The people I see usually arrive having already noticed something in themselves, a way of relating or reacting that keeps costing them, and they want to live with it more functionally. I'm not in the business of handing you a label or a clinical verdict to carry around. When two people are actually right for this kind of work, it's some of the most worthwhile time I spend with anyone.
What these patterns actually look like
Words like borderline and narcissistic get thrown around so loosely that they've nearly stopped meaning anything, so it helps to get concrete about what people are really living with when they come in.
Borderline patterns tend to show up as some mix of:
- feeling that swings hard and fast, where an afternoon can turn on a single text message
- relationships that run hot or cold with very little in between
- a sense of self that thins out and goes blurry when there's no one around to reflect it back
- a fear of being left that can quietly run the show long before anyone has actually left
Narcissistic patterns usually wear a different face. A self-image that has to be defended even when defending it pushes away the people you most want close. Achievement that lands for about a day and then stops counting, so you need the next thing immediately. Underneath a lot of it, often, a low background hum that something is missing and you can't name it.
What we do with any of this is slow the loops down enough to actually see them. We name them out loud, without drama. And then we work on the skills and the inner footing that hold up when you're under pressure rather than only when you're calm in my office, so the patterns start working more for you than against you, at home and in the unremarkable middle of a Tuesday. With narcissistic traits in particular, I'll be direct in a way that doesn't flatter you, and most people who do well in this work end up telling me that was the part that helped.
What I'm offering, and what I'm not
I need to be plain here, because people sometimes arrive expecting something I don't provide. I am not offering DBT. Dialectical behavior therapy is the full, intensive protocol, and it's a genuinely different animal: weekly individual work alongside group skills training, often for years, with the same therapist, plus out-of-hours crisis contact, the two-in-the-morning phone call. That's a serious commitment of a very particular kind, and it belongs in clinics built specifically to deliver it. If that's what you actually need, I'll tell you straight, and I'll point you toward where to get it.
What I do is lighter and more contained. Trait-focused work inside ordinary, bounded sessions, for people who want to get a real handle on the impulses and patterns that keep getting in their way. For a lot of people that's exactly the right size. For some it isn't, and being honest about which is which is part of my job.
Why the first sessions decide it
This work asks a fair amount of both of us, and it only does much good if you can bring some real insight to it, a willingness to look at your own part without going to pieces or shutting down. So I treat the opening sessions as their own thing. They go toward two honest questions: am I the right person for you, and is this the right moment in your life to be doing this kind of work at all? Sometimes the patterns are real and worth working on but everything else is on fire right now, and the timing is wrong. If the answer to either question is no, you'll hear it from me, and I'll help you find someone better suited rather than keep you in a chair that isn't serving you.
Around the ten-session mark we stop and take stock together, honestly, about whether this is going anywhere. That rhythm matters even more with this kind of work than it does elsewhere. Book a free 20-minute call.