Narcissists and Psychopaths Devalue Their Psychotherapists

In 1978, a medical doctor by the name of J.E. Groves published in the prestigious New England Journal of Medicine an article titled "Taking Care of the Hateful Patient". In it he admitted that patients with personality disorders often evoke in their physicians dislike or even outright hatred.

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As Garfield noted in 1957, the first step perforce involves a voluntary action: the subject seeks help because he or she experiences intolerable discomfort, ego-dystony, dysphoria, and dysfunction. This act is the first and indispensable factor associated with all therapeutic encounters, regardless of their origins.

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Even a complete battery of tests, administered by experienced professionals sometimes fails to identify abusers and their personality disorders. Offenders are uncanny in their ability to deceive their evaluators. They often succeed in transforming therapists and diagnosticians into four types of collaborators: the adulators, the blissfully ignorant, the self-deceiving, and those deceived by the batterer's conduct or statements.

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Ideally, after a period of combined tutoring, talk therapy, and (anti-anxiety or antidepressant) medications, the survivor will self-mobilise and emerge from the experience more resilient and assertive and less gullible and self-deprecating.

But therapy is not always a smooth ride.

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Your abuser "agrees" (is forced) to attend therapy. But are the sessions worth the effort? What is the success rate of various treatment modalities in modifying the abuser's conduct, let alone in "healing" or "curing" him? Is psychotherapy the panacea it is often made out to be – or a nostrum, as many victims of abuse claim? And why is it applied only after the fact – and not as a preventive measure?

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Adult narcissists can rarely be "cured", though some scholars think otherwise. Still, the earlier the therapeutic intervention, the better the prognosis. A correct diagnosis and a proper mix of treatment modalities in early adolescence guarantees success without relapse in anywhere between one third and one half the cases. Additionally, ageing moderates or even vanquishes some antisocial behaviours.

Whatever the type of talk therapy, the narcissist devalues the therapist. His internal dialogue is: "I know best, I know it all, the therapist is less intelligent than me, I can't afford the top level therapists who are the only ones qualified to treat me (as my equals, needless to say), I am actually a therapist myself…"

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One of the most important presenting symptoms of the narcissist in therapy is his (or her) insistence that he (or she) is equal to the psychotherapist in knowledge, in experience, or in social status. The narcissist in the therapeutic session spices his speech with psychiatric lingo and professional terms.

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Psychological theories of the mind are metaphors of the mind. They are fables and myths, narratives, stories, hypotheses, conjunctures. They play (exceedingly) important roles in the psychotherapeutic setting – but not in the laboratory.

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Descriptive criteria aside, what is the essence of mental disorders? Are they merely physiological disorders of the brain, or, more precisely of its chemistry? If so, can they be cured by restoring the balance of substances and secretions in that mysterious organ? And, once equilibrium is reinstated – is the illness "gone" or is it still lurking there, "under wraps", waiting to erupt? Are psychiatric problems inherited, rooted in faulty genes (though amplified by environmental factors) – or brought on by abusive or wrong nurturance?

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Narcissists are not prone to "irresistible impulses" and dissociation (blanking out certain stressful events and actions). They more or less fully control their behavior and acts at all times. But exerting control over one's conduct requires the investment of resources, both mental and physical. Narcissists regard this as a waste of their precious time, or a humiliating chore. Lacking empathy, they don't care about other people's feelings, needs, priorities, wishes, preferences, and boundaries. As a result, narcissists are awkward, tactless, painful, taciturn, abrasive and insensitive.

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