The Challenging Covert Narcissistic Patient: Insights and Strategies
Covert narcissism presents a unique therapeutic challenge due to the subtle and manipulative nature of the condition. While often overlooked, individuals with covert narcissism form intense and emotionally dependent relationships where control, manipulation, and a victim mentality dominate. This article will explore how to identify covert narcissism, its developmental origins, and effective psychodynamic therapeutic strategies to engage with these patients, helping them towards emotional healing and growth.
Recognizing Covert Narcissism
Though grandiose and covert narcissists share core traits such as lack of empathy, grandiose fantasies, and a persistent need for validation, the expression of these traits differs significantly. Covert narcissists, unlike their more overt counterparts, often hide behind a facade of introversion, insecurity, or humility, making their narcissism harder to spot.
Here are four key traits of covert narcissism:
Hypersensitivity to Criticism: While grandiose narcissists outwardly display aggression or rage when criticized, covert narcissists respond more subtly. Their reactions may include sadness, resentment, or passive-aggressive behavior, masking deeper feelings of shame and inadequacy. The hypersensitivity creates a fragile self-esteem, making engagement tricky.
Clinical Example: One patient, a young man, repeatedly avoided social gatherings, claiming they were pointless because “everyone is just getting wasted or doing drugs.” To avoid being vulnerable to social interaction, he positioned himself as morally superior to mask his deep fear of rejection.
Emotional Manipulation: Covert narcissists are experts at passive-aggressive behavior. They often manipulate others by playing the victim, shifting the focus from their own actions to elicit sympathy.
Victim Mentality: Covert narcissists feel perpetually wronged or mistreated. This defensive posture allows them to evade responsibility for their actions, reinforcing their self-perception as blameless in conflicts.
Clinical Example: In couples therapy, a wife described her husband as volatile, pathological, and losing control. When questioned about the impact of her words, she immediately felt attacked and claimed the therapist was taking her husband’s side. Her shift from describing his behavior to feeling victimized by the therapist is a classic example of covert narcissistic manipulation.
Grandiose Fantasies:
Despite their outward humility or introversion, covert narcissists harbor hidden fantasies of superiority and grandiosity. These internal fantasies rarely manifest in obvious ways, but they become evident when covert narcissists expect others to conform to their inflated self-image. This can result in tension, as their unspoken expectations clash with the reality of human relationships.
Clinical Example:
A young man came into therapy, unwilling to engage socially and openly dismissive of others, saying things like, “It’s just a stupid party. Everyone’s getting wasted or doing drugs. I don’t have time for that.” Beneath this outward disdain was a sense of grandiose fantasy—he believed he was above the triviality of others, viewing himself as superior to the people he was criticizing. This underlying belief is common in covert narcissists, whose fantasies of specialness often remain hidden beneath their modest or introverted exterior.
In therapy, I gently explored the deeper roots of this contemptuous attitude. By reflecting on his avoidance of social interaction, we uncovered how his reluctance to engage was not due to moral superiority, as he presented it, but rather a profound fear of being judged or feeling inadequate in those situations. The grandiose fantasy served as a defense mechanism to protect him from confronting his vulnerabilities. Over time, through careful exploration, he began to understand how his sense of being “above” others was really shielding him from uncomfortable emotions like inadequacy and shame.
What Causes Covert Narcissism: Mahler’s Theory of Separation-Individuation
To understand why covert narcissists exhibit such behaviors, it is essential to explore psychoanalytic theories about their development. Margaret Mahler’s theory of separation-individuation is particularly relevant in explaining the roots of covert narcissism.
Mahler’s theory emphasizes that healthy psychological development hinges on the child’s ability to gradually separate from the primary caregiver while maintaining a secure sense of self. The caregiver’s attunement to the child’s emotional needs during early development is crucial for fostering trust, safety, and emotional security. When this “blissful union” between caregiver and child is ruptured too quickly or not nurtured properly, the child may develop a vulnerable sense of self. Covert narcissism can stem from these early disruptions. (Margaret Mahler, n.d.)
Research supports the idea that early experiences of neglect, emotional unavailability, or inconsistent caregiving set the stage for narcissistic wounds that persist into adulthood. When the caregiver fails to provide adequate attunement, the child may feel emotionally abandoned, creating a fragile self that constantly seeks validation in adulthood. These adults often long for a “reunion” with a nourishing caregiver, and this desire fuels their narcissistic behaviors.
This understanding allows therapists to guide patients through the difficult process of recognizing and integrating feelings of inadequacy and loss. For example, patients often bring their unresolved emotional needs from early relationships into the therapy room. They might unknowingly project their unmet needs for love, attention, and understanding onto the therapist. By staying attuned and empathetic, therapists can help patients see how these unmet needs shape their current emotional struggles, gently guiding them toward healing.
Therapeutic Challenges and Strategies
Engaging covert narcissists requires a nuanced approach due to their hypersensitivity and defensive reactions. Rather than merely addressing surface behaviors, effective therapy should focus on underlying emotional needs stemming from early childhood experiences, as discussed in psychoanalytic theory. Here are four advanced psychodynamic and empirically-based strategies for working with covert narcissists in therapy:
1. Avoid Over-Validation While Maintaining Empathy
While it’s crucial to acknowledge the patient’s emotional pain, excessive validation can reinforce their narcissistic need for constant reassurance rather than fostering meaningful growth. The balance lies in acknowledging their distress without affirming the maladaptive coping strategies they rely on, such as emotional manipulation or a victim mentality.
Technique: Therapists can use reflective listening paired with empathic confrontation to validate the patient’s feelings while gently challenging their perceptions. For example, in response to hypersensitivity to criticism, rather than simply reassuring the patient, the therapist might reflect, “I can see how painful it is for you to feel misunderstood, but I wonder if there might be another way to view the situation.” This subtle redirection helps them explore alternative viewpoints without reinforcing their need for constant validation.
Clinical Example: In the case of the woman feeling criticized for recounting her husband’s behavior, instead of validating her sense of being “ganged up on,” I acknowledged her emotions while gently shifting focus towards her partner’s perspective. Over time, this facilitated greater self-awareness, allowing her to first, feel deeply understood, and then realize how her own actions contributed to the dynamic, reducing her reliance on victimhood.
2. Focus on Emotional Regulation with Mentalization-Based Therapy (MBT)
A core component of therapy for covert narcissists involves helping them regulate their emotions, particularly their intense reactions to perceived criticism. Many covert narcissists respond to criticism with profound feelings of shame, inadequacy, or anger, leading to heightened defensiveness. In my practice, I incorporate clinically effective, empirically-based techniques to help patients manage these emotions.
One of the approaches I utilize is Mentalization-Based Therapy (MBT), which has proven effective in enhancing individuals’ abilities to understand and reflect on their own and others’ mental states (Bateman & Fonagy, 2016). By fostering emotional awareness and helping patients to “mentalize”—to see situations from other people’s perspectives—therapy helps covert narcissists navigate the tumultuous waters of shame, inadequacy, and rage more effectively.
When patients develop the capacity to mentalize, they can begin to recognize how their hypersensitivity to criticism and their tendencies toward emotional manipulation are rooted in deeper feelings of vulnerability. This technique not only fosters emotional regulation but also deepens their understanding of their own unconscious thoughts and feelings and how these feelings influence their relationships.
Clinical Example: In one case, a patient frequently reacted defensively to constructive feedback, often spiraling into feelings of inadequacy and anger. Pulling on MBT, we explored what she heard when her husband had a different perspective, and what she imagined he was thinking when he complimented her parenting skills. As the patient learned to mentalize, she started to see how her defensiveness stemmed from her desire to avoid confronting painful feelings of vulnerability, leading to healthier emotional responses over time.
3. Address Grandiose Fantasies with Empathic Confrontation
Covert narcissists often maintain hidden fantasies of superiority despite an outward appearance of humility. These fantasies serve as a defense mechanism against feelings of inadequacy and vulnerability. Addressing these fantasies directly can provoke defensiveness, so the therapeutic approach must be one of empathic confrontation rather than confrontation alone.
Therapists can use gradual exposure to gently expose grandiose fantasies. By empathically confronting the patient’s unrealistic expectations without invalidating their emotions, therapists can help them explore the disconnect between their fantasies and reality. Over time, this leads to a deeper understanding of the unconscious fears and vulnerabilities driving their behavior.
Clinical Example: For example, in therapy with the wife, I acknowledged her underlying fear of not being understood. By reflecting this fear back to her in a way that felt empathetic yet gently challenged her grandiose expectation of total agreement, I was able to shift the focus from her need for validation to her deeper wish for complete union through a merged way of thinking.
Conclusion
Covert narcissism is a complex and challenging condition, but with the right strategies, therapists can help patients emerge from their emotional defenses. By understanding the developmental roots of covert narcissism, particularly through Mahler’s theory of separation-individuation, and by using therapeutic techniques that validate without reinforcing maladaptive patterns, it is possible to guide covert narcissists toward greater self-awareness and healthier relationships.
In every step of the therapeutic journey, the goal remains the same: to help these individuals understand and address the unconscious emotional wounds that drive their narcissistic behaviors, offering them the opportunity for true emotional healing.
If you or someone you know struggles with covert narcissism, seeking professional help from a trained therapist experienced in working with personality disorders can be a vital step toward healing. Engaging with a compassionate professional can create a safe environment for exploring these complex emotions and fostering meaningful connections.
For further insights and support, explore:
The Narcissism Decoder Podcast: get a deeper understanding through expert discussions and real-life stories.
Videos on Narcissistic Relationships: Visual resources to help navigate the complexities of narcissistic dynamics and recovery.
These resources can provide additional guidance as you navigate your journey toward healing and personal growth
References
- Bateman, A. W., & Fonagy, P. (2016). Mentalization-Based Treatment for Personality Disorders: A Practical Guide. Oxford University Press.
- Mahler, M. S., Pine, F., & Bergman, A. (2000). The Psychological Birth of the Human Infant: Symbiosis and Individuation. Basic Books.
- Margaret Mahler. (n.d.). Wikipedia. https://en.wikipedia.org/wiki/Margaret_Mahler