Feelings are extremely uncomfortable things for these patients, and their defenses are unbelievably important to them. When uncovered, they seem to produce the painful affects Otto described with his parents. I find it remarkable that Dr. Nathanson was able to elicit the material from Otto that he did. In Control-Mastery terms he must have passed numerous tests. I probably would not have tried to bring Otto s woman friend into therapy with him.
Narcissists seem to want to guard any information about themselves.
I have found that refusing a request by a patient to bring someone into therapy, passes a test. I usually decline with the statement that I think they are capable of telling me the opinion of another in their life. And it is worth noting that Otto did not comply with Dr. Nathanson s request. With regard to the outcome, my suspicion is that Otto was involved in something that he didn t want Dr. Nathanson to find out about. As a hypothesis, it might be that Otto was involved in drug smuggling.