ic DisorderPsychological Theories and Therapeutic Interventions in the Narcissistic DisorderThe ‘narcissistic personality disorder’ is a complex and often misunderstood disorder. The prominent feature of the narcissistic personality is the grandiose sense of self-importance, but actually underneath this grandiosity the narcissist suffers from a chronically fragile low self-esteem. The grandiosity of the narcissist, however, is often so pervasive that we tend to dehumanize him or her.
The narcissist conjures in us images of the mythological character Narcissus who could only love himself, rebuffing anyone who attempted to touch him. Nevertheless, it is the underlying sense of inferiority, which is the real problem of the narcissist, the grandiosity is just a disguise used to cover the deep feelings of inadequacy. The narcissist’s grandiose behavior is designed to reaffirm his or her sense of adequacy. Since the narcissist is incapable of asserting his or her own sense of adequacy, the narcissist seeks to be admired by others. However, the narcissist’s extremely fragile sense of self worth does not allow him or her to risk any criticism. Therefore, meaningful emotional interactions with others are avoided.
By simultaneously seeking the admiration of others and keeping them at a distance the narcissist is usually able to maintain the illusion of grandiosity no matter how people respond. Thus, when people praise the narcissist his or her grandiosity will increase, but when criticized the grandiosity will usually remain unaffected because the narcissist will devalue the criticizing person. discusses six areas of pathological functioning, which characterize the narcissist. In particular, four of these narcissistic character traits best illustrate the pattern discussed above.
(1) a narcissistic individual has a basic sense of inferiority, which underlies a preoccupation with fantasies of outstanding achievement; (2) a narcissistic individual is unable to trust and rely on others and thus develops numerous, shallow relationships to extract tributes from others;(3) a narcissistic individual has a shifting morality-always ready to shift values to gain favor; and (4) a narcissistic person is unable to remain in love, showing an impaired capacity for a committed relationship. The narcissist who enters therapy does not think that there is something wrong with him or her. Typically, the narcissist seeks therapy because he or she is unable to maintain the grandiosity, which protects him or her from the feelings of despair. The narcissist views his or her situation arising not as a result of a personal maladjustment; rather it is some factor in the environment which is beyond the narcissist’s control which has caused his or her present situation. Therefore, the narcissist expects the therapist not to ‘cure’ him or her from a problem which he or she does not perceive to exist, rather the narcissist expects the therapist to restore the protective feeling of grandiosity.
It is therefore essential for the therapist to be alert to the narcissist’s attempts to steer therapy towards healing the injured grandiose part, rather than exploring the underlying feelings of inferiority and despair. The most extreme form of narcissism involves the perception that no separation exists between the self and the object. The object is viewed as an extension of the self, in the sense that the narcissist considers others to be a merged part of him or her. Usually, the objects, which the narcissist chooses to merge with, represent that aspect of the narcissist’s personality about which feelings of inferiority are perceived. For instance if a narcissist feels unattractive he or she will seek to merge with someone who is perceived by the narcissist to be attractive. At a slightly higher level exists the narcissist who acknowledges the separateness of the object, however, the narcissist views the object as similar to himself or herself in the sense that they share a similar psychological makeup.
In effect the narcissist perceives the object as ‘just like me’. The most evolved narcissistic personality perceives the object to be both separate and psychologically different, but is unable to appreciate the object as a unique and separate person. The object is thus perceived as useful only to the extent of its ability to aggrandize the false self (Manfield, 1992). Pending the perceived needs of the environment a narcissist can develop in one of two directions. The individual whose environment supports his or her grandiosity, and demands that he or she be more than possible will develop to be an exhibitionistic narcissist. Such an individual is told ‘you are superior to others’, but at the same time his or her personal feelings are ignored.
Thus, to restore his or her feelings of adequacy the growing individual will attempt to coerce the environment into supporting his or her grandiose claims of superiority and perfection. On the other hand, if the environment feels threatened by the individual’s grandiosity it will attempt to suppress the individual from expressing this grandiosity. Such an individual learns to keep the grandiosity hidden from others, and will develop to be a closet narcissist. The closet narcissist will thus only reveal his or her feelings of grandiosity when he or she is convinced that such revelations will be safe (Manfield, 1992) Narcissistic defenses are present to some degree in all people, but are especially pervasive in narcissists.
These defenses are used to protect the narcissist from experiencing the feelings of the narcissistic injury. The most pervasive defense mechanism is the grandiose defense. Its function is to restore the narcissist’s inflated perception of himself or herself. Typically the defense is utilized when someone punctures the narcissist’s grandiosity by saying something which interferes with the narcissist’s inflated view of himself or herself.
The narcissist will then experience a narcissistic injury similar to that experienced in childhood and will respond by expanding his or her grandiosity, thus restoring his or her wounded self-concept. Devaluation is another common defense which is used in similar situations. When injured or disappointed the narcissist can respond by devaluing the ‘offending’ person. Devaluation thus restores the wounded ego by providing the narcissist with a feeling of superiority over the offender.
There are two other defense mechanisms which the narcissist uses. The self-sufficiency defense is used to keep the narcissist emotionally isolated from others. By keeping himself or herself emotionally isolated the narcissist’s grandiosity can continue to exist unchallenged. Finally, the manic defense is utilized when feelings of worthlessness begin to surface. To avoid experiencing these feelings the narcissist will attempt to occupy himself or herself with various activities, so that he or she has no time left to feel the feelings (Manfield, 1992).
The central theme in the Psychodynamic treatment of the narcissist revolves around the transference relationship which emerges during treatment. In order for the transference relationship to develop the therapist must be emphatic in understanding the patient’s narcissistic needs. By echoing the narcissist the therapist remains ‘silent’ and ‘invisible’ to the narcissist. In essence the therapist becomes a mirror to the narcissist to the extent that the narcissist derives narcissistic pleasure from confronting his or her ‘alter ego’. Once the therapeutic relationship is established, two transference like phenomena. The mirror transference and the idealizing transference, collectively known as self-object transference emerge.
The mirror transference will occur when the therapist provides a strong sense of validation to the narcissist. Recall that the narcissistically injured child failed to receive validation for what he or she was. The child thus concluded that there is something wrong with his or her feelings, resulting in a severe damage to the child’s self-esteem. By reflecting back to the narcissist his or her accomplishments and grandeur the narcissist’s self esteem and internal cohesion are maintained (Manfield, 1992).
There are three types of the mirror transference phenomenon, each corresponding to a different level of narcissism (as discussed previously). The merger transference will occur in those narcissists who are unable to distinguish between the object and the self. Such narcissists will perceive the therapist to be a virtual extension of themselves. The narcissist will expect the therapist to be perfectly resonant to him or her, as if the therapist is an actual part of him or her. If the therapist should even slightly vary from the narcissist’s needs or opinions, the narcissist will experience a painful breach in the cohesive self object function provided by the therapist.
Such patients will then likely feel betrayed by the therapist and will respond by withdrawing themselves from the therapist (Manfield, 1992). In the second type of mirror transference, the twin ship or alter ego transference, the narcissist perceives the therapist to be psychologically similar to him or herself. Conceptually the narcissist perceives the therapist and himself or herself to be twins, separate but alike. In the twin ship transference for the self-object cohesion to be maintained, it is necessary for the narcissist to view the therapist as ‘just like me’ (Manfield, 1992).
The third type of mirror transference is again termed the mirror transference. In this instance the narcissist is only interested in the therapist to the extent that the therapist can reflect his or her grandiosity. In this transference relationship the function of the therapist is to bolster the narcissist’s insecure self (Manfield, 1992). The second self object transference, the idealizing transference, involves the borrowing of strength from the object (the therapist) to maintain an internal sense of cohesion. By idealizing the therapist to whom the narcissist feels connected, the narcissist by association also uplifts himself or herself. It is helpful to conceptualize the ‘idealizing’ narcissist as an infant who draws strength from the omnipotence of the caregiver.
Thus, in the idealizing transference the therapist symbolizes omnipotence and this in turn makes the narcissist feel secure. The idealization of the object can become so important to the narcissist that in many cases he or she will choose to fault himself or herself, rather than blame the therapist (Manfield, 1992). The idealizing transference is a more mature form of transference than the mirror transference because idealization requires a certain amount of internal structure (i. e. , separateness from the therapist).
Oftentimes, the narcissist will first develop mirror transference, and only when his or her internal structure is sufficiently strong will the idealizing transference develop (Manfield, 1992). The self-object transference relationships provide a stabilizing effect for the narcissist. The supportive therapist thus allows the narcissist to heal his or her current low self-esteem and reinstate the damaged grandiosity. However, healing the current narcissistic injury does not address the underlying initial injury and in particular the issue of the false self. To address these issues the therapist must skillfully take advantage of the situations when the narcissist becomes uncharacteristically emotional; that is when the narcissist feels injured.
It thus becomes crucial that within the context of the transference relationship, the therapist shift the narcissist’s focus towards his or her inner feelings (Manfield, 1992). The prevailing opinion amongst Psychodynamic theorists is that the best way to address the narcissist’s present experience is to utilize a hands-off type of approach. This can be accomplished by letting the narcissist ‘take control’ of the sessions, processing the narcissist’s injuries as they inevitably occur during the course of treatment. When a mirror transference develops injuries will occur when the therapist improperly understands and/or reflects the narcissist’s experiences. Similarly, when an idealizing transference is formed injuries will take the form of some disappointment with the therapist which then interferes with the narcissist’s idealization of the therapist.
In either case, the narcissist is trying to cover up the injury so that the therapist will not notice it. It remains up to the therapist to recognize the particular defense mechanisms that the narcissist will use to defend against the pain of the injury, and work backwards from there to discover the cause of the injury (Manfield, 1992). Once the cause of the injury is discovered the therapist must carefully explore the issue with the narcissist, such that the patient does not feel threatened. The cure of the narcissist than does not come from the self-object transference relationships per se. Rather, the self-object transference function of the therapist is curative only to the extent that it provides an external source of support, which enables the narcissist to maintain his or her internal cohesion.
For the narcissist to be cured, it is necessary for him or her to create their own structure (the true self). The healing process is thus lengthy, and occurs in small increments whenever the structure supplied by the therapist is inadvertently interrupted. It is important to understand that the Self in analytical psychology takes on a different meaning than in psychodynamic thought (Self is thus capitalized in analytical writings to distinguish it from the psychodynamic concept of the self). In psychodynamic theory the self is always ego oriented, that is the self is taken to be a content of the ego.
By contrast, in analytical psychology the Self is the totality of the psyche, it is the archetype of wholeness and the regulating center of personality. Moreover, the self is also the image of God in the psyche, and as such it is experienced as a transpersonal power, which transcends the ego. The Self therefore exists before the ego, and the ego subsequently emerges from the Self (Monte, 1991). Within the Self we perceive our collective unconscious, which is made up of primordial images, that have been common to all members of the human race from the beginning of life. These primordial images are termed archetypes, and play a significant role in the shaping of the ego. Therefore, When the ego looks into the mirror of the Self, what it sees is always ‘unrealistic’ because it sees its archetypal image which can never be fit into the ego (Schwartz-Salant, 1982; P.
19)In the case of the narcissist, it is the shattering of the archetypal image of the mother which leads to the narcissistic manifestation. The primordial image of the mother symbolizes paradise, to the extent that the environment of the child is perfectly designed to meet his or her needs. No mother, however, can realistically fulfill the child’s archetypal expectations. Nevertheless, so long as the mother reasonably fulfills the child’s needs he or she will develop ‘normally’. It is only when the mother fails to be a ‘good enough mother’, that the narcissistic condition will occur (Asper, 1993).
When the mother-child relationship is damaged the child’s ego does not develop in an optimal way. Rather than form a secure ‘ego-Self axis’ bond, the child’s ego experiences estrangement from the Self. This Self-estrangement negatively affects the child’s ego, and thus the narcissist is said to have a ‘negativized ego’. The negativized ego than proceeds to compensate for the self-estrangement by suppressing the personal needs which are inherent in the self; thus the negativized ego of the narcissistically disturbed person is characterized by strong defense mechanisms and ego rigidity.
A person with this disturbance has distanced himself from the painful emotions of negative experiences and has become egoistic, egocentric, and narcissistic (Asper, 1993; P. 82). Since the narcissistic condition is a manifestation of self-estrangement, the analytical therapist attempts to heal the rupture in the ego-self axis bond, which was created by the lack of good enough mothering. To heal this rupture the therapist must convey to the narcissist through emphatic means that others do care about him or her; that is the therapist must repair the archetype of the good mother through a maternally caring approach (Asper, 1993). A maternal approach involves being attentive to the narcissist’s needs.
Just as a mother can intuitively sense her baby’s needs so must the therapist feel and observe what is not verbally expressed by the narcissist. Such a maternal approach allows the narcissist to experience more sympathy towards his or her true feelings and thus gradually the need to withdraw into the narcissistic defense disappears (Asper, 1993). It is difficult for the individual to truly be himself or herself because society offers many rewards for the individual who conforms to its rules. Such an individual becomes alienated because he or she feels that society’s rituals and demands grant him or her little significance and options in the control of his or her own destiny. To compensate such an individual takes pleasure in his or her own uniqueness (grandiosity), he or she enjoys what others cannot see and control. Thus, the alienated person sees himself as a puppet cued by social circumstances which exact ritualized performances from him.
His irritation about the inevitability of this is counterbalanced by one major consolation. This consists of his narcissistic affection for his own machinery-that is, his own processes and parts (Johnson, 1977; P. 141). The existential treatment of the narcissist is based on the existential tenant that all existing persons have the need and possibility of going out from their centeredness to participate in other beings (Monte, 1991; P. 492). The severely alienated narcissistic individual, however, does not believe in the validity of experience outside of the self.
Unlike others, the narcissist does not believe that a constructive relationship with others is possible. Existentialists therefore believe that the therapist, through emphatic understanding, must create a strong bond with the narcissist, so that he or she can see that others have feelings too (Johnson, 1977). The humanistic treatment of the narcissist is in general no different from the humanistic treatment of any other client. The humanistic therapist wants the narcissist to rediscover his or her individuality, which was suppressed by the conditions of worth imposed by significant others. In order to accomplish this, the proper environment must be set in therapy, free of any conditions of worth. The narcissist must feel that whatever he or she does is all right with the therapist.
The therapist therefore gives the narcissist unconditional positive regard. There is no judgment of the narcissist, instead the therapist honestly and caringly tries to see things through the eyes of the narcissist. When the narcissist comes to accept his or her true needs he or she will be congruent with the personal self and the narcissistic front will no longer be needed. Each of the psychological approaches discussed above contains both strengths and weaknesses, in attempting to solve the narcissistic puzzle. Nevertheless, the psychodynamic model possesses a big advantage over the other approaches in its ability to offer both a comprehensive theory of etiology and a detailed description of treatment.
With respect to etiology the other approaches suffer from: a lack of concrete observational validity (the analytical approach), lack of clarity in capturing the essence of narcissism (the existential approach), and lack of continuity in predicting narcissism (the humanistic approach). The analytical model of narcissism depends on too many hypothetical concepts, such as the collective unconscious, which are not supported by any concrete evidence. By emphasizing the narcissist’s tendency to withdraw into the pleasures of the self, existentialists overlook the immense suffering which so characterizes the narcissist. With respect to treatment the major advantage of the psychodynamic approach is that it goes beyond the exclusive use of emphatic means to treat the narcissist.
By limiting treatment to emphatic understanding the other approaches fail to address the underlying issues inherent in narcissism. Therefore, the other approaches might shore up the narcissist’s damaged self-esteem in the short run, but it is doubtful if they will be able to transform the narcissist. Possibly the only weakness of the psychodynamic approach lies in the length that it takes to treat narcissism. Recall that a successful psychodynamic treatment requires the therapist to be very careful about maintaining the narcissist’s delicate self-perception. Only gradually can the psychodynamic therapist direct the narcissist’s attention towards the real underlying emotional feelings. No matter which approach is utilized in the explanation and treatment of narcissism it is important to recognize that the narcissistic individual is a complex and multifaceted human being.
Deep inside narcissistic individuals experience tremendous pain and suffering, for which they attempt to compensate for by the projection of the grandiose front. These people are not character disordered. They are people tortured by narcissistic injury and crippled by developmental arrests in functioning which rob them of the richness of life they deserve. They are good people, who are hurting. They are living and suffering the narcissistic style. History
