Fragile Selves: Working with Narcissistic and Borderline States of Mind

The Transformative Power of Working Affectively and Empathically with Narcissistic Patients

Frank Lachmann believes that infant research shows that how we perceive, remember, feel and behave are relationally co-created between child and caregiver. He argues that when we combine this understanding of early development with knowledge of the organization of the mind and transference, new therapeutic possibilities emerge. Deep, enduring change occurs when therapist and client are affectively related. This is especially true for narcissistic patients who have difficulty connecting to and bonding with others. Working with such patients can also evoke negative feeling in the therapist which can sabotage the process.

Despite the challenges of working with affect and showing empathy, Lachmann argues that integrating these aspects into treatment is deeply transformative, especially so for these patients who have deep early developmental deficits and who have been traditionally seen as ‘treatment resistant.’