The most recent meeting of Fells and Dales Counsellors explored Grandiose Narcissism as an adaptation in response to an early lack of empathy. Kohut’s Self Psychology Model was used as an initial stimulus to the debate.

It was noteworthy that people with narcissistic traits present for therapy relatively rarely. However, a good proportion of clients in therapy are the children of narcissists.

We used professional and personal experience to think and talk about the particular challenges of working with people who relate in this way. We recognised that we are best serving these clients when we can meet the vulnerable parts of the individual. These parts might have low self esteem or  feel shame and inadequacy , or be interpersonally isolated. The therapeutic challenge is to access this suffering through the thicket of a complex defence mechanism. When defences include a sense of entitlement, grandiosity or bravado, and an extreme sensitivity to criticism, the work is delicate.


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