Ivey G
Department of Psychology, University of Natal, Dalbridge, South Africa.
Am J Psychother. 1995 Summer;49(3):350-70. doi: 10.1176/appi.psychotherapy.1995.49.3.350.
Psychotherapy with narcissistic patients exposes therapists to a set of interactional pressures which threaten to disrupt the desired therapeutic stance of empathic relatedness. The therapeutic relationship is a field of unconscious mutual influence in which therapists' own narcissistic vulnerabilities are threatened by narcissistic patients' characteristic interpersonal style. A typical constellation of countertransference feelings and reactions is aroused, characterized by a temporary or chronic state of narcissistic symmetry between patients and therapists. In this relational state both patients and therapists unconsciously defend their respectively tenuous sense of self-esteem from the perceived threat posed by the other, using similar defensive narcissistic strategies. Unless this interactional narcissistic symmetry is diffused a therapeutic impasse ensues, which may jeopardize the therapeutic alliance. This potential is exacerbated in the case of those therapists with characterological narcissistic features, as they unconsciously require constant affirmation from their patients in order to enhance their deficient self-esteem. Enduring, understanding, and adaptively processing narcissistic countertransference responses facilitates the resumption of the desired empathic stance, characterized by an optimal condition of narcissistic asymmetry between therapists and patients.
对自恋型患者进行心理治疗会使治疗师面临一系列互动压力，这些压力有可能破坏所期望的共情关系治疗立场。治疗关系是一个无意识的相互影响领域，在这个领域中，治疗师自身的自恋脆弱性会受到自恋型患者典型人际风格的威胁。一种典型的反移情情感和反应组合会被激发出来，其特征是患者与治疗师之间存在暂时或长期的自恋对称状态。在这种关系状态下，患者和治疗师都会无意识地保护自己各自脆弱的自尊感，使其免受对方所带来的感知威胁，他们会使用相似的防御性自恋策略。除非这种互动性自恋对称得以化解，否则就会出现治疗僵局，这可能会危及治疗联盟。对于那些具有性格自恋特征的治疗师来说，这种可能性会加剧，因为他们无意识地需要患者持续的肯定来提升自己缺失的自尊。持久、理解并适应性地处理自恋型反移情反应有助于恢复所期望的共情立场，其特征是治疗师与患者之间处于自恋不对称的最佳状态。
