ABSTRACT
The grandiose have hidden self-esteem deficits, and the overly entitled are harboring the seeds of deflated depression. As in literature, when prospective patients present one of these aspects, it is only a matter of time before the other side surfaces. The analyst must be a person who is unusually aware of his or her own self-esteem issues. In moments that have the potential to shame one or both participants in a treatment session, the analyst makes choices that reflect what most matters to them. The shame-prone person can be extremely challenging to treat. One way to describe the strain of treating narcissism is to refer back to one of the first to try: Echo, in the myth of Narcissus, in Ovid's Metamorphosis. The narcissist's analyst must capitalize on the pressure of time, but that can only happen if life has purpose.
