I’ve been in psychodynamic therapy now for about a year. This isn’t my first therapist. I wouldn’t say my past therapists were very effective (and a few were just really bad), but on the other hand, I probably wasn’t ready to do the work. I used to evade my feelings, interrupt the therapist, and play “cutesy” mind games (more annoying than cute now that I think about it, but at the time I thought I was being so adorable), and not stay with the topic at hand.
This has still been a problem for me, though less so because I’m more motivated than ever to change and am willing to do whatever it takes. But old habits die hard. When I don’t want to confront something, sometimes I start changing the subject, making jokes, etc. I was pissing myself off that I kept doing this. So finally I asked my therapist to please stop me whenever I do this and help direct me, because I always left feeling like I hadn’t made any progress and we’d just been chatting like old friends. I don’t pay him to be my buddy! He agreed with me about this, and now he doesn’t let me “escape” anymore. Even though sometimes it annoys me when he interrupts me to tell me to stay on topic or stay with whatever emotion is coming up, I’m always grateful. He’s very good at what he does.
Another thing my therapist has done is “model” emotions for me. When I first came to therapy, I felt numb and always vaguely depressed, but depressed in that dead, auto-pilot kind of way, which is far worse, really, than the more “active” sort of depression or sadness that involves “weeping and gnashing of teeth.” I’m blessed that he’s an empath and also in touch with his own emotions, enough so that he doesn’t hesitate to feel something “for” me until I can feel it too. He’s comfortable enough to actually use his own emotions to help me. It also probably helps that he’s also a Method actor, which is a somewhat recent acting technique that involves using one’s own emotions to “feel” the character instead of “acting” a part and results in more natural performances. But what he does isn’t a performance because it isn’t fake. He does this without overdoing it or freaking me out.
Here are two examples of what I mean. Once he correctly sensed that I was angry about something but I was talking about it in a flat, unemotional way, as if it happened to someone else other than me. So he told me how angry what happened to me made him and he LOOKED angry! This surprised me at first but then I came alive. I agreed with him and began to feel angry about it too. We were then able to work with the anger.
He also knows I had a problem crying, and both of us knew I needed to. I told him how frustrating that was for me, that I couldn’t cry when I felt like I needed to. After that, several times when I told him something sad, he not only empathized, but actually got tears in his eyes. I pointed this out to him. He smiled and said, “I feel how sad you are. Would it bother you any if I show my own sadness about this?” I didn’t know what to say, I was very touched. I just said, “sure.” He was quiet for a minute and a few tears came out, he sniffled once, blew his nose, and then he was done. Nothing over the top, no sobbing or loss of control. It was definitely unconventional, but it was very controlled and it wasn’t about him at all so I didn’t feel like I had to comfort him or anything. I just appreciated that someone cared that much. I also appreciated that he asked me permission first, to avoid overstepping my boundaries. I thanked him and felt myself choke up in gratitude but I didn’t cry that time. I felt a little envious that he could cry for me but I still couldn’t for myself. But soon after that session, tears began to come to me during my sessions and I realized this was because he had empathized so deeply with my pain and made me learn to trust him enough that I could be that vulnerable. Crying doesn’t bother me anymore (even though I have yet to REALLY let go in session) and I always feel better after.
It turned out my therapist in both cases was using something called “temporary indwelling”, part of Kohut’s self psychology. It’s related to re-parenting. Counter-transference is used to help a client be able to feel and express certain emotions trough modeling them/experiencing them for the client. It only works if the therapist is empathic enough to know what emotion is bubbling under the surface and is comfortable expressing their own emotions. Otherwise, it could be awkward and even seriously freak a patient out. The great thing about temporary indwelling is that it helps you learn to empathize with your inner child (true self) instead of feeling ashamed. From there, by learning to love and empathize with your own true self, you learn how to empathize in general and hopefully, develop meaningful connections with others. The therapist serves as a surrogate parent, nurturing the inner child that was shamed instead of loved the way they should have been.
Here’s a good definition of how temporary indwelling works. Even though it’s a common technique used with narcissistic patients (and I do not have an NPD diagnosis), it’s sometimes used for clients with BPD and other problems where the honest expression of emotion has been an issue and is hindering the progression of therapy, or where there is a great deal of shame or an emotional disconnect to the client’s real self.
Psychotherapy with a Narcissistic Patient Using Kohut’s Self Psychology Model.
According to Kohut’s self psychology model, narcissistic psychopathology is a result of parental lack of empathy during development. Consequently, the individual does not develop full capacity to regulate self esteem. The narcissistic adult, according to Kohut’s concepts, vacillates between an irrational overestimation of the self and irrational feelings of inferiority, and relies on others to regulate his self esteem and give him a sense of value. In treatment, Kohut recommends helping the patient develop these missing functions. Kohut proposes that the therapist should empathically experience the world from the patient’s point of view (temporary indwelling) so that the patient feels understood. Interpretations are used when they can help the patient understand his sometimes intense feelings about any empathic failure on the part of the therapist, and understand why he (the patient) needs to restore solidity and comfort after being injured by any failed empathic (self object) ties. As insight develops, the patient begins to understand why he might experience these apparently small empathic failures so deeply.In this article, therapy with a narcissistic patient is approached from the point of view of Kohut’s self psychology theory, and the successes and problems that were encountered with this approach are described and discussed.
A narcissist in therapy: Kohut’s Self-Psychology Model