A client with narcissistic personality disorder feels that her advice is extraordinarily helpful to others in making major life decisions. She tells her therapist that she was very hurt recently when her son's fiancé said that the client should mind her own business and not try to guide her about her career and how their getting married could hurt her professional future. To be most helpful to the client, the therapist must achieve a balance between:

• A. Empathic mirroring and helping the client see the fiancée's point of view
• B. Empathy and praise
• C. Challenge and support
• D. Detachment and boundaries

Answer: (A)

The client with narcissistic traits tends to rely on others’ admiration and may become defensive when her influence is questioned. The most helpful stance for the therapist is to combine empathic mirroring—reflecting and validating the client’s feelings to reduce defensiveness—with inviting the client to consider the fiancé’s point of view. This approach preserves the therapeutic alliance by showing understanding while also broadening the client’s perspective enough to recognize how her advice could be experienced as intrusive and how that may affect relationships and future opportunities.

Praise would risk reinforcing narcissistic tendencies, detachment would reduce engagement and progress, and simply challenging without any empathic connection can trigger defensiveness. By pairing empathy with perspective-taking, the therapist supports both emotional regulation and reality testing needed for growth.