Our shaken collective self-esteem

How can psychotherapists best work with patients suffering in the aftermath of the recent devastating economic meltdown and deal with our shaken collective and individual self-esteem? Working with patients who have lost their jobs or their nest eggs, or whose retirement is imperiled, involves addressing the dynamics of mourning. Patients may be experiencing disbelief, shock, anger, and denial of the immensity of the loss, as well as shame and humiliation at their vulnerability. At the same time, because we personally may be confronting many of the same fears and uncertainties, it is important that we as therapists avoid overly identifying with our patients and failing to treat them as individuals in their own right. The author discusses strategies for addressing patients' defenses, a tendency to catastrophize and give way to panic, a sense of narcissistic injury, and anger directed at the people they blame for the economic collapse as well as at themselves for having gotten in over their heads. Using Kohut's concepts of a developmental line of narcissism, therapy may reinforce mature self-esteem while helping patients work through their emotions and come to terms with their new realities. Optimally, they can find new resources within themselves and grow in their ability to value relationships with others.