Because they have little parental contact, many children of the very
rich lack self-esteem and clear role models, resulting in shallow values
and pathological narcissism. Low self-awareness and the absence of great
suffering work against therapeutic progress, as do the efforts of the
parents, who may feel threatened, and countertransference feelings of envy
or anger by middle-class therapists. A supportive psychotherapeutic
relationship is the most likely means of developing trust and
self-discipline in these patients.