Psychological Theories and Therapeutic Interventio

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Psychological Theories and Therapeutic Interventions in the Narcissistic Disorder





Psychological Theories and Therapeutic Interventions in the Narcissistic Disorder
The ‘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;
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