Many therapists have the point of view that they are only required to meet their clients’ needs for support, empathy, therapeutic skill; and to have no needs of their own in the therapeutic relationship. But my experience is that a therapist that takes this viewpoint is apt to experience burnout and to come to dislike the work.
My opinion is that therapists have narcissistic needs of their own that must be met in order for them to continue to find fulfillment in their profession. These needs can be referred to as “mature narcissism.” In this article I shall discuss the term narcissism from a Self Psychology perspective. In the next article, I shall discuss the (hopefully) mature narcissistic needs that therapists should feel entitled to be met in their relationships with their clients.
The term “narcissism” is usually considered a negative description of someone. But as Heinz Kohut, the founder of psychoanalytic Self Psychology pointed out, everyone is narcissistic to some extent. No one, no matter how mature, can go without some occasional positive affirmation from other people and from one’s self. Kohut used the term “mirroring” for what are, essentially, self-esteem needs. These include even the recognition, at a deep level, that one actually exists. And that he or she is understood and responded to in a way that feels affirming and empathic. What distinguishes so-called pathological from normal narcissism in the adult, is how immature the narcissistic needs are. Pathologically narcissistic people are immature precisely because their narcissistic needs were not met consistently or appropriately enough during their growing up years.
A baby has an almost constant need of positive, empathic, attuned responses to him or her from the primary caregivers. But as the baby grows into childhood, the frequency and concreteness of his or her need for attuned responsiveness from others becomes lessened. Attuned parents are able to vary, over the years, the manner and frequency of their responsiveness to their child. As a result, the child gradually becomes better and better able to meet some of these narcissistic needs himself or herself by self-affirmation, resulting in feelings of pride and self-confidence. The child is also able to to get affirmation from people other than the parents. These changes are possible because the growing person is gradually internalizing a kindly, approving, supportive parental self that expresses approval and encouragement, particularly when circumstances become difficult. Over time the self-esteem rewards become more and more abstract and symbolic; e.g., seeing positive comments or a good grade for a book review written in school.
In adulthood, there are many other ways that these narcissistic, self-esteem needs can be met: getting a raise in a job, seeing one’s children succeeding, having one’s favorite sports team doing well. But most people, no matter how mature, still need occasional positive “strokes” from real other people. That’s one reason why feeling loved and feeling loving toward others is so important. If a person has not gotten the requisite attuned responsiveness from her or his caregivers while growing up, the needs for affirmation are still similar to those of a young child. There is a lack of an internal approving self and, although often not conscious, there is the presence of the opposite: a doubting, disapproving self., what Eric Berne and others have referred to as a critical internal parent. The person is “stuck” at a relatively primitive level, needing constant approval and recognition from the outside world. The good feeling that results when praise or success is achieved is very temporary and the person then must quickly make new attempts to get approval and recognition. Other people will often describe such as person as insatiable for attention. And that’s when the term “narcissistic” to describe the person is appropriate.
But the person who has had, in Winnicott’s term, “good enough parenting,” can supply himself or herself encouragement and support when things are difficult, pride when successful at some endeavor; and knows how and feels entitled to reach out to others for praise and support when it is needed.