Clinical-Psychodynamic
What narcissism does in relationships
Narcissism is, at its core, a disorder of relationship: the other no longer appears as a subject with an inner world, but as a means to preserve one’s own balance. Reciprocity disappears; what remains is a dance of affirmation and control, attraction and withdrawal.
In this clinical-psychodynamic essay, narcissism is not approached as pride, but as a survival form of pain. By bringing together insights from psychoanalysis, attachment theory and modern psychotherapy, a deeper understanding unfolds of what narcissism truly does within relationships and how love, as both a moral and existential principle, can open the way toward the restoration of inner life.
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The inner mechanism
Behind the confident surface of narcissism, true certainty is rarely found. What appears outwardly as strength, independence or charisma is often a carefully constructed defense against an underlying sense of shame and emptiness. Narcissism, in the words of Heinz Kohut, is not an excess of self-love but a disturbance in the development of the self.
When empathic mirroring is absent in early childhood — the experience of being truly seen and affirmed from within — the core of the self remains fragile. To avoid feeling that loss, the child constructs a compensatory self-image: an ideal of grandeur or invulnerability that shields the vulnerable core. Otto Kernberg described this as the formation of a grandiose self-object — an internal structure in which positive and negative self- and object representations remain split. Love and hate, idealization and rejection, are not integrated but kept apart.
Thus arises the fundamental splitting that defines narcissistic functioning: the ability to idealize the other completely as long as they provide nourishment and to devalue them just as radically the moment they frustrate. The world is experienced in extremes, without the psychic space in between where ambiguity and difference can be tolerated.
The grandeur or victimhood that narcissistic individuals display are, in that sense, not signs of arrogance, but of armor. They protect against an archaic fear of disappearing. Where the healthy self can contain tension, shame and dependency, the narcissistic structure projects every unwelcome feeling outward — a mechanism Freud called projective identification, later elaborated by Melanie Klein. The other becomes the carrier of what cannot be endured: guilt, doubt, shame, dependency and so on.
In this way, the relationship itself becomes a form of self-regulation. The other serves as an extension of inner equilibrium — a living mirror-object that must constantly affirm, soothe or reflect to keep the fragile self intact. Studies by Elsa Ronningstam and Aaron Pincus have shown that this mode of affect regulation through the other lies at the heart of the modern understanding of narcissistic personality dynamics: it's not about superiority, but about vulnerability transformed into control.
Narcissism can thus be understood as an unconscious attempt at self-preservation; a strategy to avoid feeling what was once unbearable. Yet the cost is high: because the self remains dependent on external regulation, it can never find rest within itself. The inner life is reflected rather than lived; emotional depth is replaced by control.
The world splits into light and dark: as long as you provide, you are idealized; once you set a limit, you are devalued. Closeness becomes instrumental; a means to maintain balance. Dependency is denied precisely because it is so great.
From a clinical perspective, this is not malice, but tragedy. What appears as coldness is often fear; what sounds like superiority is protection against a deeper sense of deficiency. To understand without excusing, to see without idealizing — that's where the possibility of true encounter begins, both in therapy and in life itself.
The relational cycle
Relationships marked by narcissistic dynamics rarely begin in neutrality. There is often a magnetic pull that overwhelms both partners, a sense of destiny, as if you've finally found someone who truly sees you. In terms of attachment, this reflects the activation of an old longing: the hope for a safe mirror that was once missing. The first phase of idealization offers precisely that; a temporary restoration of the self through the gaze of the other.
According to John Bowlby and Mary Ainsworth, attachment is not a choice but a biologically anchored system that becomes activated by proximity and threat. In adult relationships, this system replays itself: those who experienced inconsistent caregiving in childhood often develop an anxious-ambivalent or avoidant attachment style. In contact with a narcissistic partner, these patterns are triggered anew. The person with narcissism alternates between drawing the other close and withdrawing again; the partner, in turn, feels the old hunger for recognition and does everything to restore closeness.
Otto Kernberg described this compulsion as repetition compulsion: the unconscious drive to recreate early traumatic situations in the hope of achieving a different outcome. The narcissistic relationship thus becomes a re-enactment of the original attachment struggle; an attempt to gain control over what once felt powerless.
The cycle unfolds in three recurring phases. First comes fusion: the other seems to complete the self. Then comes rupture: the confrontation with difference or boundary triggers the pain of early rejection. The reaction is coldness, criticism, or withdrawal — not out of cruelty, but out of panic. Finally comes renewed pursuit: the longing for regulation pulls the narcissistic individual back toward the source of affirmation. In this way, a push–pull dance arises that undermines every sense of stability.
Learning theory refers to this as intermittent reinforcement: the unpredictable alternation between warmth and withdrawal that paradoxically strengthens attachment. The brain begins to associate tension with love and uncertainty with hope. This makes the bond not only emotional, but neurobiologically addictive. Dopamine surges during the reward phase are followed by cortisol spikes during rejection — a chemical cycle that sustains emotional dependence.
Patrick Carnes and Judith Herman have described this process as trauma bonding: the paradoxical attachment to someone who provides both comfort and pain. It is a survival strategy in which the brain can no longer clearly distinguish between love and threat. The relationship ceases to be a free choice and becomes a regulation mechanism — the other is both the wound and the medicine.
From a clinical perspective, this pattern calls not for judgment, but for insight. The relational cycle is not a game, but a repetition of unconscious suffering. Only when one dares to recognize the underlying attachment pain — the primal fear of being abandoned or engulfed — can the repetition begin to loosen its hold.
That's where healing begins: not through distance or analysis, but through awareness. In the recognition that what feels like love may at times be the echo of unhealed loss. And that true intimacy becomes possible only when we learn to distinguish between connection and repetition.
The impact on the partner
Those who live for an extended time within a narcissistic relationship slowly lose their orientation. Reality is not taken away all at once, but subtly shifted. What once felt self-evident — your feelings, intuition, boundaries — becomes less reliable than the partner’s moods.
In the literature, this process is known as gaslighting: the systematic undermining of your sense of reality. It may appear through small denials, corrections or minimizations — “I never said that,” “You’re exaggerating,” “You’re too sensitive” — through which doubt infiltrates the inner compass. In psychodynamic terms, this is a form of projective identification: the partner begins to carry feelings that are not their own and starts to behave in ways that confirm the projection of the narcissistic person.
The constant emotional oscillation — warmth, rejection, renewed closeness — creates a form of co-regulation that drains rather than nourishes. In healthy relationships, partners attune to each other’s emotional rhythm, creating a sense of safety. In a narcissistic dynamic, that attunement becomes one-sided: the partner regulates, while the narcissistic person withdraws. The balance between giving and receiving collapses.
Allan Schore and Daniel Siegel, in their neurobiological research, describe how the autonomic nervous system continually adapts to the presence of the other. When that presence becomes unpredictable, the system enters chronic hypervigilance: the body remains alert, trying to anticipate the next mood shift. This not only causes emotional exhaustion, but also physical symptoms — insomnia, muscle tension, concentration problems, lowered immunity and forgetfulness.
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The alternation between idealization and rejection creates a pattern of intermittent reinforcement that, paradoxically, strengthens attachment. As with addiction, it's not the reward itself, but its unpredictability that activates the brain. The partner becomes emotionally conditioned: each rare moment of warmth feels like proof that the love is “still alive,” and that hope makes it hard to let go.
This cycle forms what Patrick Carnes calls trauma bonding — a paradoxical attachment in which the perpetrator is also the source of comfort. Pain and reward become so closely intertwined that distinction fades. The partner tries to restore safety by adapting even more: more understanding, more empathy, more care. It looks like love, but in essence it is an attempt to neutralize danger.
In practice, life begins to shrink around the other. Friends drift away, hobbies lose meaning and the inner world becomes overshadowed by the constant effort to repair the relationship. The gaze turns outward — toward the moods, reactions and needs of the person one cannot bear to lose.
The paradox is that this self-forgetfulness initially feels like devotion, but in truth it dissolves the self. As Judith Herman writes in Trauma and Recovery:
“The loss of connection with one’s own inner world is the core of traumatic submission.”
Healing begins when the partner reclaims that inner space — when you relearn to feel what you feel and to know what you know. Only then can you discern the difference between empathy and self-erasure, between love and dependency.
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The mutual distortion
In every narcissistic relationship, a closed system unconsciously forms in which both partners affirm each other’s pain. What appears on the surface as an unequal dynamic — one who dominates and one who adapts — reveals itself, upon closer look, as a mutual regulation of wounds.
The narcissistic person uses the other as an extension of their self-worth; the partner uses the relationship as a source of existential security. Both move within patterns that once served survival. In Jeffrey Young’s terms from schema focused therapy, their schemas become entangled: one activates the Inferiority Schema (I’m not good enough), while the other activates the Dependency Schema (I must not show dependency).
Within such relationships, alternating modes arise; emotional states that take over the self. The narcissistic person shifts between the Impulsive Child, the Detached Self-susser and the Attention and recognition seeker; while the partner moves between the Vulnerable Child and the Willess Compliant. These modes sustain one another: each confirms precisely what the other unconsciously fears.
The process resembles what Otto Kernberg called complementary transference: the unconscious tendency of two people to reenact each other’s internal object relations. What once occurred between parent and child is repeated between lovers. The narcissistic partner relives the power and dependency of early relationships, while the other tries to repair what once felt unsafe — often by appeasing or rescuing.
Here arises the mutual distortion: one becomes increasingly dominant, the other increasingly adaptive. The dynamic is not rooted in malice, but in fear. The narcissistic person fears the loss of control; the partner fears the loss of connection. One cannot bear the other’s distance, the other cannot bear that closeness hurts.
Psychodynamically, this constitutes a closed regulatory system: both partners serve as containers for each other’s unprocessed affects. Nancy McWilliams describes this as projective circulation — a continuous exchange of unintegrated parts of the self, giving the relationship its paradoxical sense of necessity.
In everyday life, this translates into endless patterns of appeasing, explaining, repairing and hoping. The partner who makes herself smaller often believes this is an act of love, but in reality, it's self-protection: If I adapt, the other will calm down and the bond will survive. Meanwhile, the narcissistic person experiences this adaptation as natural, further losing touch with reciprocal reality.
The relationship loses its dialogical nature; what remains is a dual monologue. One speaks to be recognized; the other listens to survive. The authenticity of both souls becomes distorted and precisely because of that, narcissism reveals itself not only as a personality structure but as a relational field — a self-sustaining system.
From a schema-therapeutic perspective, healing begins with breaking this complementarity: recognizing the modes that evoke one another. Once the partner stops responding from the Vulnerable Child and begins to act from the Healthy Adult, the narcissistic behavior loses its grip. The key is not confrontation or persuasion, but awareness — seeing what happens without being drawn back into it.
At its core, this is a process of re-membering: returning to the inner space that has not been deformed by fear. There — where knowing and feeling once again coincide — the cycle can finally come to rest.
Where healing begins
Healing begins where judgment gives way to understanding. Narcissism may manifest as moral failure, yet it is not a moral failure — it is a survival strategy, formed in a time when vulnerability was dangerous. The pattern once served to avoid pain, not to cause harm. That realization opens the door to compassion, without dissolving responsibility.
For the narcissistic individual, healing begins in the encounter with someone who refuses to participate in the old cycle of idealization and rejection. In the therapeutic space, repetition is not ignored but carefully worked through. Here, the therapist provides what Donald Winnicott called the corrective emotional environment: a space in which the mask can gradually loosen; not because it's torn away, but because it's no longer needed.
The therapeutic stance requires holding and containment — terms from object relations theory referring to the capacity to bear affect without retaliating or collapsing. As Bion wrote: “The task of the therapist is to think what the patient cannot yet think.” By holding the feelings that the client cannot yet contain, the therapist helps make the inner world habitable again.
In contemporary language, this process is known as mentalization: the ability to understand your own and others’ behavior in terms of underlying feelings, thoughts and intentions. For people with narcissistic vulnerability, this capacity is often selectively developed: they can read others as long as they feel affirmed, but lose that ability when touched in places of shame or dependency. The task of therapy, then, is not correction but restoration — helping the person regain their mentalizing capacity under stress.
Safety is the essential prerequisite. The therapist must remain steady where unpredictability once ruled, patient where rejection once followed. Gradually, a new experience of attachment can emerge — an earned secure base — in which shame, dependency and vulnerability become bearable again.
For the partner, by contrast, healing begins with remembrance of the self: the recovery of inner space. In trauma-therapeutic terms, this means relearning to feel without immediately acting, relearning to know without instantly doubting. As Judith Herman outlines, recovery unfolds in three phases — safety, remembrance and reconnection. First, one must find physical and emotional stability; only then can the story be told and integrated.
In that phase, grief becomes inevitable. The partner mourns not only the loss of the other, but the loss of the idealized image that love once was. The illusion of being able to save or change the other gives way to a slower, deeper realization: that healing is possible only in relation to reality, not illusion.
From an attachment perspective, this marks the transition from insecure to autonomous attachment — not through distance, but through the capacity to tolerate closeness without losing yourself.
In both trajectories — that of the narcissistic individual and that of the partner — inner life again becomes the source of truth. When you learns to trust your own experience, the need for constant mirroring or control dissolves. Therapy is not re-education, but re-encounter: with the part of yourself that once had to become invisible in order to survive. In that encounter, the human being can, slowly but genuinely, become a subject again in their own story.
Love as a clinical principle
In the therapeutic setting, love does not mean sentimentality, but presence. It's the willingness to let the other truly exist — with both light and shadow — without trying to correct or control. While psychology often speaks of methods and techniques, clinical practice reminds us that the essence of healing is relational.
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Carl Rogers called this unconditional positive regard: the fundamental acceptance of the client as a human being, regardless of behavior or mask. That acceptance is not passive approval, but an active trust in the innate capacity for growth that exists in every person. Rogers saw empathy, genuineness and unconditional acceptance as the three pillars of therapeutic change. In their interplay they form what he called the healing relationship; not as technique, but as moral stance.
From an existential perspective, this resonates with Martin Buber’s vision of the I–Thou: the understanding that the other is not an object of knowledge, but a living presence who co-shapes our being. In therapy, this means that the client is not merely analyzed, but encountered. The therapeutic relationship becomes a microcosm of human existence itself: a space where truth and empathy do not exclude one another, but deepen each other.
Erich Fromm would say that love, in the therapeutic context, is an act of being, rather than possession. It's the choice to see without grasping, to understand without controlling. For him, love was a moral discipline: an attitude of attention, responsibility, respect and knowledge. When this attitude lives in the therapist, an atmosphere arises in which the client can slowly begin to feel themselves again.
In contemporary psychology, Paul Gilbert has elaborated this stance in Compassion-Focused Therapy. Compassion is defined there as: “the courage to meet suffering and the willingness to alleviate it.”
It is not soft pity, but the deliberate activation of the care system in the brain, capable of calming fear and shame. Neuroscientific research shows that compassion — also in the therapist — activates the parasympathetic nervous system and communicates safety through tone, body language and gaze.
In this sense, love is a clinical principle in the literal sense: it is the foundational rule upon which healing rests. Love is the counterforce to manipulation because it's not aimed at changing the other, but at affirming their right to exist. It works not through interpretation, but through resonance.
Empathy, viewed in this light, is not indulgence, but moral clarity: I see you and I remain faithful to reality. Where truth can be held, the mask loses its purpose. In the safe mirror of a loving gaze, shame is not denied, but transformed — from a destructive judgment into shared humanity.
There — where the therapist does not rescue but remains present — something arises that words can hardly capture: the moment in which a person feels, perhaps for the first time, that they exist without conditions. That moment is arguably the purest form of love possible within the clinical setting and the most transformative.
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The ethics of maturity
Ultimately, the clinical always culminates in ethics. Therapy that doesn't lead to moral growth — to responsibility, discernment and integrity — remains trapped in self-regulation. True healing requires a shift from surviving to being able to respond: the transition from reaction to response, from impulse to awareness.
Donald Winnicott called this the birth of the true self: the ability to be spontaneous without fear of losing love. Where the false self lives through adaptation and obedience to external demands, the true self arises from an authentic sense of existence. In narcissistic dynamics, that true self is often deeply buried — in both the narcissistic person and the partner. The mask protects against rejection, yet also blocks genuine intimacy.
The ethics of maturity means learning to be close while sustaining difference. The narcissistic structure knows only fusion or distance; mature love tolerates ambiguity. It allows the other to exist without losing yourself. This requires courage, for it touches what was once too painful to feel — dependency, vulnerability, desire and need. Yet it's precisely this renewed access to need that makes love possible as a reciprocal movement rather than a strategy.
In moral terms, this aligns with Lawrence Kohlberg’s notion of post-conventional reasoning: the stage in which moral choices are no longer guided by punishment, reward or approval, but by an inner conscience. Carol Gilligan expanded this view with her ethics of care: moral maturity doesn't mean isolated autonomy, but responsibility within relationship. She speaks of relational autonomy — the freedom that arises not in opposition to connection, but through it.
Psychologically, this marks the transition from dependency to interdependency. The human being acknowledges mutual influence yet chooses consciously how to relate. Mature love is neither boundaryless nor self-sacrificing, but reciprocal and transparent. It can say no without guilt and being called a egotist; yes without fear or self-abandonment.
From a clinical perspective, this requires a moral transformation: from control to responsiveness, from projection to dialogue. The mature person no longer uses the other as a mirror, but meets them as a fellow human being. They do not seek confirmation of worth, but affirmation of being.
In therapeutic practice, healing is complete only when a person can love again without losing themselves — when the inner world is strong enough to tolerate difference. Winnicott might say: “It’s joy to be hidden and disaster not to be found.” Maturity resides precisely in that tension: the freedom to be without masks and the willingness to be found.
Thus the human being returns to the foundation of ethics: not obedience to rules, but fidelity to reality. Love then becomes the most mature form of morality, because it demands truth, responsibility and presence all at once.
Summary
In its deepest meaning, narcissism is not a sin of self-love but an expression of self-loss. It's the attempt to avoid feeling what was once too painful: shame, dependency, rejection, vulnerability. What appears in practice as power or coldness is, at its core, fear — the fear of disappearing without a mirror.
In that sense, narcissism is not merely an individual pattern but a symptom of our time. It mirrors the collective disorientation of a culture that confuses connectedness with visibility and self-worth with performance. What was once relational — to be seen, to be loved, to be near — has been replaced by the language of measurement, scoring and control. Thus arises an empty middle: a world in which we are constantly oriented toward one another, yet rarely truly meet.
The clinical-psychodynamic perspective helps us approach this emptiness not with condemnation, but with understanding. It reveals that the root of narcissism lies in the failure of relationship — in the fracture between I and Thou, between inside and outside. Healing can therefore only occur along that same path: by making encounter possible again.
In the therapy room, this takes shape as a rediscovery of humanity. There, where the façade is not pierced but held, where shame is not unmasked but contained, a person can slowly let go of their defensive structure. The mask loses its purpose once it's allowed to be seen without judgment.
For the partner and, more broadly, for anyone touched by this dynamic, healing lies in reclaiming inner space. This means not only distance, but discernment: knowing what's mine and what belongs to the other. The movement of healing is one of re-membering — returning to the inner compass that was once silenced.
In this way, love becomes visible again as a clinical, moral and existential principle. Love is the force that brings the I and the Thou back into dialogue; it restores the continuity of inner life where narcissism has broken it. Love presupposes boundaries, for only where difference is recognized can connection be genuine.
From this flows the ethics of maturity: not the abolition of dependency but the capacity to bear it. Mature love is closeness with distinction — the freedom to remain near the other without losing yourself.
In the empty middle, where old certainties have dissolved, love once again becomes an orientation principle: not an emotion, but a form of truth. It restores resonance between human and world, between knowing and feeling, between I and we.
Those who love in this sense leave the hall of mirrors. They no longer live to be seen, but to see. And in that quiet shift of perspective, the human being finds their soul again.
