In a previous article, I discussed the psychological dynamics of covert narcissism, focusing on how individuals with covert narcissism manipulate emotional dependencies. I explored key traits that set covert narcissism apart from grandiose narcissism, such as hypersensitivity to criticism, emotional manipulation, victim mentality, and grandiose fantasies. Additionally, I traced the psychoanalytic roots of these traits, particularly the covert narcissist’s sense of victimization. Lastly, I discussed therapeutic strategies to manage covert narcissists, addressing the challenges their defensive and manipulative behaviors present during treatment.
In this article, we will expand on that foundation by exploring covert narcissism from a clinical perspective. We’ll examine the subtle yet powerful defenses these individuals use, and I’ll provide a detailed clinical example featuring a covert narcissist named “Sam.” This case study will highlight my interventions and therapeutic approach, offering insight into how therapists can effectively work with covert narcissists.
What is Covert Narcissism?
Covert narcissism, also called vulnerable or introverted narcissism, manifests differently from the grandiosity typically linked with narcissistic personality disorder (NPD). These individuals may not overtly seek admiration or attention, but their internal world is still dominated by fantasies of superiority and the need to be perceived as special. When their self-esteem is threatened or they feel misunderstood, covert narcissists often experience emotional dysregulation, resulting in emotional withdrawal, anger, or passive-aggressive behavior.
From a psychodynamic perspective, covert narcissism develops from early childhood experiences where the individual did not receive consistent or empathic emotional attunement from caregivers. As a result, they grow up with a fragile sense of self-esteem and an overwhelming need for external approval, which they try to meet through passive-aggressive or manipulative behaviors.
Clinical Example and the Psychodynamic Therapeutic Process
Disclaimer: The clinical examples provided are a synthesis of experiences seen both online and within my private practice to protect patient anonymity.
I want to dig deep into the treatment approach with a patient I’ll call Sam, who presented with covert narcissistic traits. After failing out of law school, Sam cut off all contact with friends and isolated herself in her childhood home with her “narcissistic mother.” She withdrew from basic hygiene and spent her days binge-eating, watching TV, and fantasizing about becoming a successful lawyer, despite the fact that she had already dropped out. She seemed completely disconnected from reality and was caught in a loop of withdrawal and complaint.
Sam’s interactions with her mother were a constant source of distress. She often recounted how her mother infantilized her, treating her like a little girl, criticizing her for not contributing to household chores, and listing her perceived shortcomings. In response, Sam’s anger and feelings of helplessness would escalate, resulting in long, detailed narratives filled with accusations of emotional violence from her mother. I found myself repeatedly listening to these stories, feeling the same helplessness and frustration that Sam was projecting onto me.
As therapists, we must be acutely aware of our own emotional responses, as they can provide valuable insights into the patient’s unconscious dynamics. In this case, I recognized that Sam’s covert narcissistic presentation triggered feelings of futility in me. I sensed that beneath her anger and complaints was a profound sense of despair and helplessness. Sam projected this helplessness onto me, unconsciously hoping that I would hold it for her rather than throw it back at her, with a list of all her shortcomings.
Techniques for Treating Covert Narcissism: The Role of Containment
One of the most crucial therapeutic techniques when working with covert narcissism is containment (Bion, 1962), as covert narcissists often struggle with emotional dysregulation. Containment, rooted in both psychoanalytic and psychodynamic theory, involves holding and processing the patient’s distress without becoming overwhelmed by it. It’s not simply about agreeing with the patient or becoming an emotional punching bag for their projections. Instead, containment allows the therapist to absorb the patient’s unbearable emotions, process them internally, and eventually return them in a more manageable form.
In Sam’s case, containment was essential. She unconsciously projected her feelings of helplessness and despair onto me, expecting me to carry them for her. My role was to hold these emotions within myself, creating a safe space for them to be explored without overwhelming her or reinforcing her defenses. By naming her distress and validating her feelings, I helped Sam begin to process these emotions in a more constructive way. For example, I may reflect upon how “… it seems like what’s happening is unbearably painful for you, and that makes it feel like you’re stuck and there is nothing you can do.”
At moments like this, Sam’s mood would change, and she would become more present, more reflective, and engageable. There were subtle but significant shifts, such as her offering a rare “thank you” at the end of a session. These moments of connection were brief but powerful, indicating that Sam was beginning to feel heard and understood.
It is important to remember that covert narcissism involves a deep-seated need to feel validated and understood, often as a result of early narcissistic wounds. In Sam’s case, her narratives were attempts to resurrect that sense of understanding and connection she never received from her mother. By validating her distress, I allowed Sam to feel seen and heard in a way that she had been (unconsciously) desperately seeking but was unable to articulate.
As therapy progressed, I also employed what Steiner (1993) refers to as “analyst-centered interpretations.” These interventions focus not on the patient’s internal world, but on one’s own emotional experience or “countertransference” as a means of understanding the patient’s unconscious processes. In Sam’s case, I began to explore how she believed I was seeing her, emphasizing her view that I was uninterested or dismissive of her struggles. “You seem convinced that I don’t care about what you’re going through,” I might say, “as if I’m dismissing your experience or not taking you seriously.”
By focusing on her subjective experience of me, I helped Sam reflect on her tendency to project her inner fears of rejection and neglect onto others. This allowed her to become more aware of how these unconscious processes influenced her relationships, not just with me, but with her mother and others in her life.
Managing Aggression in Covert Narcissism
One of the most challenging aspects of working with covert narcissism is managing the patient’s aggression without reinforcing their sense of victimhood. In Sam’s case, as with many covert narcissists, her anger often came out in passive-aggressive ways, and confronting this aggression directly would only make her feel judged and misunderstood.
At earlier stages of treatment, I avoided directly addressing Sam’s aggression. Instead, I focused on her feelings of being wronged and mistreated by others. A more advanced therapeutic approach came later when I helped her recognize how her need to control interactions was a defense against her fear of being mistreated or abandoned. By taking control of the interaction and not allowing others to have a say, Sam reinforced her belief that no one really cared about her.
Conclusion
Treating covert narcissism is a delicate and often lengthy process that requires patience, empathy, and the ability to tolerate the patient’s defenses without becoming overwhelmed. By using techniques like containment and analyst-centered interpretations, therapists can help these individuals begin to reflect on their inner worlds, allowing them to feel seen and understood in ways they never experienced. The goal is to move beyond their emotional manipulation and defensive posturing to help them reconnect with their vulnerable selves. With an experienced therapist, successful treatment can lead to deeper and more meaningful progress.
If you or someone you know is struggling 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.
Bion, W. R. (1962). Learning from Experience. London: Heinemann.
Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic, Neurotic and Borderline Patients. London: Routledge.