The Twin Image in the Treatment of the Narcissistic Patient

I was already seated on the bus when I saw Mrs. G boarding. I looked at her until she recognized me and then we said hello. With a little nervous laugh the patient sat near me. Then there was an interminable silence for about four blocks that seemed like hours. I looked toward the front of the bus, waiting to ring the bell for my bus stop. Mrs. G looked out the side window. As I left I said I would see her on Tuesday (her regular appointment day).

I felt extremely inadequate that, after two and a half years of treating this patient, I had not known how to put us both at ease and enable us to have a superficial conversation. I worried that the patient would think I was overeating. I was mildly uneasy that the patient had seen the exact neighborhood in which I lived. I was only glad that the patient had not seen the shopping bag from the unprestigious clothes store which had been obscured by the ice cream bag I was also carrying.

I felt sure that the patient would go home and gossip with her husband (whom I see with the patient in marital sessions) about how terrible I had looked. I also had a strong fear that the patient would no longer want me as her analyst now that she had seen me this way.

How much of this was objective and how much subjective narcissistic countertransference, and did one feed the other?

I had been feeling overweight, tired and unattractive and had finally found a dress that I could accept as looking decent on me, but not fantastic, and the store was certainly one I would never brag about. There was also some small guilt about the ice cream. I certainly had my share of self-attacking feelings.

But the patient in past sessions had told me about a previous therapist