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Patients who have experienced severe disturbance in their early maternal care and who were disallowed narcissistic experience prove very difficult to treat in a therapeutic context. The nature of the problem, clinical implications and traditional treatment methods are explored. This group of patients, although very often seen as ‘worthwhile’, do not seem to get better in any fundamental way and are often rejected as untreatable. Whilst some therapists have explored the area of encouraging a patient's creativity, this has typically been done to improve morale or in an attempt to ‘make whole’ rather schizoid personalities. It is argued here that the patient needs to be helped to become the good-enough and non-contemptuous parent to himself, and that the creative sphere is the area for this. The patient's artistic efforts can be mothered, and are immune to the damaging influence to which real children would be subject. Narcissistically disturbed patients often have clinically envious personalities. Encouraging their creativity also provides a valuable psychological space in which they are able to show gratitude, and have this received in a safe way.
Caution is expressed about need to ‘hold’ this process whilst working with the patient in this way and about some of the dangers inherent in the creative process, using the work of a gifted poet as an illustration.