, introducing the idea of "healthy narcissism" to the therapeutic relationship. Occupational hazards that engender narcissistic entanglements in the therapy process, the therapist's identity, and the therapist's personal life are discussed. Rational and irrational contracts are explored as they relate to the therapist's narcissism. The psychologically complex phenomenon of money is covered in a chapter that discusses its meanings, fee arrangements, contractual specifics, and the need for the development of a healthy narcissism by therapists in regard to money. Elements of narcissism in the related concepts of countertransference and fantasy are examined in an intriguing chapter that outlines the development and definition of countertransference and illustrates, through clinical examples, the uses of therapists' fantasies in psychotherapy. Other chapters examine such important topics as the idiosyncratic response and what happens to the therapist's narcissism when he or she feels anxiety, boredom, anger, eroticism, or confusion in the therapy relationship. Patient problems that are particularly prone to stimulating narcissistic responses in the therapist--such as loneliness, envy, passive-aggressiveness, and resistance--are examined in four separate chapters. These set the stage for the authors' broad view of psychoanalytic theory, which encompasses narcissistic components in explaining theory choice, protraction, and identity development, and illuminates the clinical processes of psychodynamic formulation, confrontation techniques, clarification, interpretation, and working through. The final chapter reviews developments in the concept of narcissism, particularly those that lead toward healthy narcissism as an essential component of the "good enough therapist.