On Narcissism: Psychological Theories and Therapeutic Interventions in the Narcissistic DisordersIntroductionUnderstanding the Narcissistic PhenomenonThe 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, but 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 PersonalityThe narcissists 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 narcissists 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.(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 Therapeutic Essence of Treating NarcissismThe 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 narcissists controlwhich 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 narcissists attempts to steer therapy towards healing the injured grandiose part, rather than exploringthe underlying feelings of inferiority and despair.Differential Psychological Views of NarcissismThe 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 Freuds psychoanalytic theory in 1914 in his essay On Narcissism. Freud conceptualized narcissism as a as a sexual perversion involving a pathological sexual love to ones 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 NarcissismThe 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 everyones psyche. We are all born as narcissists and gradually our infantile narcissism matures into a 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 a 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.Kohuts Theory of NarcissismKohut 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 thecoping 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 the 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).
Kernbergs Theory of NarcissismKernbergs views on narcissism are based on Mahlers theory of the separation-individuation process in infancy and early childhood. Mahlers 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 narcissists 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 of the world around him. This new ability endows the child with a sense of grandiosity and omnipotence which closely resemble the narcissists behavior. However, reality soon catches up with the child as the child enters the rapprochement subphase(age 14 to 24 months). At this stage the child discovers that he or she is not omnipotent, that there are limits to what he or she can do. According to Kernberg if the child is severely frustrated at this stage he or she can adapt by re-fusing or returning to the practicing subphase, which affords him 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 Mahlers 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 PersonalityAccording 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 he or she is not.
The narcissistically injured individual is thus told Dont 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 individuals 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 Narcissists View of OthersJust 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 narcissists 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 doesnt really see and hear and feel who we are and, to the extent that we are narcissistic, 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 to me. I am an object to you (Johnson, 1987; P. 48). It is apparent than that the narcissist maintains the infantile illusion of being merged to 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 NarcissismThe 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 narcissists 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 narcissismPending 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 individuals 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 suchrevelations will be safe (Manfield, 1992)Narcissistic Defense MechanismsNarcissistic 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 narcissists inflated perception of himself or herself. Typically the defense is utilized when someone punctures the narcissists grandiosity by saying something which interferes with the narcissists 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 narcissists 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).Psychodynamic Treatment of the NarcissistThe 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 patients 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. Grunbergers 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 doesnt have to be either good or bad-he doesnt 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 TransferenceOnce 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 a severe damage to the childs self-esteem. By reflecting back to the narcissist his or her accomplishments and grandeur the narcissists 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 narcissists 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 grandiosity. In this transference relationship the function of the therapist is to bolster the narcissists insecure self (Manfield, 1992).The Idealizing TransferenceThe 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 TherapyThe selfobject 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 narcissists focus towards his or her inner feelings (Manfield, 1992).
The prevailing opinion amongst Psychodynamic theorists is that the best way to address the narcissists 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 narcissists 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 narcissists experiences. Similarly, when an idealizing transference is formed injuries will take the form of some disappointment with the therapist which then interferes with the narcissists 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 backwardsfrom 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 patients 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 seem 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 of the narcissist than does not come from the selfobject transference relationships per se. Rather, the selfobject 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. In this context it is useful to recall Kohuts concept of optimal frustration. If the interruptions to the therapists selfobject function are not so severe as to overwhelm the patients deficient internal structure, they function as optimal frustrations, and lead to the patients development of his own internal structure to make up for the interrupted 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 tackling narcissism 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 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). Narcissism as an Expression of Self-EstrangementIn 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 childs archetypal expectations. Nevertheless, so long as the mother reasonably fulfills the childs 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 childs ego does not develop in an optimal way. Rather than form a secure ego-Self axis bond, the childs ego experiences estrangement from the Self. This Self-estrangement negatively affects the childs 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).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 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 narcissists needs. Just as a mother can intuitively sense her babys 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). The Existential Perspective of NarcissismExistentialists perceive narcissism to be a byproduct of an alienating society. 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 societys 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).
Existential Treatment of NarcissismThe 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 (Client-Centered) Perspective of NarcissismThus far, no specific formulations have been advanced by humanistic theorists about the etiology of the narcissistic condition. Nevertheless, by utilizing general humanistic principles it is possible to explain narcissism.
Essentially, much like the psychodynamic explanation, humanistic psychology would argue that narcissism results when individuals are not allowed to truly be who they are.According to humanistic theory, humans have an innate need for self actualization. We want to be the best person that we could possibly be. This is accomplished by internalizing the behaviors that fit with the individuals personal self concept (that which the individual finds to be appealing). However the self is also subject to pressure from significant others. Significant others place upon the individual, conditions of worth, upon which their love and approval is dependent. These conditions may or may not be congruent with the individuals personal self.
If they contrast sharply with the personal self, and the individual does not want to risk loosing the approval or love of significant others, then that individual will behave in ways maladaptive to his or her self actualization needs. Although humanistic theory does not elaborate on the specificity of these maladaptive behaviors, it is possible to speculate that narcissism is one possible outcome. Specifically, the Words/ Pages : 5,294 / 24