My name is Sam Vaknin, I am the author of Malignant Self-Love, Narcissism Revisited.

The narcissist regards therapy as some kind of competitive sport.

In therapy, the narcissist usually immediately insists that he or she is equal to the psychotherapist in knowledge, in experience, or in social status.

To substantiate this claim and level the playing field, the narcissist, in the therapeutic session, spices his speech with professional psychological lingo and terms.

Lingo makes appearance, appearance makes substance. This is the narcissist’s motto.

The narcissist is actually sending a message to his psychotherapist.

The narcissist says, there is nothing you, the psychotherapist, can teach me. I am as intelligent as you are. You are not superior to me. Actually, we should be collaborating as equals in this unfortunate state of things in which we inadvertently find ourselves involved.

At first, the narcissist idealizes, but then he devalues the therapist.

The internal dialogue of the narcissist goes something like this.

I know best. I know everything. The therapist is less intelligent than I. I can’t afford the top level therapist who are the only ones qualified to treat me as my equals, needless to say. I’m actually as good a therapist as my therapist. I’m as good as a therapist.

Another thread of internal dialogue, he, my therapist, should be my colleague. In certain respect, it is he who should accept my professional authority. He should learn from me. Why would he be my friend? After all, I can use the lingo, the psychobabble, as even better than he does. It’s us, him and me, against a hostile and ignorant world.

This way, the narcissist creates a shared psychosis between him and the psychotherapist, as though they are both in one boat fighting the whole world.

The inner dialogue continues.

Narcissist says to himself, just who does he think he is asking me all these questions? What are his professional credentials to start with? I’m a success. And he is a nobody therapist in a dingy office. He is trying to negate my uniqueness. He is trying to reduce me to his level. He is an authority figure. I hate him and I will show him. I will humiliate him. I will prove him ignorant. I will have his license revoked.

Freud called this transference.

Actually, the narcissist says to himself, my therapist is pitiable, a zero, a failure, otherwise he wouldn’t be doing what he is doing.

And these self-delusions and fantastic grandiosity are really the narcissist’s defenses and resistance to treatment.

This abusive internal exchange becomes more of a vituperative and pejorative as therapy progresses.

The narcissist distances himself from these painful emotions by generalizing and analyzing them, by slicing his life and hurt into neat packages of what he thinks are professional insights, which he condescendingly, patronizingly and kindly provides his therapist with.

The narcissist has a dilapidated and dysfunctional true self overtaken and suppressed by a false self.

In therapy, the general idea is to create the conditions for the true self to resume its growth, safety, predictability, justice, love, and acceptance, what we call a holding environment.

But to achieve this ambience, the therapist tries to establish a mirroring, a re-parenting environment.

Therapy is supposed to provide these conditions of nurturance and guidance through transference, cognitive relabeling, or other methods.

The narcissist must learn that his past experiences are not laws of nature, that not all adults are abusive, that relationships can be nurturing and supportive.

Most therapists try to co-opt the narcissist’s inflated ego, his false self, and his defenses. They complement the narcissist, challenging him to prove his omnipotence by overcoming his own disorder. They appeal to his quest for perfection, brilliance and eternal love and to his paranoid tendencies in an attempt to get rid of counterproductive, self-defeating and dysfunctional behavior patterns. Some therapists try to stroke the narcissist’s grandiosity and ego.

By doing so, they hope to modify or counter cognitive deficits, thinking errors, and the narcissist’s victim stance martyrdom. They contract with the narcissist to alter his conduct.

Psychiatrists tend to medicalize the disorder by attributing it to genetic or biochemical causes.

Narcissists like this approach, as it absolves them from responsibility for their actions. Not my fault, it’s my genes, it’s not my fault, it’s the biochemistry of my brain, says the narcissist.

Therapists with unresolved issues and narcissistic defenses of their own sometimes feel compelled to confront the narcissist head-on and to engage in power plays and power politics. For instance, by instituting disciplinary measures, they compete with the narcissist, these narcissistic therapists. So they compete with their patients and they try to establish their superiority.

They say, I am clever than you are, I have more knowledge, my will should prevail, and so on.

This form of immaturity is decidedly unhelpful and could lead to rage attacks and a deepening of the narcissist’s persecutory delusions.

These delusions are bred, to start with, by his humiliation. And if this humiliation in early childhood is reenacted in the therapeutic settings, all narcissistic defenses erupt.

Narcissists generally are averse to being medicated, as this amounts to an admission that something has been wrong and needs fixing.

They also hate to lose control. They are control freaks and they hate to be under the influence of mind-altering drugs prescribed to them by others.

Many narcissists believe that medication is the great equalizer. It will make them lose their uniqueness, superiority, and astounding mind. That is unless they can convincingly present the act of taking their medicine as heroism, a daring enterprise of self-exploration, part of a breakthrough clinical trial, and so on and so forth.

Narcissists often claim that the medicine affects them differently than it does other people, or that they have discovered a new exciting way of using the medicine, or that they are part of someone’s, usually themselves, learning curve, part of a new approach to dosage, part of a new cocktail which holds great promise, etc.

Narcissists must dramatize their lives, they are drama queens, to feel worthy and special, out-neal, out-unique. Either be special or don’t be at all. Narcissists are drama queens and their life is one big theater show.

Very much like in the physical world, change is brought about only through incredible powers of torsion and wreckage. Only when the narcissist’s elasticity gives way, only when he is wounded by his own intransigence, only then is their only hope.

It takes nothing less than a real crisis.

And we at Bordeaux are not enough.