The American Journal of Psychoanalysis, Vol. 55, No.

2, 1995

NARCISSISTIC CHARACTERS WITH

OBSESSIVE FEATURES: DIAGNOSTIC AND
TREATMENT CONSIDERATIONS

Cheryl Glickauf°Hughesand Marolyn Wells

Most of today's patients present with a mixture of features from different

characterological styles. In spite of the prevalence of these mixed disor-
ders, a search of the psychological literature revealed only three previously
described combinations: paranoia and masochism (Nydes, 1963), narcis-
sism and masochism (Cooper, 1988; Gear et al., 1981), and narcissism and
sadism (Gear, Hill, and Liendo, 1981). The current authors have frequently
observed a third mixed personality style that combines both narcissistic
and obsessive-compulsive characteristics.
While differences between the narcissistic and obsessive-compulsive
personalities have previously been discussed (Sorotzin, 1985; Trijsburg and
Duivenvoorden, 1987), a clinical picture of individuals who manifest both
obsessive-compulsive and narcissistic features has not yet been articulated.
This article represents a preliminary attempt to delineate and discuss the
unique features of a narcissistic character with obsessive-compulsive fea-
tures including presentation in psychotherapy and salient treatment consid-
erations.

DESCRIPTIVE CLINICAL OVERVIEW

Narcissistic characters with obsessive features often present with some

typical characteristics related to an underlying narcissistic organization,
obsessive-compulsive defenses, and the particular synthesis of both charac-
terological features. These include: (1) extreme perfectionistic strivings; (2)
intellectual grandiosity; (3) the need to be idiosyncratically special; (4) the
proclivity to employ obsessive-compulsive mechanisms to defend against
underlying narcissistic problems; (5) an impaired capacity to depend on
others; (6) a strong capacity to narcissistically cathect their intellect and a

Cheryl Glickauf-Hughes, Ph.D., Department of Psychology, Georgia State University, Atlanta,

Georgia 30303-3097. Marolyn Wells, Ph.D., Counseling Center, Georgia State University,
University Plaza, Atlanta, Georgia 30303-3097.
129
0002-9548/95/0600-0129507.50/1© 1995Associationfor the Advancementof Psychoanalysis
130 GLICKAUF-HUGHES AND WELLS

primary underlying attachment-withdrawal or need-fear dilemma (Solo-

mon, 1989).
Perfectionistic strivings are an important feature in this character organi-
zation as perfectionism is common in both narcissists and obsessives. The
perfectionistic strivings manifested by the narcissistic character are moti-
vated by the wish to "avoid shame for not living up to an archaic, grandi-
ose view of the self" (Sorotzin, 1985, p. 564). In contrast, the obsessive-
compulsive's perfectionistic need is to mitigate against guilt for not living
up to the demands of an excessively harsh superego (Sorotzin, 1985). The
narcissistic with obsessive features is often motivated by both needs pro-
ducing perfectionistic tendencies in the extreme.
Furthermore, if narcissists strive to be perfect and obsessive-compulsives
strive to do things perfectly, narcissistic characters with obsessive features
often strive to achieve the illusion of perfect knowledge. While narcissists
tend to overrely on innate talents and abilities and obsessive-compulsives
tend to overrely on rules and quasi-moral shoulds, narcissists with obses-
sive features tend to overrely on personal expertise or some area of esoteric
knowledge.
Grandiosity is another prominent feature in this character pattern. While
the narcissist often feels entitled to adoration for being the greatest and the
obsessive-compulsive wants approval for being right, the narcissisl: with
obsessive features needs approval for being intellectually superior and/or
maintaining a perfect sense of intellectual integrity.
Complementing their perfectionistic strivings and feelings of grandiosity,
narcissistic characters with obsessive features also tend to present a strong
need to be special. Once again, this need tends to be manifested differently
than in the narcissistic personality without obsessional features. While the
narcissist tends to be flamboyant and frequently seeks admiration for more
conventional accomplishments, the narcissist with obsessive features often
attempts to get self-esteem and individuation needs met through success in
more esoteric or idiosyncratic activities (e.g., ancient philosophy, astron-
omy). Even when the primary area of ambitious striving is more traditional
(e.g., sales, law), it often becomes specialized in a more unusual area (e.g.,
legal history).
Finally, in terms of superficial social presentation, the narcissist is usually
experienced as personable, charming, and attention-getting while the nar-
cissist with obsessive features is typically experienced as superficially en-
gaged but more critical and intellectualized. Their social presentation is
thus less interpersonally appealing than the narcissist's charismatic presen-
tation. On the other hand, narcissists with obsessive features typically pre-
sent in a more engaged, spontaneous manner than obsessive-compulsives
who are experienced as socially stiff or stilted due to the role-assuming
 NARCISSISTIC CHARACTERS 131

nature of their interactions (e.g., "1 am in the co-worker role now so I

should behave as a co-worker does").
The authors have also observed a proclivity for narcissistic characters
with obsessive features to utilize obsessive-compulsive mechanisms (e.g.,
isolation of affect, intellectualization, circumstantial talking, argumen-
tativeness, pickiness) in order to defend against underlying narcissistic vul-
nerabilities. These vulnerabilities include (1) a fragile sense of self, (2) in-
tense fears of being psychologically engulfed, objectified, or used by
another, (3) unstable self-esteem, (4) an unconscious envy of needed self-
objects. This defensive style is further complicated by a hallmark tendency
to use obsessive-compulsive mechanisms as part of a larger defensive ef-
fort, that is, as part of a projective identification that induces another per-
son to experience and deal with an unwanted self-experience or bad-ob-
ject representation.
For example, one narcissistic patient with obsessive features repeatedly
told his therapist that he wanted her to take a more active stance. He
frequently complained that when she was quiet he felt unconnected with
her. Despite his stated wish, the patient tended to speak in detailed long
monologues that made it difficult for the therapist to participate. When the
therapist did respond during pauses, the patient either argued with the ther-
apist's response or interrupted her to continue his monologue. When the
therapist began to comment on this process, the patient became extremely
anxious in the session and canceled his next appointment.
When he returned to therapy the following week, he spoke of his
mother's erratic, intrusive behavior and self-serving domination of the chil-
dren and how at times it made him feel as though he did not exist. This
same patient frequently complained about being bored with his partner
due to her dependence, passivity, and lack of "a mind of her own." When
his partner entered therapy, however, and began to take a more indepen-
dent and assertive role in the relationship, this patient felt extremely threat-
ened.
in this example, the patient's unconscious passivity (related to a desire to
be taken care of and intense fears of rejection) raised secret feelings of
disgust and inadequacy and were thus defended against through projective
identification. The patient's passive self-representation, which had been
rendered helpless by a dominating, intrusive mother, was initially pro-
jected onto the therapist. The patient then induced passivity in the therapist
through the rigid use of obsessive defense mechanisms (intense ambiva-
lence, pickiness, unilateral or circumstantial talking) that were uncon-
sciously intended to control participation and induce a sense of defeat in
the therapist.
Because obsessive-compulsive mechanisms are often distractingly effec-
132 GUCKAUF-HUGHES AND WELLS

tive, socially sanctioned, and ego-syntonic, and because the fear of experi-
encing underlying narcissistic injury is so great, this character style is usu-
ally highly resistant to change. In addition, the defensive tactics of these
patients typically sabotage reciprocity or mutuality in social relationships
and collaborative work in the therapeutic relationship. Over time, people
typically feel bored, irritated, or helpless with them and tend to disengage,
leaving them uninfluenced and/or more entrenched in their belief that "you
cannot really get what you need from people."
As is often true with all narcissistic resistances, the underlying problem
of narcissists with obsessive features involves their impaired capacity to
depend on others (e.g., Kernberg et al., 1989). Although these patients are
often covertly if not overtly demanding of attention and admiration, they
find it difficult to internalize what other people have to offer them. While
they often demand that people give them undivided attention, they have
difficulty feeling that they are getting anything substantially helpful or that
they really deserve the help they are offered.
Narcissists with obsessive features also manifest strong tendencies to
overcathect their intellect. Their identity and self-esteem are often so de-
pendent on their intellectual capabilities that they tend to persist in exercis-
ing their cognitive functions even when the social environment gives them
feedback that doing so is inappropriate or counterproductive in a given
situation. For example, one patient (who was herself a student therapist)
had a proclivity to provide a detailed analysis of her partner's character
and underlying motives when he shared his problems with her. Further-
more, she continued to do so even when her partner told her that it made
him feel angry and not understood by her. The demonstration of intellec-
tual ability in this character has a more phallic-exhibitionistic quality than
the quasi-moral motives of the neurotic obsessive. These patients fre-
quently use their command of language to impress or intimidate as op-
posed to communicate or elucidate.
It should be noted that narcissists with obsessive features not only over-
cathect their intellect, but also feel unentitled to their feelings. Because of
the egregious unattunement that they suffered throughout childhood, they
have learned to suppress painful feelings of alienation, longing, shame, and
emptiness. In addition, they have some proclivity to equate emotionality
with the onset of destructive behavior, which reinforces their unconscious
resolution to avoid intense feelings and remain cognitive. Paradoxically,
anger is often the one emotion that they feel more comfortable expressing,
particularly in the form of contempt or ridicule, because of its mobilizing
and distancing effects.
Finally, while narcissistic characters with obsessive features demonstrate
excessive ambivalence similar to that expressed by the obsessional neu-
 NARCISSISTIC CHARACTERS 133

rotic (Salzman, 1980), their ambivalence is more compartmentalized and

intensified and tends to revolve around more narcissistic concerns. A pri-
mary area of ambivalence for these patients is between their need for rela-
tionship (including engagement with others in the here-and-now) and their
great fear of being engulfed, objectified, and/or used by others. Reflecting
this conflict they often vacillate between what they need and what they
fear, and thus, over time, give mixed messages to others. Their attachment-
withdrawal dilemma (Solomon, 1989) can be understood in terms of a
more developmentally advanced derivative of Guntrip's (1969) schizoid
compromise, the fundamental purpose of which is to retain relationships in
a form that does not require complete emotional engagement.
Narcissists with obsessive features thus differ from the obsessional neu-
rotic who is less conflicted in this area and manifests more realistic expec-
tations for relationship (and self) as well as a more developed capacity for
true intimacy. Furthermore, these patients tend to present more generalized
ambivalence in romantic relationships than the narcissist who tends to
manifest a particular pattern of intense engagement during the idealized
infatuation stage followed by emotional withdrawal as the relationship be-
comes more reality-oriented (Willi, 1982). Narcissists with obsessive fea-
tures also differ from schizoids in this area in that they tend to manifest this
conflict most blatantly in intimate or primary relationships while schizoid
patients are in more pervasive denial about their needs for relationship and
thus remain more emotionally withdrawn in all their relationships.
The authors have thus observed that while narcissists with obsessive fea-
tures can be very frightened by relationships, they also tend to be aware of
their strong needs for attachment. Furthermore, they have generally devel-
oped sufficient superego and ego functions to manifest some measure of
real concern about their partner's feelings. These developments make them
better able to sustain relationships than the narcissistic personality without
obsessional features who cannot seem to stay in love or appreciate others
outside of their narcissistic functioning. The narcissistic personality tends to
devalue or abandon anyone who is no longer perceived as a source of
narcissistic supplies, whereas the patient described in the earlier example
remained with his partner even when he found her boring or threatening
(in part because he still cared for and valued who she was). Consequently,
narcissists with obsessive features often demonstrate greater concern for a
partner's happiness in the relationship than one observes from purely nar-
cissistic patients.
In sum, narcissistic personalities with obsessive features are charac-
terized by intense perfectionism and underlying shame. They have both the
narcissistic wish to be special and adored and the obsessive need to be in
control and omniscient. Most especially, they often appear to invest a great
134 GLICKAUF-HUGHES AND WELLS

deal of energy in knowing and narcissistically cathecting their intellect.

They tend to manifest entrenched obsessive-compulsive defense mecha-
nisms against underlying narcissistic issues (e.g., impaired self-esteem regu-
lation) and often employ these mechanisms as part of a larger projective
identification.
Narcissists with obsessive features experience extreme ambivalence be-
tween their need for relationships and their fear of engulfment, mistreat-
ment, and control by others. Furthermore, narcissistic needs are often grati-
fied through intellectual pursuits (often of an esoteric nature). Finally,
narcissists with obsessive features are generally able to sustain relationships
to a greater degree than the pure narcissistic character.

TYPICAL PRESENTATIONS IN PSYCHOTHERAPY

As previously noted, narcissists with obsessive features tend to develop

more superficial social awareness than obsessive-compulsive patients and
thus behave in a manner that appears to be more extroverted, confident,
and engaging (e.g., maintaining eye contact). However, the inner self expe-
rience of these patients differs from their false self-presentation. The au-
thors have often observed that while the behavior of narcissists with obses-
sive features appears to be involved, these patients generally feel reserved
and detached from others. While they appear to want relatedness, they are
often difficult people with whom to feel connected.
For example, one patient maintained almost unrelenting eye contact but
looked at a spot on the therapist's forehead rather than in the therapist's
eyes. This behavior gives the appearance of engagement while providing a
self-protective vigilance of the other. Averting true eye contact helped the
patient avoid the feeling of being observed and manages feelings of vul-
nerability or exposure.
These superficial engagement behaviors represent one side of this char-
acter style's extreme conflict between the desire for attachment and ap-
proval versus the fear of being controlled or humiliated by the therapist.
This conflict induces the patient to both invite and thwart relationships in
such a critical, judgmental manner that the therapist may often experience
some sense of frustration, inadequacy, and confusion.
One of the primary difficulties in working with narcissists with obsessive
features "is that they will engage in behaviors that make therapists feel
discounted and angry while at the same time demanding total involvement
and confirming responses" (Solomon, 1989, p. 199). Thus, they may com-
plain that no one understands them while fending off empathic offerings
through pickiness, circumstantial talking, ignoring, ridicule, and help-re-
jecting complaining.
These patients' resistance to internalizing what they need may be multi-
 NARCISSISTIC CHARACTERS 135

ply determined, reflecting their needs to (1) resist any real dependency on
the therapist; (2) feel in control of their experience; (3) avoid labeling; and
(4) stave off feeling unduly exposed or manipulated. These patients often
harbor tremendous shame and may fear that therapy "will expose some
material that will add to an already overflowing reservoir of humiliation"
(Solomon, 1989, p. 120).
Thus, narcissists with obsessive features are so sensitive to implied
slights, criticisms, or rejections that it is extremely difficult for them to hear
anything helpful from the therapist without turning it against themselves.
Even questions aimed at exploring what makes it hard for them to hear
genuine empathy can be met with defensiveness. As a patient (in a later
stage of treatment) was able to articulate: "We're on a very slippery slope
here because in order to talk about what makes it hard, I have to acknowl-
edge that I'm not able to do something for myself that I feel I should be
able to do. Your questions make me feel inadequate, so I want to shut you
up and tell you that I already know this stuff or it's not helpful."
Therapists thus experience an emotional bind with these patients, remi-
niscent of the patient's own childhood experiences. For example, early in
treatment one patient appeared to reject nearly every empathic statement
the therapist proffered. When the therapist told the patient that it sounded
like his parents expected a great deal of him, he replied: "No. They were
very fair." In an attempt to convey more accurate understanding, the thera-
pist said: "So, your parents had fairly reasonable standards." The patient
responded: "Not always. One time when I was about eight, I brought home
a report card with all A's and one B and they asked me why I got the B."
The therapist said: "That must have hurt." The patient responded that he
was "not h u r t . . , just disappointed."
After repeatedly having her responses rejected, the therapist in this ex-
ample wondered if her interventions were being experienced by the patient
as intrusive impingements and began doubting her ability to understand
this patient. As a result she became more quietly observant and less ver-
bally responsive. The patient then complained that the therapist was "too
aloof" and told her that he wanted more feedback from her. The therapist
now felt in a bind with the client. When she was responsive, the patient
argued with virtually everything she said. When she was quietly observant,
he told her she was cold and clinical and did not care about him. Over
time, the patient's behavior induced in the therapist a sense of helpless
passivity and impotent annoyance.
The bind felt by this therapist is often a hallmark of early treatment inter-
actions with narcissists with obsessive features and can be an indication of
the patient's unconscious use of projective identification. In the previous
example, the patient projected his own unwanted, inadequate self upon
the therapist, and then, through an identification with his controlling, dou-
136 GLICKAUF-HUGHES AND WELLS

ble-binding mother, he behaved in such a way toward the therapist so as to

induce feelings of frustration, ineffectualness, and rejection. It is important
to note that the interpersonal pressure itself and the accompanying induced
set of thoughts and feelings are usually "extremely elusive and difficult to
formulate verbally because the information is in the form of an enactment
in which the therapist is participating and not in the form of words and
images upon which the therapist can readily reflect" (Ogden, 1991, p. 4).
As a result, the therapist can feel like an unwitting actor in someone else's
drama with the patient's stage directions serving to induce a particular role.
This can be confusing and inexperienced therapists can initially react by
trying to override and even deny their feelings of self-denigration or irrita-
tion with the patient in their strivings to be a better mirror or more em-
pathic selfobject. As a result, the patient generally escalates these behav-
iors, leading to an uncomfortable therapeutic impasse.
If the underlying purpose and intent of the patient's enactments remain
out of awareness and the therapist handles the induced feelings through
denial, projection, self-effacement, or actions aimed at tension relief (e.g.,
distancing behavior), the patient "is confirmed in his belief that his feelings
and fantasies are indeed dangerous and unbearable" (Ogden, 1991, p. 2).
In this case, the patient's original pathology is further consolidated through
his identification with the therapist's handling of the induced feeling states.
To the extent that therapists can live with and manage their feelings of
impotence and annoyance "by mastery through understanding or integra-
tion with more reality-based self-representations" (Ogden, 1991, p. 2),
these patients may be able to identify with more mature ways of handling
feelings of helplessness and frustration.
Therapeutic interventions that address projective identifications are dis-
cussed in the next section on treatment. Each of these interventions can
help to create a better working alliance if the therapist is able to maintain
genuine regard for the patient and phrase interventions in a nonaccusatory,
normalizing, and empathic manner that invites collaboration. Due to the
extreme sensitivity of these patients, even seemingly innocuous therapeutic
interventions can be perceived as narcissistically injuring and/or control-
ling. As a result, any sign of hurt or defensiveness should be explored and
all interventions need to be executed with warmth, great tact, and genuine
appreciation for the patient's defensive style.

TREATMENT OF THE NARCISSISTIC PATIENT WITH OBSESSIVE FEATURES

The authors have repeatedly observed that the initial phase of treatment
of narcissists with obsessive features is often more difficult than it is with
either the narcissistic personality or the obsessive neurotic. One patient
with this character style, in describing why she liked the computer, said
 NARCISSISTIC CHARACTERS 137

that it was "infinitely patient and never critical." As the preceding exam-
ples demonstrate, treatment of these patients often requires a great deal of
sensitivity and patience and an appreciation for how frightened, self-criti-
cal, and unentitled to their feelings these individuals feel (even when they
are behaving in a critical, blaming, or superior manner).
In addition, obsessive mechanisms used to serve narcissistic aims can be
confusing to a therapist and serve to further unattunement, which can con-
tribute to the patient's sense of hopelessness about ever being understood.
One of the first therapeutic tasks in working with narcissists with obsessive
features is understanding how the patient's obsessive-compulsive defensive
style is motivated by underlying narcissistic issues. For example, mecha-
nisms such as defensive ambivalence and help-rejecting complaining are
often not primarily meant to serve the obsessive need for control over mak-
ing mistakes (Salzman, 1980). Instead, these obsessive mechanisms are
often motivated by the narcissistic need to preserve the integrity of the self-
experience and to fend off feelings of engulfment or loss of self to a poten-
tially hurtful other.
In general, the authors have observed that there are two somewhat over-
lapping stages to the treatment of narcissists with obsessive features. The
first phase of treatment involves the therapist's ability to facilitate a needed
(and previously truncated) selfobject relationship with the patient in order
to provide opportunities for greater self-development and more stabilized
self-esteem regulation. Once the patient has achieved a cohesive sense of
self and more realistically based self-regard, the second phase of treatment
can begin. In this phase, such obsessive-compulsive issues as the fear of
mistakes, insecurity over lack of guarantees, affective overcontainment,
and the overvaluation of pseudo-logic can be addressed.

Phase One: Treating Structural Deficits

When treating any personality disorder, preoedipal or structural issues

take therapeutic precedence over dynamic conflicts (Homer, 1990). In
treating the narcissist with obsessive features, therapists are thus advised to
first address the structural issues associated with the patient's narcissism
before addressing obsessive conflicts (Homer, 1989). Initial therapeutic
focus often entails (1) understanding the patient's disturbance in identity
and false grandiose self-development (Johnson, 1987); (2) integrating the
grandiose selfobject representation with the nuclear self (Kernberg et al.,
1989); (3) mobilizing and strengthening of the patient's authentic nuclear
self (Homer, 1990); (4) establishing stable, reality-based self-esteem; (5)
understanding and resolving projective identifications; and (6) facilitating
separation-individuation.
This first phase of treatment invariably includes repeated analyses of the
138 GLICKAUF-HUGHES AND WELLS

patient's attachment-withdrawal dilemma (Solomon, 1989), including his

pseudo-independent, superior false self. These analyses will include an un-
derstanding of how projective identification is used to regulate intense
fears of dependency, feelings of inadequacy, and inferiority (Stern, 1987).
Both therapist and patient must come to understand how these defenses
operate to protect a highly vulnerable, exquisitely sensitive, and deeply
wounded real self.
Complementary issues that often need to be understood by both patient
and therapist include (I) how difficult it is for these patients to feel joined;
(2) how much they wish to be deeply known, understood, and accepted
(but how afraid they are of being manipulated, taken over, or invaded); (3)
the impossible expectations and requirements these patients have for them-
selves and others; (4) how cruel they are to themselves when they fail to
live up to their expectations; and (5) their sense of not being entitled to
their real feelings. Narcissists with obsessive features thus require genuine
regard for the understandableness of their deep mistrust and the survival
value of their self-protective mechanisms as well as compassionate, deep
understanding for their genuine desire for intimate relationship.
The most difficult therapeutic challenges in working with these patients
often revolve around understanding the narcissistic issues that motivate ob-
sessive defenses. This may include addressing double binds and working
through projective identifications. Understanding how these patients use
obsessive defenses to protect their fragile sense of self is the key to provid-
ing a reparative selfobject relationship with narcissistic patients with obses-
sive features.
Kohut (1977) believed that the emergence of needs for adequately re-
sponsive selfobjects (mirroring, idealizing, or twinship) in therapy was the
key to recovery for narcissistic problems. The therapist's primary task was
acknowledging the validity and legitimacy of the patient's demands for
development-enhancing selfobject responses. Understanding how these
patients are caught in a push-pull dilemma with others and use obsessive
mechanisms to keep others involved (but at arm's length) are believed to
promote an "empathic-accepting grasp" of the self (Kohut, (1977) p. 105)
and increase self-esteem regulating functions through the process of trans-
muting internalizations. Through this process, it is hoped that the "good"
qualities of the therapist (e.g., compassion, calmness, strength, and empa-
thy) can be internalized, solidifying the foundation for a more compassion-
ate, accepting, resilient, and empathic self.
When dealing with double binds in narcissists with obsessive features,
therapists are recommended to openly discuss the induced bind with the
patient. Confronting the bind breaks the implicit collusion that binds are
not to be talked about. This confrontation is usually less threatening to the
 NARCISSISTIC CHARACTERS 139

patient if the therapist first asks the patient how she or he feels about how
they are communicating with one another and then attempts to empathize
with the patient's apparent point of view before addressing the impact of
the patient's behavior on the therapist.
In the previous example, the therapist eventually shared with the patient
that she noticed that they sometimes seemed to be in a bind with each
other. She was aware that when she more actively responded to him, he
seemed to feel intruded upon and when she listened quietly he appeared
to feel hurt and rejected. She noted that she was confused and invited the
patient to share his thoughts and feelings about their apparent bind. After
they had come to some common understanding of this bind from the pa-
tient's point of view (e.g., he felt she didn't really care about him and was
afraid she would either humiliate or criticize him), she asked him if he had
ever felt the type of discomfort that he experienced with her in other im-
portant relationships.
It is critically important for both therapist and patient to come to under-
stand how the therapist has actually "missed the boat" with the patient
(e.g., what need really was not getting addressed by the therapist and in
what way was an empathic error made) as well as how the patient's reac-
tions to the therapist's interventions might be affected by his history (e.g.,
sensitivity to unattunement because of mother's dominating controlling in-
trusions; distrust of other's motives and genuineness due to father's manip-
ulativeness).
Finally, effective treatment in the first phase of working with narcissists
with obsessive features involves addressing the patient's use of projective
identification. Kernberg et al. (1989) outlined five steps in working with
projective identifications. These include (1) experiencing and tolerating the
confusion; (2) identifying the actors; (3) naming the actors; (4) attending to
the patient's reactions; and (5) interpreting primitive defenses. All defenses
are framed as a means of the patient's protecting him or herself from intol-
erable feelings or conflicts.
In the first step of this process, the therapist thus needs to tolerate and
contain the unwanted self- and/or object representations that the patient is
projecting into the therapist. In the earlier example, the patient induced
feelings of inadequacy, helplessness, and irritation by behaving as a reject-
ing but demanding patient needing to fend off a needed but potentially
dangerous therapist. The patient used obsessive mechanisms (e.g., critical
corrections or demands for precision) to keep the therapist at arm's length
while demanding the therapist's total involvement.
After containing the induced feelings, the therapist then needs to con-
sider how the interchanges between the therapist and patient may reflect
"scenes in a melodrama with different actors playing different roles" (Kern-
140 GLICKAUF-HUGHES AND WELLS

berg, et al., 1989, p. 102). This format helps therapists make sense out of
the confusion or uncomfortable feelings that they experience.
The third step entails finding an appropriate time to offer the hypothe-
sized roles to the patient for the patient's reaction. Kernberg et al. (1989)
recommend that such interpretations are "best offered when the client de-
ploys some spontaneous curiosity about the nature of the interaction and
has achieved some distance from its immediacy" (pp. 104-105).
The authors have found that it is often useful at this time to propose to
the patient that it might be important to sort out (1) what ways the therapist
is really "missing the boat" with the patient and (2) what might be difficult
roles or feelings that the patient has brought into the room from the past. If
the patient is receptive, therapists might acknowledge their regret that they
may not always understand the patient's internal experience as precisely as
they would like to as well as an awareness that it sometimes seems that the
patient has a difficult time feeling supported or understood by them when
the therapist is "in the ballpark but not on the exact base."
If the patient expresses further curiosity at this point about investigating
what their interactions mean, the therapist may tentatively ask the patient if
he or she is "aware of sometimes experiencing the two of them as stuck in
uncomfortable feeling states." If the patient affirms this observation, the
therapist can ask the patient how he or she would describe them. In the
case example cited throughout this article, the patient recognized that he
saw the therapist as an uncaring, remote, and egocentric parent who only
wanted him to aggrandize her. In turn, he saw himself as an unwanted,
needy, and angry child who wanted the therapist-mother to recognize
what he needed without his having to ask or negotiate. When these feeling
states remained unspoken, distance was put between the patient and thera-
pist (causing them both to feel at an impasse). Once these feeling states
were openly acknowledged, both patient and therapist were able to appre-
ciate how feeling stuck in those roles made it understandably difficult for
the patient to trust the ways in which the therapist was able to offer under-
standing and support.
Thus, if the therapist can help patients to talk about ego-dystonic feelings
without shaming them, patients may then be able to reintroject the feelings
as "less bad" than when they were projected (Stern, 1987). This process is
especially important for narcissistic patients with obsessive features be-
cause their projective identification in a search of the lost good object
(Stern, 1987) frequently recapitulates bad object experience. This recapitu-
lation is related to the fact that the effect of projective identification "is to
encourage the recipient of the projection to behave in the bad or rejecting
way" (p. 71). Consequently, it is very important to remain empathic with
the patient throughout this investigative process. In the process of empathic
 NARCISSISTIC CHARACTERS 141

investigation, the patient will hopefully feel supported enough to begin

sorting out the realities and distortions of how he views the therapist and
himself or herself.
The authors have observed that once narcissistic patients with obsessive
features have developed a more integrated and secure sense of self (with
more realistically based ego ideals), their power and control issues with
others frequently become less extreme as there is less need to defend
against potential engulfment and shame. As transmuting internalizations of
realistic therapist functions are integrated into the patient's central ego, the
unrealistic compensatory ego ideal and grandiose false self is modified.
With more structuralization, the patient is able to tolerate more cathartic
work in treatment and to experience others as separate and valued individ-
uals in their own right.

Phase Two: Treating Obsessive Issues

The second stage of treatment thus focuses on genetic connections (re-

claiming the past), obsessive dynamics (e.g., desire for self-expression and
spontaneity versus the need to be right), and integration and valuation of
the patient's affective experience and relationships into the patient's still
strong reliance on self-control. In order to experience a corrective emo-
tional relationship, the patient now needs the therapist to be more reason-
ably risk-taking and spontaneous, more self-disclosing and able to create
adventures with the patient. Some important issues that therapists are ad-
vised to address at this point in treatment include helping the patient (1)
become more aware of and able to express emotions; (2) learn the value of
having relationships over being right; (3) learn the value of mistakes; (4)
continue the process of developing a more humanized view of themselves;
(5) develop alternatives to black and white thinking; (6) learn to be more
appropriately playful; and (7) tolerate ambiguity (Wells, Glickauf-Hughes,
and Buzzell, 1990). In this phase of treatment the therapist must avoid
taking one side of the patient's ambivalence and instead hold up both sides
of the conflict for the patient to understand and review.
As previously described, narcissists with obsessive features tend to be
highly intellectual and make excessive use of denial, emotional isolation,
and compartmentalization. During the second stage of treatment, therapists
may begin to inquire about these patients' feelings. When the patient an-
swers by reporting a cognition, therapists may encourage the patient to
recognize and express a true feeling. To help the patient articulate his or
her feelings, the therapist may sometimes offer the patient a choice of emo-
tional labels (e.g., "Are you feeling sad, mad, glad, or scared?"). When
these patients seem uncomfortable expressing their feelings, therapists are
142 GLICKAUF-HUGHES AND WELLS

advised to empathize with the resistance (in order to understand the fear
behind the defense), before direct encouragement of affective expression.
Finally, during the second stage of treatment, it is helpful for therapists to
model appropriate spontaneous emotional expression (Nydes, 1963).
As previously stated, narcissistic patients with obsessive features tend to
have strong needs for power and control. There are often two layers of
motivation underlying these needs: (1) protecting the self against engulf-
ment by others (narcissistic motivation) and (2) acquiring guarantees over
the unknown (obsessive-compulsive motivation) (Salzman, 1980). During
the first phase of treatment the therapist is advised to primarily empathize
with the patients' narcissistic motivations behind their control needs. As
greater self-development ensues, therapists may then begin to help these
patients become more aware of the obsessive-compulsive motivation be-
hind their overcontrolled behavior and the great price that they pay for this
behavior (e.g., distant relationships, psycho-motor tension, lack of enjoy-
ment).
During the second phase of treatment, as these patients begin to further
work through their issues with power and control, therapists may begin to
process power struggles as they occur in the therapy relationship. Observ-
ing control issues in the here-and-now with the therapist helps them begin
to understand more about how power struggles occur for them in their
other relationships. Finally, it is useful to provide patients with a relation-
ship in which neither party must be dominant or submissive.

CONCLUSION

In sum, in this article a mixed personality disorder is described that com-

bines narcissistic and obsessive-compulsive features. These features in-
clude extreme perfectionism, narcissistic cathexis of the intellect, and ob-
sessive-compulsive defenses against underlying narcissistic issues.
In therapy, narcissistic characters with obsessive features frequently
struggle between a need for engagement with and fear of engulfment by
the therapist. Thus, while they may appear extroverted, they often remain
aloof, and while they have a strong need to be understood, they frequently
reject the therapist's empathic statements.
Therapy of the narcissistic character with obsessive features consists of
two stages. In the first phase of treatment, the therapist addresses the pa-
tient's narcissistic issues and provides an appropriate selfobject relation-
ship. In the second phase of treatment (after greater self-development is
established), the therapist begins to address the obsessive-compulsive is-
sues of affective expression and control by assuming a more engaged, ini-
tiating, and personal stance with the client.
 NARCISSISTIC CHARACTERS 143

REFERENCES

Applebaum, B. (1977). A contribution to the development of the behavioral-ana-

lytic model. Journal of Sex and Marital Therapy 3:128-138.
Cooper, A. (1988). The narcissistic-masochistic character. In R. A. Glick and D. I.
Meyers (eds.), Masochism: Current Psychoanalytic Perspectives. Hillsdale, NJ:
The Analytic Press.
Gear, M., M. Hill, and E. Liendo (1981). Working Through Narcissism: Treating Its
Sadomasochistic Structure. New York: Jason Aronson.
Glickauf-Hughes, C. (1994). Dynamics and treatment of the masochistic-narcissistic
couple Psychoanalysis and Psychotherapy, 11 (1):34-46.
Guntrip, H. (1969). Schizoid Phenomena, Object Relations and the Self. New York:
International Universities Press.
Homer, A. (1979). Object Relations and the Developing Ego in Therapy. New York:
Jason Aronson.
Homer, A. (1990). The Primacy of Structure. Northvale, NJ: Jason Aronson, Inc.
Johnson, S. M. (1987). Humanizing the Narcissistic Style. New York: Norton.
Kernberg, O. F., M. A. Seizer, H. W. Koenigsberg, A. C. Carr, and A. H. Applebaum
(1989). Psychodynamic Psychotherapy of Borderline Patients. New York: Basic
Books.
Kohut, H. (1977). The Restoration of the Self. New York: International Universities
Press.
Miller, A. (1981). The Drama of the Gifted Child. New York: Basic Books.
Nydes, J. (1963). The paranoid-masochistic character. Psychoanalytic Review 50:
55-91.
Ogden, T. H. (1991). Projective Identification and Psychotherapeutic Technique.
Northvale, N J: Jason Aronson, Inc.
Salzman, L. (1980). Treatment of the Obsessive Personality. New York: Jason Aron-
son.
Solomon, M. F. (1989). Narcissism and Intimacy: Love and Marriage an Age of
Confusion. New York: W. W. Norton & Co.
SorotzJn, B. (1985). The quest for perfection: avoiding guilt or avoiding shame.
Psychotherapy 22(3):564-571.
Stern, D. B. (1987). An interpersonal understanding of an object relations view.
Contemporary Psychotherapy Review 4(1 ):67-77.
Trijsburg, R. W., and H. J. Duivenvoorden (1987). Reactive-narcissistic character,
obsessional personality and obsessive compulsive behavior: a study of the va-
lidity of Sandier and Hazari's typology. Brit. J. Med. Psych. 60:271-278.
Wells, M., and C. Glickauf-Hughes (1993). A psychodynamic/object relations
model for training differential diagnosis. Psychotherapy Bulletin 28(3):41-48.
Wells, M., C. Glickauf-Hughes, and V. Buzzell (1990). Treating obsessive-compul-
sives in psychodynamic-interpersonal group therapy. Psychotherapy 27(3):366-
379.
Wile, D. B. (1984). Kohut, Kernberg, and accusatory interpretations. Psychotherapy
21(3):353-364.
Willi, J. (1982). Couples in Collusion. New York: Jason Aronson.