Narcissism: Psychological Theories and Therapeutic Interventions

The so-called “narcissistic personality disorder” is a complex and often misunderstood disorder. The cardinal feature of the narcissistic personality is the grandiose sense of self-importance. Paradoxically, 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 facade used to cover the deep feelings of inadequacy.

The Makeup of the Narcissistic Personality

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.

Akhtar (1989) as cited in Carson & Butcher, 1992, p. 271, discusses six areas of pathological functioning which characterize the narcissist. In particular, four of these narcissistic character traits best illustrate the pattern discussed above. “A narcissistic individual has a basic sense of inferiority, which underlies a preoccupation with fantasies of outstanding achievement; a narcissistic individual is unable to trust and rely on others and thus develops numerous, shallow relationships to extract tributes from others; a narcissistic individual has a shifting morality-always ready to shift values to gain favor; a narcissistic person is unable to remain in love, showing an impaired capacity for a committed relationship.”

The Therapeutic Essence of Treating Narcissism

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 as arising not as a result of a personal maladjustment; rather it is some factor in the environment which is beyond the narcissist’s control that 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.

Differential Psychological Views of Narcissism

The use of the term narcissism in relation to psychological phenomena was first made by Ellis in 1898. Ellis described a special state of auto-erotism as Narcissus-like, in which the sexual feelings become absorbed in self-admiration (Goldberg, 1980). The term was later incorporated into Freud’s psychoanalytic theory in 1914 in his essay “On Narcissism.” Freud conceptualized narcissism as a sexual perversion involving a pathological sexual love for one’s own body (Sandler & Person, 1991).

Henceforth, several psychological theories have attempted to explain and treat the narcissistic phenomenon. Specifically, the most comprehensive psychological theories have been advanced by the psychodynamic perspective and, to a lesser extent, the Jungian (analytical) perspective. Essentially, both theories cite developmental problems in childhood as leading to the development of the narcissistic disorder. The existential school has also attempted to deal with the narcissistic problem, although the available literature is much smaller.

Existentialists postulate that society as a whole can be the crucial factor in the development of narcissism. The final perspective to be discussed is the humanistic approach, which although lacking a specific theory on narcissism, can nevertheless be applied to the narcissistic disorder. In many ways, the humanistic approach to narcissism echoes the sentiments of the psychodynamic approach.

The Psychodynamic Perspective of Narcissism

The psychodynamic model of narcissism is dominated by two overlapping schools of thought: the self-psychology school and the object relations school. The self-psychology school, represented by Kohut, posits that narcissism is a component of everyone’s psyche. We are all born as narcissists, and gradually our infantile narcissism matures into healthy adult narcissism. A narcissistic disorder results when this process is somehow disrupted. By contrast, the object relations school, represented by Kernberg, argues that narcissism does not result from the arrest of the normal maturation of infantile narcissism. Rather, narcissism represents a fixation in one of the developmental periods of childhood. Specifically, the narcissist is fixated at a developmental stage in which the differentiation between the self and others is blurred.

Kohut’s Theory of Narcissism

Kohut believes that narcissism is a normal developmental milestone, and the healthy person learns to transform his or her infantile narcissism into adult narcissism. This transformation takes place through the process which Kohut terms transmuting internalizations. As the infant is transformed into an adult, he or she will invariably encounter various challenges resulting in some frustration. If this frustration exceeds the coping abilities of the person only slightly, the person experiences optimal frustration.

Optimal frustration leads the person to develop a strong internal structure (i.e., a strong sense of self) which is used to compensate for the lack of external structure (i.e., support from others). In the narcissist, the process of transmuting internalizations is arrested because the person experiences a level of frustration which exceeds optimal frustration. The narcissist thus remains stuck at the infantile level, displaying many of the characteristics of the omnipotent and invulnerable child (Kohut, 1977).

Kernberg’s Theory of Narcissism

Kernberg’s views on narcissism are based on Mahler’s theory of the separation-individuation process in infancy and early childhood. Mahler’s model discusses how the developing child gains a stable self-concept by successfully mastering the two forerunner phases (normal autism and normal symbiosis) and the four subphases (differentiation, practicing, rapprochement, and consolidation) of separation-individuation. Kernberg argues that the narcissist is unable to successfully master the rapprochement subphase and is thus fixated at this level. It is essential, however, to understand the dynamics of the practicing subphase before proceeding to tackle the narcissist’s fixation at the rapprochement subphase.

The practicing subphase (age 10 to 14 months) marks the developmental stage at which the child learns to walk. The ability to walk gives the child a whole new perspective on the world around them. This new ability endows the child with a sense of grandiosity and omnipotence, which closely resemble the narcissist’s behavior. However, reality soon catches up with the child as they enter the rapprochement subphase (age 14 to 24 months). At this stage, the child discovers that they are not omnipotent, and that there are limits to what they can do. According to Kernberg, if the child is severely frustrated at this stage, they can adapt by re-fusing or returning to the practicing subphase, which affords them the security of grandiosity and omnipotence (Kernberg, 1976).

The Preferred Psychodynamic Model

The psychodynamic literature in general tends to lean towards the object relations school because of the emphasis it places on a comprehensive developmental explanation (i.e. the use of Mahler’s individuation-separation model). Nevertheless, the theory of Kohut has left a deep impression on psychodynamic thinking, as is evident by the utilization of many of his concepts in the literature (i.e. Johnson, 1987; Manfield, 1992; and Masterson, 1981).

Therefore, in the remainder of the psychodynamic section, a similar approach will be taken by emphasizing object relations concepts with the utilization of the occasional Kohutian idea.

The Emergence of the Narcissistic Personality

According to Kernberg and the object relations school, the crisis of the rapprochement subphase is critical to the development of the narcissistic personality. The individual who is unable to successfully master the challenges of this stage will sustain a narcissistic injury. In essence, the narcissistic injury will occur whenever the environment (in particular significant others) needs the individual to be something which they are not.

The narcissistically injured individual is thus told “Don’t be who you are, be who I need you to be. Who you are disappoints me, threatens me, angers me, overstimulates me. Be what I want and I will love you” (Johnson, 1987; p. 39).

The narcissistic injury devastates the individual’s emerging self. Unable to be what he or she truly is, the narcissistically injured person adapts by splitting his personality into what Kohut terms the nuclear (real) self and the false self. The real self becomes fragmented and repressed, whereas the false self takes over the individual. The narcissist thus learns to reject himself or herself by hiding what has been rejected by others. Subsequently, the narcissist will attempt to compensate for his or her “deficiencies” by trying to impress others through his or her grandiosity. The narcissist essentially decides that “There is something wrong with me as I am. Therefore, I must be special” (Johnson, 1987, p. 53).

The Narcissist’s View of Others

Just as the individual becomes narcissistic because that is what the environment “needed” him or her to be, so does the narcissist view others not as they are, but as what he or she needs them to be. Others are thus perceived to exist only in relation to the narcissist’s needs. The term object relations thus takes on a special meaning with the narcissist. “We are objects to him, and to the extent that we are narcissistic, others are objects to us. He doesn’t really see, hear, and feel who we are and, to the extent that we are narcissistic, we do not really see, hear, and feel the true presence of others. They, we, are objects. I am not real. You are not real. You are an object to me. I am an object to you” (Johnson, 1987, p. 48). It is apparent then that the narcissist maintains the infantile illusion of being merged with the object. At a psychological level, he or she experiences difficulties in differentiating the self from others. It is the extent of this inability to distinguish personal boundaries which determines the severity of the narcissistic disorder (Johnson, 1987).

Levels of Narcissism

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).

Types of Narcissism

Depending on the perceived needs of the environment, a narcissist can develop in one of two directions. The individual whose environment supports their grandiosity and demands that they be more than possible will develop into an exhibitionistic narcissist. Such an individual is told “you are superior to others”, but at the same time, their personal feelings are ignored. Thus, to restore their feelings of adequacy, the growing individual will attempt to coerce the environment into supporting their 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 into a closet narcissist. The closet narcissist will thus only reveal their feelings of grandiosity when they are convinced that such revelations will be safe (Manfield, 1992).

Narcissistic Defense Mechanisms

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 feelings of narcissistic injury. The most pervasive defense mechanism is the grandiose defense. Its function is to restore the narcissist’s inflated perception of themselves. Typically, the defense is utilized when someone punctures the narcissist’s grandiosity by saying something that interferes with their inflated view of themselves.

The narcissist will then experience a narcissistic injury similar to that experienced in childhood and will respond by expanding their grandiosity, thus restoring their wounded self-concept. Devaluation is another common defense 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 that the narcissist uses. The self-sufficiency defense is used to keep the narcissist emotionally isolated from others. By keeping themselves 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 themselves with various activities, so that they have no time left to feel the feelings (Manfield, 1992).

Psychodynamic Treatment of the Narcissist

The central theme in the psychodynamic treatment of the narcissist revolves around the transference relationship that emerges during treatment. In order for the transference relationship to develop, the therapist must be empathic 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 their “alter ego”.

Grunberger’s views are particularly helpful in clarifying this idea. According to him, “The patient should enjoy complete narcissistic freedom in the sense that he should always be the only active party. The analyst has no real existence of his own in relation to the analysand. He doesn’t have to be either good or bad—he doesn’t even have to be. Analysis is thus not a dialogue at all; at best, it is a monologue for two voices, one speaking and the other echoing, repeating, clarifying, interpreting correctly—a faithful and untarnished mirror” (Grunberger, 1979; p. 49).

The Mirror Transference

Once the therapeutic relationship is established, two transference-like phenomena, the mirror transference and the idealizing transference, collectively known as selfobject 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 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 selfobject 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 twinship or alter-ego transference, the narcissist perceives the therapist to be psychologically similar to himself or herself. Conceptually, the narcissist perceives the therapist and himself or herself to be twins, separate but alike. In the twinship transference, for the selfobject 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 grandeur and accomplishments. The therapist is viewed as a tool to enhance the narcissist’s self-esteem and self-image. The narcissist will be very concerned about how the therapist perceives him or her and will use the therapist’s validation as a means of confirming his or her sense of superiority and grandiosity (Manfield, 1992).

The Idealizing Transference

The second selfobject 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 a mirror transference, and only when his or her internal structure is sufficiently strong will the idealizing transference develop (Manfield, 1992).

Utilizing the Transference Relationship in Therapy

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 among 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 backward 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 following case provides a good example of the patience and skill that the therapist must possess in dealing with a narcissistic patient: “A female patient in her mid-thirties came into a session feeling elated about having gotten a new job. All she could talk about is how perfect this job was; there was no hint of introspection or of any dysphoric affect.”

The therapist could find no opening and made no intervention the entire session except to acknowledge the patient’s obvious excitement about her new job. Then, as the patient was leaving, the therapist noticed that she had left her eyeglasses on the table. He said, “You forgot your glasses,” to which she responded with an expression of surprise and embarrassment, saying, “Oh, how clumsy of me.” This response presented the therapist with a slight seam in the grandiose armor and offered the opportunity for him to intervene. He commented, “You are so excited about the things that are happening to you that this is all you have been able to think about; in the process, you seem to have forgotten a part of yourself.”

The patient smiled with a mixture of amusement and recognition. In this example, the patient is defending throughout the session, and in a moment of surprise, she is embarrassed and labels herself “clumsy,” giving the therapist the opportunity to interpret the defense (her focus on the excitement of the external world) and how it takes her away from herself (Manfield, 1992; pp. 168-169).

The cure for the narcissist 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 that 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. In this context, it is useful to recall Kohut’s concept of optimal frustration. “If the interruptions to the therapist’s self-object function are not so severe as to overwhelm the patient’s deficient internal structure, they function as optimal frustrations and lead to the patient’s development of his own internal structure to make up for the interrupted self-object function” (Manfield, 1992; p. 167).

The Ego and the Self in Analytical Psychology

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 that transcends the ego. The Self, therefore, exists before the ego, and the ego subsequently emerges from the Self (Monte, 1991).