Treating Narcissistic Personality Disorder: How to Develop True Connections
In treating narcissism, one of the key challenges is the complexity of its presentation. Narcissistic traits manifest in varied ways, from grandiosity and entitlement to more subtle forms of emotional withdrawal. This wide range of defenses, often highly maladaptive and entrenched, makes therapy particularly challenging. However, despite the difficulty, specific empirically based approaches have shown effectiveness in addressing narcissistic defenses.
One such defense is the “psychic retreat,” (Steiner, 2011) where individuals emotionally withdraw and use mechanisms like grandiosity, rage, or devaluation to avoid confronting feelings of vulnerability or inadequacy. These defenses shield them from painful aspects of reality, such as loss, helplessness, or unmet emotional needs, yet come at the cost of authentic emotional engagement.
In therapy with patients who display narcissistic traits, one of the most critical challenges is helping them move beyond their ingrained psychological defenses, which often take the form of a “psychic retreat.”
The Role of Psychic Retreats in Narcissistic Defenses
A psychic retreat is essentially a mental and emotional escape into a safer psychological space, where the person can maintain the illusion of control and invulnerability. However, these retreats lead to isolation, relationship issues, and stagnation in personal growth. As a therapist, my goal is to guide patients through these retreats, helping them recognize and gradually relinquish these defensive states so they can face uncomfortable emotions and build more authentic connections.
Clinical Example: Working Through a Psychic Retreat
To illustrate how I help patients emerge from a psychic retreat, let me share an example from my clinical practice. While the specifics have been altered for privacy, the therapeutic process and insights are drawn from real-life experiences.
The Initial Session: Rage as a Defense
A patient came into a session filled with frustration and anger. His wife had recently fallen ill, and he was consumed with rage over the additional responsibilities of caring for her. As we began to explore his feelings, it became clear that his anger was not just about the practical demands of caregiving but also a defense against deeper emotions of helplessness and loss. The illness punctured his belief that his wife—and by extension, the relationship—existed solely to meet his needs.
In this state, his rage acted as a buffer against the pain of realizing that his wife could no longer play the role he had unconsciously assigned her: that of an all-giving figure who should be there for him at all times. This is a common theme in narcissistic individuals, where relationships are expected to be one-sided, fulfilling their needs without consideration of the other person’s.
The Shift to Guilt and Compassion
Through careful guidance, I helped the patient regulate his emotions and move into a more reflective state of mind. In this more grounded space, I was able to help him recognize the thought, “There is no care for me,” which was fueling his anger. By holding this insight, the patient slowly shifted from rage to guilt. He began to express concern for his wife’s health and recognized that she had her own needs, separate from his. This marked a significant breakthrough, as it allowed him to momentarily exit the psychic retreat and engage with the reality of their relationship as a two-way interaction.
This brief movement away from narcissistic defenses was crucial because it opened the door to empathy and genuine concern for another person, signaling progress in therapy.
Returning to Narcissistic Defenses: The Projection
However, this progress was not without setbacks. Later in the session, the patient recounted an interaction with a young man who, in his eyes, did not deserve the success he had achieved. The patient labeled the man as “spoiled” and “an idiot,” attributing his success to privilege rather than hard work. This attack on the young man represented a retreat back into narcissistic defenses. Rather than facing his own insecurities about his social status and fear of inadequacy in comparison to others, the patient projected these insecurities onto the other person, devaluing him in the process to protect his fragile sense of self-worth. This moment highlighted how quickly patients with narcissistic traits can retreat into defenses when confronted with vulnerability. The therapeutic task here is to help the patient recognize the retreat, understand why it occurred, and gently guide them back to a state where they can tolerate the feelings they were trying to avoid.
Breaking Down the Therapeutic Process
When working with narcissistic individuals, helping them navigate these retreats is a central aspect of therapy. The process can be broken down into several key stages:
- Initial Rage and Defenses: The patient begins the session in a state of emotional dysregulation—often characterized by anger, frustration, or grandiosity. These defenses serve to protect the individual from confronting painful emotions such as inadequacy, rejection, or loss.
- Regulation and Reflection: Through psychodynamic interventions, the therapist helps the patient move into a more regulated state of mind, where they can begin to reflect on their emotions. This step is crucial, as it allows the patient to access feelings of guilt, sadness, or compassion, which are typically split off or repressed.
- Brief Movement Toward Vulnerability: Once the patient has begun to reflect, they may experience a brief moment of vulnerability where they acknowledge their own limitations or the needs of others. This is often the first step out of the psychic retreat.
- Retreat and Projection: However, this progress is fragile, and patients frequently retreat back into narcissistic defenses when the feelings of vulnerability become too overwhelming. In this phase, the patient may project their insecurities onto others or revert to anger, superiority, or emotional withdrawal.
- Reintegration and Tolerating Discomfort: The goal of therapy is to help the patient recognize when they are retreating into defenses and gently guide them back to a place where they can tolerate the discomfort of vulnerability. Over time, this helps the patient integrate their split-off emotions, leading to more authentic emotional contact and healthier relationships.
Techniques for Helping Patients Emerge from a Psychic Retreat
Several psychodynamic techniques are particularly effective when working with patients who engage in narcissistic retreats:
- Emotional Regulation: Before a patient can begin to reflect on their feelings, it’s essential to help them regulate intense emotions like rage or frustration. This may involve slowing down the pace of the conversation to create space for reflection.
- Interpretation of Defenses: Once the patient is in a more regulated state, the therapist can begin to interpret the narcissistic defenses that are at play. For example, in the case of the patient attacking the young man, I helped the patient come to recognize that his attack and judgment was protecting him from facing more painful feelings. This helps the patient begin to reflect and think about the connection between their external behavior and internal emotional state.
- Exploring Vulnerability: As the patient becomes more aware of their defenses, the therapist can guide them toward exploring the vulnerable feelings they are trying to avoid. This might involve asking questions like, “What would it feel like if you allowed yourself to sit with the idea that your wife has her own needs?” or “What are you afraid might happen if you didn’t retreat into anger?”
- Building Emotional Tolerance: Helping patients build tolerance for uncomfortable emotions is a long-term goal. This involves gradually increasing their ability to stay present with feelings of guilt, sadness, or loss without immediately retreating into defensive patterns.
The Importance of Empathy and Compassion in Therapy
Empathy is critical when working with narcissistic patients, as they often lack emotional attunement with themselves and others. In the therapeutic process, showing empathy toward the patient’s vulnerabilities encourages them to trust the therapeutic relationship. As seen in the clinical example, when the patient felt heard and understood, he was able to express more vulnerable emotions.
Empathy also helps to dismantle the narcissistic defenses. By validating the patient’s feelings, even when they are distorted by narcissism, the therapist can create space for the patient to explore these emotions without fear of judgment. This approach fosters emotional growth and the eventual breakdown of the psychic retreat.
Conclusion: The Path to Lasting Change
Helping narcissistic individuals emerge from a psychic retreat requires patience, empathy, and a deep understanding of the underlying emotional dynamics at play. Through careful therapeutic intervention, patients can begin to recognize their defensive patterns, regulate their emotions, and gradually build the capacity to tolerate vulnerability. Over time, this process allows for more genuine emotional contact, both in the therapeutic space and in their relationships outside of therapy.
The ultimate goal is to help the patient move beyond the narcissistic retreat, integrate split-off feelings, and develop a more balanced, compassionate relationship with themselves and others.
If you or someone you know tends to retreat emotionally or seems unreachable, seeking professional help from a trained therapist experienced in working with personality disorders can be a vital step toward healing. Engaging with a compassionate professional can create a safe environment for exploring these complex emotions and fostering meaningful connections.
For further insights and support, explore:
The Narcissism Decoder Podcast: get a deeper understanding through expert discussions and real-life stories.
Videos on Narcissistic Relationships: Visual resources to help navigate the complexities of narcissistic dynamics and recovery.
These resources can provide additional guidance as you navigate your journey toward healing and personal growth
References
Steiner (2011). Seeing and Being Seen: Emerging from a Psychic Retreat