El Chapo on the Couch: Inside a Drug Lord's Therapy Sessions

“Sensitive to criticism.” “Fearful of attention.” “Egocentric and narcissistic.” That’s the profile that emerges from 63 therapy sessions with the world’s most notorious drug lord.


The sessions seem to have begun as a routine psychological assessment in late 1995, when El Chapo was lodged in Module III, Section I, Level A, Room 307, Bed B at Puente Grande prison in Mexico.

A little-noticed section of the resulting psychological profile can be found online. It gives a shrink’s view of the man who went on to become what former DEA Chief of Operations Michael Braun called “the most ruthless organized crime leader on the face of the earth.” El Chapo’s capture last month caught the whole world’s attention. This report from nearly 20 years ago suggests that he is not so different from what you might imagine cable television’s Melfi saying about her Mafiosi patient.

“Is a subject who presents himself as a being with confidence in himself: egocentric and narcissistic, with a grandiose feeling of his own importance, giving him expectations of special treatment,” the official assessment of El Chapo reads in part.

The similarity with Soprano continues as the real life report suggests that El Chapo’s big shot bluster was just “a reactive formation, counter reacting to his true personality.” The real real life El Chapo was said to be “introverted and with a tendency to be needy.”

The report further indicates that El Chapo was “sensitive to criticism,” and “presents egodystonic aggression subject to the mechanism of denial, according to/depending on the surrounding conditions.”

Egodystonic in this context means that, along with being touchy, El Chapohad aggressive thoughts and urges that he realized are unreasonable and run contrary to his ideal image of himself, though in certain circumstances he was able to rationalize it all.

One example might be reacting to a slight by ordering the offender decapitated and then telling yourself it was necessary to keep your many enemies in line. Theoretically speaking, of course.

El Chapo was also said to harbor a particular phobia that was certainly understandable for somebody who at various times had everybody from the DEA to the FBI to the CIA to the Mexican military after him, not to mention literally thousands of murderous enemies in rival cartels.

“A fear of being the center of attention,” the report notes.

The report suggests that in countering his fears and his desire to cloak his true self perhaps from even himself, El Chapo was driven by “feelings of ambition and the need to maintain an acceptable appearance in interpersonal relationships, being expansive in his manner of interacting and behaving as a leader.”

The report further indicates that despite being touchy and secretly seething, El Chapo generally could maintain the classic Godfather detachment: it’s not personal…it’s strictly business.

An ability to generally keep his cool was joined by “notable” and ““expansive” leadership qualities.

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“With an ability to analyze and synthesize…capable of relating facts and ideas and drawing logical conclusions from them,” the report finds.

That said, the official diagnosis was “adult anti-social behavior” and the prognosis was “reserved,” accompanied by a recommendation of “treatment at an individual level with humanist focus, Gestalt techniques.”

Gestalt therapy generally involves examining thoughts and feelings at the particular moment within the context of present relationships with other people, as opposed to examining the past. This approach sometimes includes what is known as “the empty chair technique,” in which the patent addresses the chair in question as if it were occupied by another person or even a particular aspect of himself.

Already years ahead of James Gandolfini’s Mafia boss, El Chapo may have also been ahead of Clint Eastwood’s surreal debate with an empty chair occupied by an imaginary President Obama at the Republican national convention.

The objectives of the Eastwood method, according to the report: “Strengthening his judgment, increasing his capacity to learn from the experience and his capacity for introspection.”

Whatever the particulars of his treatment, El Chapo was said to have made real progress. And his time in prison was further eased by something else noted in his psychological profile.

“He possesses an adequate relationship with authority figures, to suit his interests,” the report says.

The most immediate authority figures in his life at that point were the prison guards, and he reportedly sought a more than adequate relationship with them via suitcases stuffed with cash. That facilitated food to equal what he could have enjoyed on the outside as well as regular trysts with a female inmate. And, he did not have the stress of constantly worrying about getting arrested for narcotics trafficking because he already had been.

The combination of noshing, nookie and normalcy seem to have made El Chapo content enough that he did not even attempt escape until January 2001.

That was when Mexico changes its laws so as to facilitate extradition to the United Sates. El Chapo seems to have put to further use his relationship with authority figures to suit his interests, which in this instance was to escape.

In the years that followed, El Chapo fully employed his leadership qualities. His grandiose sense of himself was matched by Forbes magazine rating him a billionaire and one of the most powerful people on earth. The Chicago Crime Commission declared him Public Enemy No. 1, declaring that he was a bigger menace than Al Capone had ever been.

His 63 therapy sessions aside, his psychological orientation remained essentially the same.

“Frequently/commonly he is interested in aspects related to power, success, and physical beauty, orienting his behavior toward their obtention,” the report noted.

He demonstrated his passions for power and for beauty when he deployed hundreds of black clad gunmen to ensure that the gorgeous woman who was to be his newest wife won a contest that officially made her a beauty queen. He was cooking breakfast for her and their twin toddlers when he was finally captured last month.

(Related: Drug Cartel Beauty Queens Face an Ugly End)

El Chapo is presently being held in Altiplano prison, Mexico’s maximum security faculty. The warden is Marissa Quintanilla, who remains within its three-foot thick walls around the clock as a precaution against possible attack by outside henchmen of the prisoners she oversees. She is a psychologist who is a passionate believer in rehabilitation and her most famous prisoner is said to be once again the subject of a psychological profile.

If he is not extradited, maybe El Chapo can go back into therapy.