Narcissistic pathology and its presentation has been a part of our cultural heritage since times immemorial. Aside from the myth of Narcissus, the narcissistic bipolar self and its constant pain which arises from disharmony of mental representations of actual and the ideal self can be found in folk tales, written literature, films and even definitions of the present society. Shiva, Dr. Jekyll &Mr. Hide, Kent Clark& Superman are just a few examples of the above mentioned dichotomy of impotence and power, of fragile and grandiose self. Sometimes the sense of entitlement and unrealistic goals results in failure and uncontrollable aggresion, which often includes rebellious and manipulative suicidal behaviour.

Exploring the types of defence mechanisms used by therapists dealing with narcissistic patients and their agressive behaviour.

Presenting the diversity of possible clinicians' emotional responses and in parallel raising awareness of deficient literature and lack of quantitative studies on that matter

Case presentation of a 40-year-old narcissistic patient with manipulative behaviour and suicidal threats, including a range of personal responses of the involved members of our team in addition to integrative psychopharmacological and psychodynamic approach.

Several clinician-focused researches and our own experience indicate the provocation of various emotions and defense mechanisms, which consequently may alter the treatment efficacy.

The awareness of one’s spontaneous emotional reactions to a patient may be useful in understanding the patient’s intrapsychic dynamics, thereby considered as an important factor in therapeutic alliance and treatment outcome.