Therapists should assume that some motivation for treatment exists in this clientele, that research on borderline and narcissistic personalities is relevant, that a fragile self-image exists under a tough exterior, and that self-help groups and other support systems can be useful adjuncts to therapy. Clear, simple referral procedures are important to the successful treatment of these clients. In addition, the therapist should establish an atmosphere of modeling, honesty, openness, directness, and respect. The therapist's role must also be active and not passive. Finally, the therapist must combat the tendency to consciously or unconsciously give up on the therapeutic relationship, must plan the intervention strategy carefully, and must be flexible in the treatment approach. 39 references