A narcissist in therapy (Kohut’s Self Psychology Model)

Heinz Kohut, psychoanalyst and pioneer in treating people with NPD

The following is a pretty fascinating scholarly article from one of Sam Vaknin’s sites about a patient named Michael who underwent psychotherapy (using Heinz Kohut’s Self Psychology Model) for his NPD.

Being as interested as I am in possible healing and therapy methods for people with NPD, this article was right up my alley. For a scholarly article, it’s not a difficult read.

Psychotherapy with a Narcissistic Patient Using Kohut’s Self Psychology Model
Jamie McLean, MD, corresponding author


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.

Read the rest of the article here.


10 thoughts on “A narcissist in therapy (Kohut’s Self Psychology Model)

    • It’s a controversial topic. There are some who think no narcissist can ever get better, then there are those who think it may be a possibility for some who aren’t malignant narcissists or psychopaths. Of course it would require a desire on the part of the narcissist as well as not quitting therapy when the going gets rough (and it will get very rough).


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