Countertransference in a Patient with Narcissistic Personality and Secondary Gain

Aim: This paper discusses countertransference in the context of its broader definition. It is about the overall reactions of psychotherapists when working with patients with narcissistic personality structures who expects secondary gain. Case report: The emergence of the negative side of the countertransference reaction and the feeling of discomfort in the psychotherapist was observed during the treatment of a narcissistic patient who expected to be on sick leave primarily because of the illness for which she was being treated. Through clinical work and supervision, the authors have learned to observe every manifestation in the patient as a symptom. This meant accepting the patient’s expectation of secondary gain as one of the forms of acting out. The authors own countertransference helped them to better understand the patient’s personality. Conclusion: A negative countertransference reaction, aggression towards the patient and discomfort in treating such patients is an expected reaction in younger and less experienced psychotherapist’s. The occurrence of the described countertransference also indicates that these are more regressive personalities, using primitive defence mechanisms and with more severe ego damage, whose treatment can benefit significantly from the carefully guided supervision of an experienced and empathic supervisor, especially in nov- ice psychotherapist’s or those who have not yet resolved their own narcissistic longings.