ABSTRACT
This chapter explores some of the major dilemmas confronting the narcissistically damaged patient in therapy: Fear of and longing for dependency, Problems with gender identity and sexuality, Impairment of the capacity for mourning and empathy and Sado-masochistic object relating. Alan, an advertising copy-writer in his early thirties, reluctantly agreed to consider psychotherapy at the suggestion of his mother. As the therapy evolved it became clear that, although consciously Alan feared being trapped into demanding situations by an Echo-like female, unconsciously the needy, infantile, part of his psyche feared the absence of the maternal through her narcissistic self-absorption. Bridget, a young woman in her thirties, came to her first assessment session powerfully dressed in a crisp blue business suit appearing cool, self-possessed and very poised. At school and university, Bridget's intelligence and laconic humour won her academic and social success but a repetitive pattern of failure in her love relationships began to emerge.
