Most psychotherapies designed to focus on treating narcissistic disorders rely on empathy as one of their primary tools. This is because almost all narcissistic clients respond better to empathic interventions than to any form of confrontation. This can be a problem for many therapists because it is difficult to empathize with clients who are mercilessly abusive to others. The worse the abuse, the harder it is to take an empathetic stance.

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

Note: In this article, I use the terms “narcissist” and “narcissist” as shorthand for 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 supply primarily through dominating and humiliating others, especially women. Below is a sample of how Jeff described his behavior. It has been slightly edited to protect the client’s privacy.

I hate women. I especially hate the kind of attractive women who ignored me in high school. They made me feel like a worm. Now I’m a famous photographer and beautiful women who want to break into the modeling business are hitting on me.

Want to know what I do to them? I like to traumatize them by sexually humiliating them. I play with them first. I have them come to my studio for a test shoot. I have them stripped down in front of me. Then I put them in positions that are designed to embarrass them. I keep going until they look extremely uncomfortable. Some start crying. I love that I’ve crushed them. Then I coldly say, “You’re too ugly to make it in modeling.” Sometimes I have sex with them before I throw them out.

Jeff seemed like an unlikely candidate for therapy. Most people with NPD deny they have a problem and never voluntarily seek therapy. Malignant narcissists, like Jeff, are often even more resistant to the idea. So I asked Jeff to explain what he was looking for in therapy. He was very direct and specific. Here’s a shortened version of what Jeff said in response to my question:

I’ll be honest with you. I’ve never been interested in changing anything about myself. I never thought I’d seek therapy. I love humiliating women. I love feeling special and powerful and enjoy using my high status to dominate others. But I have a problem I need to work on. Once I have sex with a woman, I usually lose all interest in her immediately. If I try to have sex with her again, I lose my erection. The longest I have been able to have a romantic relationship for two weeks. I have had a thorough checkup and the doctor has told me that my problem is psychological, not physical. I am intelligent enough to envision the future. Unless something changes, I will never be able to have a long-term relationship, get married, or start a family like others. I do not like my options to be limited in this way. I want to be able to have sex whenever I want and my erection problem is holding me back.

Did I feel emotional empathy for Jeff? No, I did not. My emotional empathy was for his victims. When I told him the story of how he humiliated the models, he would smile and watch me for signs of shock and discomfort. I realized that Jeff had chosen therapy on purpose. He expected that in addition to his therapy, he would get another chance to torture a woman. He was a sadist and wanted to feed off any discomfort I might show him.

This was also a clear attempt to control me as well. However, it is not uncommon for exhibitionist or malignant narcissists to play “controlling the therapist” in their first session. They do this to compensate for the underlying shame they feel about seeking therapy. By going to therapy, they are admitting that there is something they cannot do on their own and that they need my help. This feeds into their underlying insecurities about their self-esteem. So their need for me conflicts with their need to feel superior to me. And here Jeff’s need to feel superior won out. So in addition to telling me his story, he sought to make me feel uncomfortable.

Was I still willing to do therapy with him? Yes. I suspected that on a subconscious level, in addition to trying to control and embarrass me, the part of him that wanted to help me was checking my reactions to see if I would feel disgusted and judged.

So how was I able to work with Jeff when I was 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 any further, I want to briefly define the two basic types of empathy.

Emotional empathy: This is an automatic, felt response to another person’s emotional state or life situation. We emotionally feel someone else’s joy or sadness.

Cognitive empathy: This is the ability to think about and understand what someone else might be feeling. It doesn’t require “feeling,” it requires pausing to think and understand the client’s feelings and reactions to a situation in their life.

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

How childhood abuse affects our adult clients’ behaviors and self-esteem.

How unconscious psychological defenses interfere with our clients’ realistic view of themselves and others.

How different forms of mental illness create chaos in people’s lives.

Is emotional empathy always necessary and helpful?

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

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

In short: All therapists need cognitive empathy to do their job well. They don’t always need emotional empathy. There is no such thing as too much cognitive empathy, but a therapist may have too much emotional empathy.

In Jeff’s case, I was able to feel a small amount of emotional empathy for him when I imagined him as a teenage boy who was rejected by girls. To do therapy with him, I had to try not to focus on how I felt about the women he had mistreated. I chose to ignore my emotional empathy because it would be counterproductive in this situation. I had to rely almost entirely on my cognitive ability to be in the same room with Jeff.

Do all therapists have emotional empathy?

Not all therapists are the same. As individuals, therapists can vary greatly in how emotionally empathetic they are. Good therapists generally have some emotional empathy, cultivate compassion, and rely on cognitive empathy. Bad therapists are sometimes undisciplined and poorly trained. They are like “wild cards.” They may have a lot of emotional empathy, but without adequate training and self-discipline, the way they act on their emotions in therapy may not be helpful to their clients. Sometimes they become overly intrusive in their clients’ lives. They lose their objectivity. They often do what they want in therapy in the hope that it will work.

CanTherapistsEmpathizeWithAllTheirClients?

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 Jeff’s example, I had more disgust than emotional empathy toward him. To work with Jeff, I had to rely on my ability to cognitively empathize.

Many of my narcissistic clients do some very unpleasant things to others, including me. I try to understand their reasoning and emotional context, and not judge them for their behavior. In some cases, this is the best they can expect from me. It is a huge win for me to stay present and continue to provide therapeutically helpful responses. My true emotional empathy is for their victims.

The bottom line: Not all therapists have emotional empathy for all their narcissistic clients. But that doesn’t make them bad therapists unless they also lack cognitive empathy. Excessive emotional empathy can sometimes be a problem for the therapist and interfere with the success of therapy. The more abusive clients are, the harder it is for most therapists to empathize with them emotionally. If you’re wondering how my therapy sessions with Jeff ended, he left therapy prematurely. During one session, despite my best intentions, I couldn’t muster enough cognitive empathy. At one point, I seemed to criticize his behavior, and he couldn’t or wouldn’t tolerate that kind of response from me. He left therapy and never returned.