Inside the Private World of Power, Pressure and Psychology

What do you see in powerful individuals that the outside world never does — and how has your understanding of vulnerability changed after thirteen years with CEOs, heirs and public figures?

One of the most striking things I've learned is that success doesn't make people less vulnerable — it often makes them more so. The higher the position, the fewer safe spaces there are, and the more carefully doubts, fears, and insecurities are hidden. No amount of external validation exempts those in positions of power from the inherent pain of the human condition. Status, wealth, and visibility create a unique form of pressure. One that isolates, attracts projection and judgment, and invites both overt and subtle hostility from society. It also generates anxiety, especially the quiet, paralyzing fear of being exposed as insufficient.

Many of the most influential and wealthy people in the world live inside invisible cages: frameworks of perfectionism, control, and performance that once enabled success but eventually become prisons. Power, in this sense, can turn into a form of captivity. Despite having everything, many still struggle with meaning, real connection, and a sense of inner freedom — admired by millions, yet rarely truly seen by either society or those closest to them.

What I have come to understand is this: for most of my clients, external success is never enough. Yet, a sustainable, fulfilling life does not come from abandoning one's public identity, but from integrating it with one's authentic self. It requires the courage to be vulnerable, the capacity to be authentic, and the willingness to be truly recognized by another human being. In the end, those we call powerful are not less human than the rest of us — often, they are simply more exposed.

Where does true resilience come from in people who carry enormous responsibility?

In my experience, resilience, grit, and adaptability are essential, indispensable, and defining factors in sustained success — particularly for those who shoulder extraordinary responsibility. Resilience is best understood not merely as capacity to endure, adapt, and recover in the face of difficulty, but as a dynamic quality rooted in purpose, self-regulation, and adaptive growth. It is sustained by emotional regulation and cognitive flexibility, enabling leaders to interpret challenges not simply as obstacles, but as opportunities for learning and strategic recalibration. This form of resilience is reinforced through networks of trust, informed by experiential knowledge, and moderated by self-compassion and measured optimism.

Effective leaders maintain a strong sense of agency and control over their decisions and behaviors, even under conditions of uncertainty and pressure. By doing so, they are able to navigate adversity with consistency and strategic composure, guided by the understanding that setbacks are inherently transient and often instrumental in long-term development, performance, and organizational progress.

Nonetheless, even individuals of exceptional resilience and elevated position are not immune to adversity; when it strikes, it often proves uniquely destabilizing, leaving them vulnerable to irrational and self-destructive behavior. Paradoxically, despite having access to every conceivable form of therapeutic support, they remain hesitant to seek help for fear of being objectified, having their vulnerabilities exploited, or being reduced to labels such as entitled, narcissistic, or problematic. In this context, specialized psychotherapeutic or coaching-based interventions offer particularly effective pathways for strengthening individual resilience factors, refining one's self-concept, and supporting health-promoting psychological functioning.

Why does private psychiatry and psychotherapy for HNWIs require a different framework than standard psychiatric care — and what exactly are clients paying for beyond your time: risk, responsibility, access, confidentiality?

Private psychiatry and psychotherapy for high-net-worth individuals require a different framework because extreme visibility, power, and access fundamentally reshape the psychological and relational context in which suffering occurs. Effective therapeutic work should see these individuals in the fullness of their being, grounded in an understanding of the deeper contextual frameworks within which they live as dynamic human beings, and be guided by unconditional positive regard.

Treatment must offer a clinically excellent, reparative environment oriented toward qualitative change — restoring intimacy, self-regard, and peace of mind — while addressing the destruction caused by personality, mental health, relational, addictive, and physical disorders. This necessitates treatment frameworks sufficiently broad to hold the uniqueness of each individual's identity while concurrently facilitating an authentic interpersonal connection that supports the process of healing. In this model, therapy is not merely symptom management, but a space for psychological, relational, and existential repair.

Such work requires absolute privacy and discretion, combined with a holistic, state-of-the-art approach that integrates psychological, physical, social, and cultural dimensions of care. Tailored clinical interventions must be matched with deep psychological insight, attending not only to emotional life, but also to generational and existential dimensions of health and suffering. Only through this level of personalized, integrative, and context-sensitive approach, the treatment meets the true complexity of this specific group of individuals.

How do you personally stay grounded while carrying the inner worlds of others?

That is a very important question. As psychiatrists and psychotherapists, we undergo long and highly differentiated training, which equips us to process and contain the often very dynamic and emotionally demanding inner worlds of our clients. At the same time, professional training alone is not sufficient. Good psychological self-care and a balanced lifestyle — nurturing close relationships, maintaining physical and mental activity, prioritizing good nutrition, and getting enough sleep — are essential, as is the ongoing support of continuous professional supervision. All of this serves not only stability, but also continued self-understanding and personal development.

I also believe it is crucial to cultivate empathy not only for one's clients, but for oneself and for those close to us. Being able to see the often impressive paths that clients take in therapy as a gift, rather than as a burden, makes a profound difference.

And finally, I try to regularly remind myself what a privilege it is to work with such fascinating people, and to honor my own ongoing process of growth in all its complexity, uncertainty, and depth as an integral part of this work. It is this sense of gratitude and humility that keeps me anchored, open, and deeply human in the presence of others.

How do you stay independent when a client is used to bending systems?

That may actually be the wrong question — because what you are describing is, in many ways, a deeply human and predictable response. When someone is confronted with the therapeutic "threat" of having to show vulnerability and to be seen as fully human, the impulse to retain control is entirely natural. They often "bend systems" because they are afraid that someone might discover their vulnerabilities, their limitations, or their sense of inner insufficiency.

In my work, I deal with a very small and specific group — almost comparable to a cultural minority — that requires specialized support. Their psychological reflexes differ markedly from those of most clients and need to be understood within their own distinct "cultural" and biographical context. Their first reaction, when therapy begins to touch something truly internal, is often an attempt to control the process. That reaction itself must be made visible and worked with in therapy rather than fought against.

For this to happen, the therapist must first develop a differentiated and nuanced understanding of the client in order to make sense of their avoidance strategies and flight responses. Many of these individuals have learned to relate to the world as a potentially hostile place — one in which they are either objectified or instrumentalized, and their reflexes are shaped by this experience.

It is therefore essential to meet clients where they actually are, not where I might expect or wish them to be. At the same time, I have to remain aware that therapists are not immune to their own prejudices, assumptions, and unconscious reactions toward their clients.

Engagement with this group typically unfolds more slowly. They often protect themselves through isolation, emotional distancing, and control. They may manipulate, keep others at arm's length, and actively resist or attack anyone who feels threatening or intrusive. Many of them are highly accomplished, powerful, and can be both impressive and intimidating in their presence. One must also keep in mind that people in elite positions usually have high cognitive capacities and a finely tuned ability to read others — their reactions, motivations, and weak spots.

The therapeutic task is to create an environment that the client can gradually identify with rather than one they feel compelled to escape from. This also means working with them as a collaborator rather than from the position of an all-knowing expert. At the same time, a therapist should not become merely a constant source of empathy and containment — even if these clients are very used to being handled that way. They need to be confronted, challenged, and met with honesty — both about themselves and about the relational process. There is always a delicate balance: if pressure is applied too early or too bluntly, the risk is that they will leave and simply continue their dysfunctional cycle.

Ultimately, staying independent does not mean staying distant. It means remaining grounded, clear, and truthful while tolerating a slower, more cautious process of trust-building.

And despite all of this complexity, I hold these patients in deep esteem. They have a special place in my heart, because they entrusted me with their most private experiences and allowed me to be part of their transformation.

Which psychological challenges appear only in families with extreme resources?

Families with extreme resources do not suffer less psychologically — rather, they often suffer differently. Power, prestige, visibility, and abundance create a psychological climate that both amplifies and distorts normal developmental and relational dynamics, giving rise to very specific forms of vulnerability and pathology.

One well-known example is sudden wealth syndrome, which is the emotional and identity crisis that can follow the abrupt acquisition of great wealth. Yet, even in families where wealth and status span generations, similar inner conflicts appear. Some individuals live in a strangely diminished inner state, forever chasing a dream that never quite arrives. Others become consumed by status, performance, or the pursuit of visibility and admiration — often to their own psychological detriment. The insatiable hunger for "more" — more recognition, more success, more affirmation — is one of the forces that drives many high-profile individuals into burnout, addiction, or self-destructive behavior.

A particularly painful and widespread theme is the feeling of being an impostor: the sense of being unworthy of one's success or position, of having somehow deceived the world. Closely related is perfectionism, which often functions as a defense against deep fears of shame, judgment, and blame. Both impostor feelings and perfectionism frequently pave the way toward addictive behaviors, which serve as attempts at emotional regulation and compensation.

Another central issue is psychological alienation. Many people who grow up in extreme privilege experience a subtle but profound form of neglect, or a persistent sense of being "othered" by the world — never quite belonging anywhere. This often feeds into identity crises marked by survivor guilt, fragile or performative social bonds, a lack of genuine purpose, and relationships that depend on maintaining an image of success rather than on authentic connection. These inner conflicts are intensified by enormous external pressures: succession dynamics, hyper-competition, the weight of family legacies, and constant public scrutiny. Autonomy struggles are common as well and are often shaped by overprotectiveness, rigid expectations, and complex family systems.

Paradoxically, the abundance of power and opportunity does not protect against suffering. On the contrary, it often fuels existential dissatisfaction: life on the hedonic treadmill of wealth, chronic fear of missing out, boredom mixed with anxiety, and a haunting sense that something essential is missing despite all external achievements.

Finally, there is the intoxicating allure of power, celebrity and privilege — combined with a social environment that can be profoundly addictive in itself. Behind the scenes, this often leads to deep loneliness, hidden despair, and psychological fragility, even in those who appear invulnerable from the outside.

In short, extreme resources do not eliminate psychological conflict — they reshape it. And in many cases, they make it harder to recognize, harder to speak about, and harder to heal.

What did a patient teach you that stayed with you?

That is a very difficult question, because I have learned something from almost every patient I have worked with — regardless of where in our beautiful world they came from or from which social context.

Some of the most formative moments for me have been those in which patients allowed me to look into their innermost worlds and shared some of their most painful and defining experiences. I remember one patient who spoke about how essential it was for him to preserve his bond with his parents, even though he had been profoundly disappointed and betrayed by his father in a political context — so much so that he was ultimately forced to leave his country.

Another patient, a young woman whom I was able to accompany over a long and very intensive period, deepened my understanding of how challenging life as a migrant in a foreign country can be. Working with her set in motion a long and very personal process of reflection about our world, which is constantly in motion and transformation.

Perhaps the most emotionally moving message, however, came from a patient I had already known as a public figure before our work together, and whom I had the privilege of accompanying during the final days of his life. Shortly before his death, he told me that in life I should focus on genuine human bonds, on curiosity and openness toward the unknown, and on truly experiencing the world. That moment touched me deeply and left me with a lasting sense of gratitude.