How to Help a Thin-Skinned Person: Commentary on Paper by Stephen Seligman

Stephen Seligman's treatment of Harriet illustrates the typical challenges and basic technical principles in working with narcissistically sensitive people. Often, with such patients there are struggles around the frame, especially issues of payment and cancellation policies. Sometimes the therapist must be flexible in negotiations with the patient. In the early phases of therapy interpretations of defense, especially the interpretation of projected aggression, are not helpful. Interventions that recognize the patient's response to something the therapist has done or failed to do are more effective and set the stage for later work focused on the patient's recognition of her self-states. A willingness to respect Harriet's identification with Joan of Arc, and to work in displacement, rather than pathologizing her preoccupation was also essential. Finally, Seligman utilized the concept of mentalization in actively discussing with Harriet the mental processes of other people in her life. All these techniques enabled Harriet to move from being dominated by a sense of grievance to becoming capable of experiencing grief.