heNarcissistic DisordersNarcissism: Psychological Theories and Therapeutic Interventions in theNarcissistic DisordersIntroductionUnderstanding the Narcissistic PhenomenonThe so called “narcissistic personality disorder” is a complex and oftenmisunderstood disorder. The cardinal feature of the narcissistic personalityis the grandiose sense of self importance, but paradoxically underneath thisgrandiosity the narcissist suffers from a chronically fragile low self esteem.
The grandiosity of the narcissist, however, is often so pervasive that we tendto dehumanize him or her. The narcissist conjures in us images of themythological character Narcissus who could only love himself, rebuffing anyonewho attempted to touch him.
Nevertheless, it is the underlying sense ofinferiority which is the real problem of the narcissist, the grandiosity isjust a facade used to cover the deep feelings of inadequacy.
The Makeup of the Narcissistic PersonalityThe narcissist’s grandiose behavior is designed to reaffirm his or hersense of adequacy. Since the narcissist is incapable of asserting his or herown 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 orher to risk any criticism.
Therefore, meaningful emotional interactions withothers are avoided. By simultaneously seeking the admiration of others andkeeping them at a distance the narcissist is usually able to maintain theillusion of grandiosity no matter how people respond. Thus, when people praisethe narcissist his or her grandiosity will increase, but when criticized thegrandiosity will usually remain unaffected because the narcissist will devaluethe criticizing person.
Akhtar (1989) as cited in Carson & Butcher, 1992; P. 271 discusses sixareas of pathological functioning which characterize the narcissist. Inparticular, four of these narcissistic character traits best illustrate thepattern discussed above. ” (1) a narcissistic individual has a basic sense ofinferiority, which underlies a preoccupation with fantasies of outstandingachievement; (2) a narcissistic individual is unable to trust and rely onothers and thus develops numerous, shallow relationships to extract tributesfrom others; (3) a narcissistic individual has a shifting morality-alwaysready to shift values to gain favor; and (4) a narcissistic person is unable toremain in love, showing an impaired capacity for a committed relationship”.
The Therapeutic Essence of Treating NarcissismThe narcissist who enters therapy does not think that there is somethingwrong with him or her. Typically, the narcissist seeks therapy because he orshe is unable to maintain the grandiosity which protects him or her from thefeelings of despair. The narcissist views his or her situation arising not asa result of a personal maladjustment; rather it is some factor in theenvironment which is beyond the narcissist”s control which has caused his orher 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 ofgrandiosity. It is therefore essential for the therapist to be alert to thenarcissists attempts to steer therapy towards healing the injured grandiosepart, rather than exploring the underlying feelings of inferiority and despair.
Differential Psychological Views of NarcissismThe use of the term narcissism in relation to psychological phenomena wasfirst made by Ellis in 1898. Ellis described a special state of auto-erotismas Narcissus like, in which the sexual feelings become absorbed in selfadmiration (Goldberg, 1980). The term was later incorporated into Freud”spsychoanalytic theory in 1914 in his essay “On Narcissism”. Freudconceptualized narcissism as a as a sexual perversion involving a pathologicalsexual love to one”s own body (Sandler ; Person, 1991). Henceforth, severalpsychological theories have attempted to explain and treat the narcissisticphenomenon. Specifically, the most comprehensive psychological theories havebeen advanced by the psychodynamic perspective and to a lesser extent theJungian (analytical) perspective. Essentially, both theories citedevelopmental problems in childhood as leading to the development of thenarcissistic disorder. The existential school has also attempted to deal withthe narcissistic problem, although the available literature is much smaller.
Existentialists postulate that society as a whole can be the crucial factor inthe development of narcissism. The final perspective to be discussed is thehumanistic approach which although lacking a specific theory on narcissism, cannevertheless be applied to the narcissistic disorder. In many ways thehumanistic approach to narcissism echoes the sentiments of the psychodynamicapproach. The Psychodynamic Perspective of NarcissismThe psychodynamic model of narcissism is dominated by two overlappingschools of thought, the self psychology school and the object relations school.
The self psychology school, represented by Kohut, posits that narcissism is acomponent of everyone”s psyche. We are all born as narcissists and graduallyour infantile narcissism matures into a healthy adult narcissism. Anarcissistic disorder results when this process is somehow disrupted. Bycontrast the object relations school, represented by Kernberg, argues thatnarcissism does not result from the arrest of the normal maturation of infantilenarcissism, rather a narcissism represents a fixation in one of thedevelopmental periods of childhood. Specifically, the narcissist is fixated ata developmental stage in which the differentiation between the self and othersis blurred.
Kohut”s Theory of NarcissismKohut believes that narcissism is a normal developmental milestone, and thehealthy person learns to transform his or her infantile narcissism into adultnarcissism. This transformation takes place through the process which Kohutterms transmuting internalizations. As the infant is transformed into an adulthe or she will invariably encounter various challenges resulting in somefrustration. If this frustration exceeds the coping abilities of the persononly slightly the person experiences optimal frustration. Optimal frustrationleads the person to develop a strong internal structure (i.e., a strong senseof the self) which is used to compensate for the lack of external structure(i.e., support from others). In the narcissist the process of transmutinginternalizations is arrested because the person experiences a level offrustration which exceeds optimal frustration. The narcissist thus remainsstuck at the infantile level, displaying many of the characteristics of theomnipotent and invulnerable child (Kohut, 1977).
Kernberg’s Theory of NarcissismKernberg’s views on narcissism are based on Mahler’s theory of theseparation-individuation process in infancy and early childhood. Mahler’smodel discusses how the developing child gains a stable self concept bysuccessfully mastering the two forerunner phases (normal autism and normalsymbiosis) and the four subphases (differentiation, practicing, rapprochement,and consolidation) of separation-individuation. Kernberg argues that thenarcissist is unable to successfully master the rapprochement subphase and isthus fixated at this level. It is essential, however, to understand thedynamics of the practicing subphase before proceeding to tackle thenarcissist”s fixation at the rapprochement subphase.
The practicing subphase (age 10 to 14 months) marks the developmental stageat which the child learns to walk. The ability to walk gives the child a wholenew perspective of the world around him. This new ability endows the childwith a sense of grandiosity and omnipotence which closely resemble thenarcissist”s behavior. However, reality soon catches up with the child as thechild enters the rapprochement subphase (age 14 to 24 months). At this stagethe child discovers that he or she is not omnipotent, that there are limits towhat he or she can do. According to Kernberg if the child is severelyfrustrated at this stage he or she can adapt by re-fusing or returning to thepracticing subphase, which affords him the security of grandiosity andomnipotence (Kernberg, 1976).
The Preferred Psychodynamic modelThe Psychodynamic literature in general tends to lean towards the objectrelations school because of the emphasis it places on a comprehensivedevelopmental explanation (i.e. the use of Mahler”s individuation-separationmodel). Nevertheless, the theory of Kohut has left a deep impression onPsychodynamic thinking as is evident by the utilization of many of his conceptsin the literature (i.e. Johnson, 1987; Manfield, 1992; and Masterson, 1981).
Therefore in the remainder of the Psychodynamic section a similar approach willbe taken, by emphasizing object relations concepts with the utilization of theoccasional Kohutian idea.
The Emergence of the Narcissistic PersonalityAccording to Kernberg and the object relations school the crisis of therapprochement subphase is critical to the development of the narcissisticpersonality. The individual who is unable to successfully master thechallenges of this stage will sustain a narcissistic injury. In essence thenarcissistic injury will occur whenever the environment (in particularsignificant others) needs the individual to be something which he or she is not.
The narcissistically injured individual is thus told “Don”t be who you are, bewho 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. Unableto be what he or she truly is the narcissistically injured person adapts bysplitting his personality into what Kohut terms the nuclear (real) self and thefalse self. The real self becomes fragmented and repressed, whereas the falseself takes over the individual. The narcissist thus learns to reject himselfor herself by hiding what has been rejected by others. Subsequently, thenarcissist will attempt to compensate for his or her “deficiencies” by tryingto impress others through his or her grandiosity. The narcissist essentiallydecides that “There is something wrong with me as I am. Therefore, I must bespecial” (Johnson, 1987; P. 53).
The Narcissist”s View of OthersJust as the individual becomes narcissistic because that is what theenvironment “needed” him or her to be, so does the narcissist view others notas they are, but as what he or she needs them to be. Others are thus perceivedto exist only in relation to the narcissist’s needs. The term object relationsthus 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. Hedoesn’t really see and hear and feel who we are and, to the extent that we arenarcissistic, we do not really see and hear and feel the true presence of others.
They, we, are objects, I am not real. You are not real. You are an object tome. I am an object to you” (Johnson, 1987; P. 48). It is apparent than thatthe narcissist maintains the infantile illusion of being merged to the object.
At a psychological level he or she experiences difficulties in differentiatingthe self from others. It is the extent of this inability to distinguishpersonal boundaries which determines the severity of the narcissistic disorder(Johnson, 1987).
Levels of NarcissismThe most extreme form of narcissism involves the perception that noseparation exists between the self and the object. The object is viewed as anextension of the self, in the sense that the narcissist considers others to bea merged part of him or her. Usually, the objects which the narcissist choosesto merge with represent that aspect of the narcissist”s personality about whichfeelings of inferiority are perceived. For instance if a narcissist feelsunattractive he or she will seek to merge with someone who is perceived by thenarcissist to be attractive. At a slightly higher level exists the narcissistwho acknowledges the separateness of the object, however, the narcissist viewsthe object as similar to himself or herself in the sense that they share asimilar psychological makeup. In effect the narcissist perceives the object as”just like me”. The most evolved narcissistic personality perceives the objectto be both separate and psychologically different, but is unable to appreciatethe object as a unique and separate person. The object is thus perceived asuseful only to the extent of its ability to aggrandize the false self (Manfield,1992).
Types of narcissismPending the perceived needs of the environment a narcissist can develop inone of two directions. The individual whose environment supports his or hergrandiosity, and demands that he or she be more than possible will develop tobe an exhibitionistic narcissist. Such an individual is told “you aresuperior to others”, but at the same time his or her personal feelings areignored. Thus, to restore his or her feelings of adequacy the growingindividual will attempt to coerce the environment into supporting his or hergrandiose claims of superiority and perfection. On the other hand, if theenvironment feels threatened by the individual”s grandiosity it will attempt tosuppress the individual from expressing this grandiosity. Such an individuallearns to keep the grandiosity hidden from others, and will develop to be acloset narcissist. The closet narcissist will thus only reveal his or herfeelings of grandiosity when he or she is convinced that such revelations willbe safe (Manfield, 1992)Narcissistic Defense MechanismsNarcissistic defenses are present to some degree in all people, but areespecially pervasive in narcissists. These defenses are used to protect thenarcissist from experiencing the feelings of the narcissistic injury. The mostpervasive defense mechanism is the grandiose defense. Its function is torestore the narcissist”s inflated perception of himself or herself. Typicallythe defense is utilized when someone punctures the narcissist”s grandiosity bysaying something which interferes with the narcissist’s inflated view ofhimself or herself. The narcissist will then experience a narcissistic injurysimilar to that experienced in childhood and will respond by expanding his orher grandiosity, thus restoring his or her wounded self concept. Devaluation isanother common defense which is used in similar situations. When injured ordisappointed the narcissist can respond by devaluing the “offending” person.
Devaluation thus restores the wounded ego by providing the narcissist with afeeling of superiority over the offender. There are two other defensemechanisms which the narcissist uses. The self-sufficiency defense is used tokeep the narcissist emotionally isolated from others. By keeping himself orherself emotionally isolated the narcissist”s grandiosity can continue to existunchallenged. Finally, the manic defense is utilized when feelings ofworthlessness begin to surface. To avoid experiencing these feelings thenarcissist 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).
Psychodynamic Treatment of the NarcissistThe central theme in the Psychodynamic treatment of the narcissist revolvesaround the transference relationship which emerges during treatment. In orderfor the transference relationship to develop the therapist must be emphatic inunderstanding the patient”s narcissistic needs. By echoing the narcissist thetherapist remains “silent” and “invisible” to the narcissist. In essence thetherapist becomes a mirror to the narcissist to the extent that the narcissistderives narcissistic pleasure from confronting his or her “alter ego”.
Grunberger”s views are particularly helpful in clarifying this idea. Accordingto him “The patient should enjoy complete narcissistic freedom in the sense thathe should always be the only active party. The analyst has no real existenceof his own in relation to the analysand. He doesn”t have to be either good orbad-he doesn”t even have to be Analysis is thus not a dialogue at all; atbest it is a monologue for two voices, one speaking and the other echoing,repeating, clarifying, interpreting correctly-a faithful and untarnishedmirror” (Grunberger, 1979; P. 49).
The Mirror TransferenceOnce the therapeutic relationship is established two transference likephenomena, the mirror transference and the idealizing transference,collectively known as selfobject transference emerge. The mirror transferencewill occur when the therapist provides a strong sense of validation to thenarcissist. Recall that the narcissistically injured child failed to receivevalidation for what he or she was. The child thus concluded that there issomething wrong with his or her feelings, resulting in a severe damage to thechild”s self-esteem. By reflecting back to the narcissist his or heraccomplishments and grandeur the narcissist’s self esteem and internal cohesionare maintained (Manfield, 1992).
There are three types of the mirror transference phenomenon, eachcorresponding to a different level of narcissism (as discussed previously). Themerger transference will occur in those narcissists who are unable todistinguish between the object and the self. Such narcissists will perceivethe therapist to be a virtual extension of themselves. The narcissist willexpect the therapist to be perfectly resonant to him or her, as if thetherapist is an actual part of him or her. If the therapist should evenslightly vary from the narcissist’s needs or opinions, the narcissist willexperience a painful breach in the cohesive selfobject function provided by thetherapist. Such patients will then likely feel betrayed by the therapist andwill respond by withdrawing themselves from the therapist (Manfield, 1992).
In the second type of mirror transference, the twinship or alter-egotransference, the narcissist perceives the therapist to be psychologicallysimilar to himself or herself. Conceptually the narcissist perceives thetherapist and himself or herself to be twins, separate but alike. In thetwinship transference for the selfobject cohesion to be maintained, it isnecessary for the narcissist to view the therapist as “just like me” (Manfield,1992).
The third type of mirror transference is again termed the mirrortransference. In this instance the narcissist is only interested in thetherapist to the extent that the therapist can reflect his or her grandiosity.
In this transference relationship the function of the therapist is to bolsterthe narcissist”s insecure self (Manfield, 1992).
The Idealizing TransferenceThe second selfobject transference, the idealizing transference, involvesthe borrowing of strength from the object (the therapist) to maintain aninternal sense of cohesion. By idealizing the therapist to whom the narcissistfeels connected, the narcissist by association also uplifts himself or herself.
It is helpful to conceptualize the “idealizing” narcissist as an infant whodraws strength from the omnipotence of the caregiver. Thus, in the idealizingtransference the therapist symbolizes omnipotence and this in turn makes thenarcissist feel secure. The idealization of the object can become so importantto the narcissist that in many cases he or she will choose to fault himself orherself, rather than blame the therapist (Manfield, 1992).
The idealizing transference is a more mature form of transference than themirror transference because idealization requires a certain amount of internalstructure (i.e., separateness from the therapist). Oftentimes, the narcissistwill first develop a mirror transference, and only when his or her internalstructure is sufficiently strong will the idealizing transference develop(Manfield, 1992).
Utilizing the Transference Relationship in TherapyThe self object transference relationships provide a stabilizing effect forthe narcissist. The supportive therapist thus allows the narcissist to healhis or her current low self esteem and reinstate the damaged grandiosity.
However, healing the current narcissistic injury does not address theunderlying initial injury and in particular the issue of the false self. Toaddress these issues the therapist must skillfully take advantage of thesituations when the narcissist becomes uncharacteristically emotional; that iswhen the narcissist feels injured. It thus becomes crucial that within thecontext of the transference relationship, the therapist shift the narcissist”sfocus towards his or her inner feelings (Manfield, 1992).
The prevailing opinion amongst Psychodynamic theorists is that the best wayto address the narcissist”s present experience, is to utilize a hands-off typeof approach. This can be accomplished by letting the narcissist “take control”of the sessions, processing the narcissist”s injuries as they inevitably occurduring the course of treatment. When a mirror transference develops injurieswill occur when the therapist improperly understands and/or reflects thenarcissist”s experiences. Similarly, when an idealizing transference is formedinjuries will take the form of some disappointment with the therapist whichthen interferes with the narcissist”s idealization of the therapist. In eithercase, the narcissist is trying to cover up the injury so that the therapist willnot notice it. It remains up to the therapist to recognize the particulardefense mechanisms that the narcissist will use to defend against the pain ofthe 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 carefullyexplore the issue with the narcissist, such that the patient does not feelthreatened. The following case provides a good example of the patience andskill that the therapist must possess in dealing with a narcissistic patient.
“a female patient in her mid-thirties came into a session feeling elated abouthaving 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 therapistcould find no opening and made no intervention the entire session except toacknowledge the patient”s obvious excitement about her new job. Then, as thepatient was leaving, the therapist noticed that she had left her eyeglasses onthe table. He said, “you forgot your glasses,” to which she responded with anexpression of surprise and embarrassment saying, “Oh, how clumsy of me.” Thisresponse presented the therapist with a slight seem in the grandiose armor andoffered the opportunity for him to intervene. He commented, “You are soexcited about the things that are happening to you that this is all you havebeen able to think about; in the process you seem to have forgotten a part ofyourself.” The patient smiled with a mixture of amusement and recognition. Inthis example the patient is defending throughout the session and in a moment ofsurprise she is embarrassed and labels herself “clumsy”, giving the therapistthe opportunity to interpret the defense (her focus on the excitement of theexternal world) and how it takes her away from herself” (Manfield, 1992; PP.
The cure of the narcissist than does not come from the selfobjecttransference relationships per se. Rather, the selfobject transferencefunction of the therapist is curative only to the extent that it provides anexternal source of support which enables the narcissist to maintain his or herinternal cohesion. For the narcissist to be cured, it is necessary for him orher to create their own structure (the true self). The healing process is thuslengthy, and occurs in small increments whenever the structure supplied by thetherapist is inadvertently interrupted. In this context it is useful to recallKohut”s concept of optimal frustration. “If the interruptions to thetherapist”s selfobject function are not so severe as to overwhelm the patient”sdeficient internal structure, they function as optimal frustrations, and leadto the patient”s development of his own internal structure to make up for theinterrupted selfobject function” (Manfield, 1992; P. 167).
The Jungian (Analytical) Perspective of NarcissismAnalytical psychology views narcissism as a disorder of Self-estrangement,which arises out of inadequate maternal care. However, prior to tacklingnarcissism it is useful to grasp the essence of analytical thought.
The Ego and the Self in Analytical PsychologyIt is important to understand that the Self in analytical psychology takeson a different meaning than in psychodynamic thought (Self is thus capitalizedin analytical writings to distinguish it from the psychodynamic concept of theself). In psychodynamic theory the self is always ego oriented, that is theself is taken to be a content of the ego. By contrast, in analyticalpsychology the Self is the totality of the psyche, it is the archetype ofwholeness and the regulating center of personality. Moreover, the Self is alsothe image of God in the psyche, and as such it is experienced as atranspersonal power which transcends the ego. The Self therefore exists beforethe ego, and the ego subsequently emerges from the Self (Monte, 1991).
Within the Self we perceive our collective unconscious, which is made up ofprimordial images, that have been common to all members of the human race fromthe beginning of life. These primordial images are termed archetypes, and playa significant role in the shaping of the ego. Therefore, “When the ego looksinto the mirror of the Self, what it sees is always “unrealistic” because itsees its archetypal image which can never be fit into the ego” (Schwartz-Salant,1982; P. 19).
Narcissism as an Expression of Self-EstrangementIn the case of the narcissist, it is the shattering of the archetypal imageof the mother which leads to the narcissistic manifestation. The primordialimage of the mother symbolizes paradise, to the extent that the environment ofthe 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 willdevelop “normally”. It is only when the mother fails to be a “good enoughmother”, that the narcissistic condition will occur (Asper, 1993).
When the mother-child relationship is damaged the child”s ego does notdevelop in an optimal way. Rather than form a secure “ego-Self axis” bond, thechild”s ego experiences estrangement from the Self. This Self-estrangementnegatively affects the child”s ego, and thus the narcissist is said to have a”negativized ego”. The negativized ego than proceeds to compensate for theSelf-estrangement by suppressing the personal needs which are inherent in theSelf; thus “the negativized ego of the narcissistically disturbed person ischaracterized by strong defense mechanisms and ego rigidity. A person withthis disturbance has distanced himself from the painful emotions of negativeexperiences and has become egoistic, egocentric, and narcissistic” (Asper, 1993;P. 82).
Analytical Treatment of NarcissismSince 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 rupturethe therapist must convey to the narcissist through emphatic means that othersdo care about him or her; that is the therapist must repair the archetype ofthe 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 therapistfeel and observe what is not verbally e
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