In my practice at the Online Therapy Clinic, I’ve often worked with individuals who display narcissistic or grandiose traits. These clients can present unique challenges, but the therapeutic process can also be deeply rewarding. Over time, I’ve come to understand that beneath their often intimidating exterior lies a vulnerable self, which they’ve learned to protect through inflated self-images and rigid defences.
From the outset, it’s clear that building a trusting relationship with someone who exhibits narcissistic tendencies requires patience and care. The grandiosity they project is often a shield, a way to protect themselves from feelings of inadequacy or shame that they may not even be aware of. My role, as I see it, is not to confront or undermine these defences but to work with them gently, allowing the client to feel both seen and understood.
Many clients with narcissistic traits have experienced deep emotional wounds, often originating in early childhood. Whether it’s inconsistent parental affection, unrealistic expectations, or emotional neglect, these early experiences can profoundly shape their approach to relationships and self-perception. In therapy, part of the work involves exploring these early life experiences and helping the client understand how they’ve contributed to their present-day behaviours.
In this process, defence mechanisms like denial and projection often come to the fore. It’s not uncommon for clients to test the boundaries of the therapeutic relationship, sometimes seeking validation, at other times pushing against authority. I’ve learned that navigating these moments requires staying grounded—acknowledging what’s happening without reacting emotionally. Instead, I guide the client to reflect on what lies beneath their reactions, helping them gradually peel away layers of self-protection.
A Clinical Case Example
One client, whom I’ll call John, came to therapy after facing repeated difficulties in his personal and professional relationships. A highly successful entrepreneur in his late 30s, John often found himself in conflict with colleagues and friends. He was quick to dismiss criticism and had a habit of dominating conversations, leaving others feeling dismissed or inferior. Though outwardly confident, he reported feeling increasingly isolated and misunderstood, yet couldn’t figure out why.
In our early sessions, John was reluctant to explore any notion of vulnerability. He would frequently steer the conversation towards his accomplishments or talk about others’ shortcomings, rarely reflecting on his own behaviours. Gradually, I began to notice how his need for constant validation and his dismissive attitude were functioning as defences, protecting him from underlying feelings of inadequacy.
As we explored his childhood, it became apparent that John had been raised in an environment where success and achievement were the only measures of worth. His parents, both high achievers, had placed immense pressure on him from a young age. While he was rewarded for his successes, any sign of emotional vulnerability or failure was met with disapproval or indifference. Over time, John had built a persona of invulnerability, masking a deep fear of being perceived as weak or unworthy.
Through our work together, I helped John recognise these patterns and how they played out in his relationships. Initially, he was resistant to the idea that his grandiosity was a defence. But over time, through the therapeutic relationship, he began to lower his defences. Transference became a central focus of our work—John would often view me as either a figure of authority he needed to impress or as someone who might criticise him. By gently exploring these reactions, I helped him see how these dynamics mirrored his interactions with others outside the therapy room.
One key breakthrough came when John began to confront his underlying feelings of shame and inadequacy. For the first time, he could acknowledge that beneath his grandiose exterior, he feared being seen as a failure or disappointment. This realisation was difficult for him, but it marked a turning point in therapy. As we continued to explore these emotions, John started to let go of his need for constant validation, and over time, he developed a more balanced, grounded sense of self.
Empathy was another crucial area of growth for John. At the start of therapy, he struggled to see beyond his own perspective, often viewing relationships as transactional or competitive. However, through our work, he began to develop a deeper understanding of the emotions and needs of those around him, leading to more authentic and fulfilling connections.
Long-Term Insight and Change
Psychoanalytic therapy with narcissistic or grandiose clients like John is not a quick fix. It requires a long-term commitment and a willingness to explore difficult emotional terrain. But in my experience at the Online Therapy Clinic, I’ve seen clients make remarkable transformations—moving from rigid self-protection to greater emotional depth, authenticity, and connection.
For more information about how I work with individuals struggling with narcissistic traits, and to explore the services we offer, feel free to visit our website: Online Therapy Clinic.
By Ari Sotiriou M.A. psychodynamic psychotherapist co-founder Online Therapy Clinic