Outtakes, Part 7: Narcissism, Weed, Booze and Goiters

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I believe this was written in 2005. It originally began as a chapter about working with Narcissist Personality Disorder and how challenging the work can be. It was also a caveat to therapists about taking unadulterated pleasure in the outlandishness of a client’s narrative, as this can damage the therapeutic work. Neither of those goals came to fruition, so instead you get two disjointed and somewhat ridiculous tales about a guy who enjoys acting like a raging asshole. With such a ringing endorsement you should obviously be biting your lip with excitement at what’s about to come. However, I did promise to post the bad with the good, so have at it and try to contain your disappointment.

Recently, one of my extremely entertaining clients, whom I’ll call Josh, began our session with the following:

“You know those entrepreneurial seminars that I like, the ones that help people with tons of money like me make more money?”

Josh was the recipient of a trust fund and invested most of it to become a multi-millionaire by the time he was 24. Now he’s 27, and is “totally living high on the hog with his sometimes bitch wife.” He really has no idea why standard rules of society should apply to him. Some would call him a narcissist, but his brutal honesty of his shortcomings (“I’m an asshole, plain and simple”) and lack of real antagonistic edge make this diagnosis slightly off.

“I’ve never been to one of those, but I’ve heard of them,” I said.

“Well, my sometimes bitch wife wouldn’t let me go to one this month. We had to go do a ‘Spit Shine your Marriage’ course. It was all fucking day. So the dude running it is talking about negative energy in the home, and he had us break up into couples, and told us to think of the most negative thing we could about our partner. Then we were supposed to try to send that negative thing or thought or whatever to the partner, just using energy.”

“That sounds pretty interesting. How did it go?”

“That’s where the problem comes in. I started giggling, because my wife has a goiter on the lower part of her neck that is, no lie, the size of one of those mini footballs that you’d throw around the school yard. So I missed the part in the instructions where he said ‘just using energy,’ and when he said ‘Go!’ I ripped into her about the goiter. I told her it was the ugliest woman I had ever seen, and that I’d bet the goiter was actually cancerous. I squeezed in there that it looked like she had two heads before she ran off in tears. I didn’t even know what I did wrong until the instructor came over and asked me to relay the story to him. She hasn’t spoken to me all week.”

Stories like these from Josh aren’t really anything new, he’s essentially a social faux pas machine. The issue is getting him to see how his behavior impacts others. It isn’t nearly as easy it it might seem.

“Jesus Josh, we go through stuff like this all the time, it seems almost weekly at this point. You are always making fun of other people and laughing at them, to their face no less. I don’t get what the thrill is for you.”

“No, I swear, I just didn’t hear the last part of the instructions.”

“But isn’t that because you were already using your wife’s deformity to have a laugh? You were already thinking of cruel things to say to her before you even had a chance to hear what you were supposed to do with your thoughts.”

“Yeah, so?”

“You see anything wrong with that?”

“Not exactly. I didn’t like seeing her cry, but she should have been to a dermatologist years ago for that shit!”

“You don’t see anything wrong with making fun of a woman’s…handicap? Right to her face?

“Not really. Remember our 2nd session, when I told you that you had a big nose and weird hair? That was classic!”

I did, in fact, remember that session.

“Yes, I remember. I also remember analyzing what your motive was for saying those things, and I also remember kicking you out of session because you wouldn’t let up.”

“Yeah, that was great! You were really an asshole that day.”


Josh came in holding an open bottle of Heineken in one hand, and a 3-pack of the same beer in the other. Apparently, he had already consumed two prior to pulling out the 3rd. He sat down, ripped the cap off with his teeth, and took a long, deep swig. “Ahhhhh,” he said, smiled, and waited for me to speak. After about 10 seconds of me trying to figure out what was going on, he spoke:

Josh: Beer?

Dr. Dobrenski: This is a joke, right? I’m on America’s Funniest Home Videos or something?

Josh: No, why?

Dr. Dobrenski: Well, you brought beer into your therapy session, and it appears that you’re already on your 3rd before we’ve even started talking.

Josh: Yeah, so? It’s a celebration.

Dr. Dobrenski: What are you celebrating?

Josh: I counted the number of chicks I’ve deflowered, and it was 58!

Dr. Dobrenski: You’ve taken the virginity of 58 women?

Josh: Virginity? What are you talking about? I’ve just slept with 58 women.

Dr. Dobrenski: “Deflowering” means taking away virginity, Josh.

Josh: Really?

Dr. Dobrenski: Have you been using that term erroneously for a while now?

Josh: Oh yeah. I told my wife that I deflowered her best friend 2 weeks before our wedding. Are you saying that my wife thinks I took away her best friend’s virginity?

Dr. Dobrenski: I have no idea what your wife thinks, but it wouldn’t surprise me if she thought that.

Josh: Dude, this information is worth the price of an entire session!

Dr. Dobrenski: Yes, I’m sure it…

I noticed a very subtle glaze over his eyes.

Dr. Dobrenski: Josh, are you stoned as well?

Josh: Why?

Dr. Dobrenski: Please answer me. Are you stoned?

Josh: Yes, so?

Dr. Dobrenski: Josh, what the fuck? How can you come in here, on your way to being drunk, and stoned, to discuss important matters? Don’t you respect our work together?

Josh: Yeah, I just wanted to respect it and be high and drunk.

Dr. Dobrenski: Well, you know what this means.

Josh: I leave and you still make me pay?

Dr. Dobrenski: Close. Yes, you are still paying, but I can’t see how you can engage in a meaningful and memorable conversation in the state you’re in. Did you drive here?

Josh: No, I took a cab.

Dr. Dobrenski: Okay. Since you didn’t drive, you are going to leave, because you’re not going to sober up within the next 38 minutes where we could actually do some work together.

Josh: What does it matter if I drove?

Dr. Dobrenski: If you had driven, I’d have to stick you in the other office for a couple of hours, because if you drive, you’re a danger to yourself and others, which means I have to call the cops. I’m going to put you in a cab again and send you home.

Josh: Will you pay for the cab?

Dr. Dobrenski: No I will not pay for the cab! And, quite frankly, I’m angry with you.

Josh: Ah, you’ll get over it.

Unfortunately, that was true.

Dr. Dobrenski: That’s true, but it doesn’t mean that your actions don’t suck. Now let’s get to the elevator, because you’re stinking up my office, and the next patient is going to think I’m some pothead who tokes up between sessions.

Josh: Maybe you should. It’s fun.

Dr. Dobrenski: Shut up, Josh.

That was probably the only time I ever told Josh to shut up, but I’m sure I thought it hundreds of times.

Fortunately, that was the last time Josh came to session either drunk or stoned. And as a neophyte therapist, what did I take from this enlightening experience? Absolutely nothing.

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11 Responses to “Outtakes, Part 7: Narcissism, Weed, Booze and Goiters”

  1. Chris says:

    I’m pretty sure this is the first time someone has combined narcissism, alcohol, marijuana and goiters into one narrative. As Buddhists would say, “Right speech”. This guy does not appear to have much. Interesting subject.

  2. Annie says:

    Love is really blind and delusional; how can she marry him in the first place?

  3. Cathryn says:

    Damn how is that chick still with that dude? I have never not once thought of coming to therapy intoxicated in any way. He would know even if I didn’t bring it in and paraded around. It would be a total sign of disrespect!
    Why does this kid even go to therapy? Just to talk? It seems like he doesn’t even want to figure out his own problems…

  4. Lonnie says:

    To all those wondering why she’s still with him… well he’s a multi-millionaire. Some people are ready to endure anything for cash. Don’t tell me this is the first trophy wife you ever hear about.

  5. Nadia says:

    Jeez. What would drive someone like him to seek treatment, and not only to start, but to stick with it? Was it required by the courts, did it promote some sort of self image?

  6. I’m curious to see what drove him to therapy. Was it something his wife wanted him to do? Although from the story it appears he could care very little about what she thinks.

  7. Tippy says:

    I can get away with this in therapy??

    I still call my doctor sir..

    Great blog.

  8. Joe says:

    This guy is great. A real asshole’s asshole. Reminds me of me, but only when I genuinely don’t like people. Though I did light a cigarette at a cancer walk once.

  9. Raul says:

    He’s paying you to hang out with him. What difference does it make if he shows up a little drunk and stoned? Three beers and a little reef and I’m perfectly capable of carrying on a conversation. I thought you were philalawyer’s buddy?!?

  10. Geoff says:

    It seems like this guy is testing you out to see if he can trust you. He wants help but he doesnt want a douche bag behind a screen. He wants someone he can relate to – one of the boys that can help him out.

    He comes in ripped and tipsy cause he feels like this is how he can best relate to people. It makes him more comfortable, removes his automatic defenses (yes for a lot of men, defenses still get thrown up when feelings are invovled). If people understand him and think like him, THEN they can help him.

    It’s not that he doesnt want help. He’s just not going to take any advice from someone who doesnt live up to HIS standards.

  11. Alp says:

    A feeling of significance is a human need everyone has and everyone meets it to a lesser degree in some way or another. Narcissism is the most misused and misunderstood phrase in psychology.