Do Therapists Empathize with Abusive Narcissistic Clients?

When emotional empathy is impossible, therapists rely on cognitive empathy.

Posted Nov 10, 2019

Source: techexpert/pixabay

Most psychotherapies that are designed to focus on the treatment of narcissistic disorders rely on empathy as one of their main tools.  This is because virtually all narcissistic clients respond better to empathic interventions than to any form of direct confrontation.  This can present a problem for many psychotherapists because it is hard to empathize with clients who are callously abusing other people. The worse the abuse, the harder it is to take an empathic stance.  

To illustrate what I mean, here is an example of a highly abusive narcissistic client with whom I could not emotionally empathize.  I had to rely on my cognitive empathy and my professionalism to treat this man.

Note: In this article, I am using the terms “narcissist” and “narcissistic” as a shorthand way to refer to people who qualify for a diagnosis of narcissistic personality disorder.

Example: My client Jeff (not his real name) was a malignant narcissist.  He got his narcissistic supplies mainly from dominating and humiliating other people, especially women. Here is a sample of how Jeff talked about his behavior. It is modified a bit to protect the client’s privacy.

I hate women. I especially hate the type of attractive women who ignored me in high school. They made me feel like a worm.  Now I am a famous photographer and beautiful women who want to break into modeling court me. 

Do you want to know what I do to them? I like to traumatize them by sexually humiliating them. I play along at first. I ask them to come to my studio for a test shoot. I tell them to take off all their clothes in front of me. Then I put them in poses that are geared to embarrass them. I keep it up until they look really upset. Some start crying. I love that I have broken them. Then, I coldly say, “You are too ugly to make it in modeling."  Sometimes I f*ck them before I kick them out.

Jeff seemed to be an unlikely candidate for psychotherapy.  Most people with narcissistic personality disorder deny that they have issues and never voluntarily go to therapy. And, malignant narcissists like Jeff, are usually even more resistant to the idea. So, I asked Jeff to explain what he was looking for from therapy. He was quite blunt and specific.  Here is an abbreviated version of what Jeff said in response to my question:

I will be honest with you.  I  have never been interested in changing anything about myself.  I never thought that I would ever seek psychotherapy.  I like degrading women.  I like feeling special and powerful and I enjoy using my high status to dominate other people. But I have a problem that I need to work on.  Once I have sex with a woman, I usually lose all interest in her immediately.  If I try and have sex with her again, I lose my erection.  The longest relationship I have been able to have is two weeks.  I had myself thoroughly checked out and the doctor told me that my problem was psychological, not physical. I am smart enough to envision the future.  Unless something changes, I will never be able to have a long-term relationship or marry or form a family like other people.  I do not like to have my options limited like this. And, I want to be able to have sex whenever I want and my problem with erections is getting in my way.

Did I feel emotional empathy for Jeff? No, I did not. My emotional empathy was towards his victims.  When he told me the story about how he humiliated the models, he was smiling and watching me for signs of shock and discomfort. I realized that Jeff had chosen a female therapist on purpose. He was anticipating that along with his therapy, he would get another opportunity to torment a woman. He was sadistic and wanted to feed off any discomfort I might show him.  

This was also an obvious attempt to try to dominate me as well. However, it is not unusual for exhibitionist narcissists or malignant narcissists to play “dominate the therapist” in their first session.  They do this to compensate for the underlying shame that they feel about seeking psychotherapy. By coming to therapy, they have admitted that that there is something that they cannot do on their own and that they need my help.  This feeds their underlying insecurity about their self-esteem.  So, their need for me wars with their need to feel superior to me.  Here Jeff’s need to feel superior won out. So along with telling me his story, he sought to make me uncomfortable.

Was I still willing to do therapy with him? Yes. I suspected that on an unconscious level, in addition to seeking to dominate and embarrass me, the part of him that wanted my help was scrutinizing my reaction to see if I would be disgusted and judgmental. 

So, how was I able to work with Jeff when I was actually disgusted and horrified by his behavior and felt little or no emotional empathy for him?  Well, the good news is that in addition to emotional empathy, we humans have cognitive empathy.  

Before I go further, I would like to briefly define the two basic types of empathy.

Emotional empathy: This is a felt automatic response to another person’s emotional state or life situation. We emotionally experience another person’s joy or sorrow.

Cognitive empathy: This is the ability to think about and understand what another person might be feeling. It does not require “feeling,” it requires stopping to think about and understand the client’s feelings and reaction to a situation in his or her life.

As therapists, we are taught to have cognitive empathy. We need to have this as a tool to do our work. We spend many years of our training learning about topics that develop cognitive empathy, such as:

  • How being abused as children affects our clients’ adult behaviors and self-esteem.
  • How unconscious psychological defenses interfere with our clients seeing themselves and other people realistically.
  • How different forms of mental illness create havoc in people’s lives.

Is emotional empathy always necessary and useful?

Most forms of psychotherapy do not require the therapist to have emotional empathy for their clients. Emotional empathy can be a two-edged sword in therapy.  A little emotional empathy is great. It helps form a bond of trust between the client and the therapist. If we have too much emotional empathy, it can interfere with our objectivity and lead us to over-identify with our clients (or in this case their victims). We can have strong, not necessarily productive countertransference responses. It may affect our ability to stay professional and keep the necessary boundaries that define the therapy space.

Our emotional empathy can cloud our judgement. We might not challenge our clients’ maladaptive thinking and behaviors, if we emotionally empathize with their responses too much. While our emotional empathy may feel great, it may not always help our clients reach their goals in therapy.

To sum this up: All therapists need cognitive empathy to do their job well. They do not always need emotional empathy. There is no such thing as too much cognitive empathy, but a therapist can have too much emotional empathy.

In the case of Jeff, I was able to have a small bit of emotional empathy for him when I pictured him as a teenage boy being rejected by girls.  To do therapy with him, I had to try not to focus on what I felt for the women he abused. In effect, I was choosing to ignore my emotional empathy because it would be unproductive in this situation.  I had to rely almost entirely on my cognitive ability to even be in the same room as Jeff.

Do all therapists have emotional empathy?

Not all therapists are alike. As individuals, therapists may differ widely from each other on how emotionally empathic they are.  Good therapists generally have some emotional empathy, cultivate compassion, and rely on cognitive empathy. Bad therapists sometimes are undisciplined and poorly trained. They are like “wild cards.” They may have a lot of emotional empathy, but without enough training and self-discipline, the way they act on their emotions in therapy may not be useful to their clients.  Sometimes they get too involved in their clients’ lives. They lose their objectivity. Often, they just do whatever they want to in therapy and hope it works.

Can therapists empathize with all their clients?

The answer is “yes,” if we are talking about cognitive empathy and “no,” if we are talking about emotional empathy. As you can see from the Jeff example, I had more disgust than emotional empathy for him.  In order to work with Jeff, I had to rely on my capacity for cognitive empathy.

Many of my narcissistic clients do some very nasty things to other people, including me. I try to understand their reasoning, the emotional context, and not judge them for their behavior. In some cases, this is the best that they can expect from me. It is a big win for me to just stay present and continue to make therapeutically useful responses. My real emotional empathy is for their victims.

Punchline: Not all therapists have emotional empathy for all their narcissistic clients. This does not make them bad therapists unless they also lack cognitive empathy. In fact, too much emotional empathy can sometimes be a problem for the therapist and interfere with the success of the therapy. The more abusive  clients are to other people, the harder it is for most therapists to emotionally empathize with them. If you are wondering how my therapy with Jeff turned out, he left therapy prematurely. During one of his sessions, despite my good intentions, I could not muster enough cognitive empathy.  That once, I appeared critical of his behavior and he could not or would not tolerate that type of response from me. He quit and never came back.

Adapted from a Quora post.