Understanding And Working With Narcissism
Narcissism has been described in many ways; a stage of development, a characterological structure, a disorder of the self, a type of sexual perversion and a defense mechanism. The Oxford Dictionary (2001) defines it as “excessive or erotic interest in oneself.” Lowen suggested that narcissists can be identified by their lack of humanness and that “narcissism denotes a degree of unreality in the individual and culture, and that the unreality verges on the psychotic”. Many clients have at least some degree of narcissistic disturbance, and for some people, narcissistic wounding might describe their core psychological problem.
The various theories suggest that narcissism can be seen as either a primitive developmental phase or a pathological state with a defensive characterological structure resulting from a developmental problem. Narcissistic personality disorder (NPD) is a disorder of the self in which the sufferer is “self-centred and demanding, overestimating his or her own abilities and specialness, is envious, exploitative and unable to console others’ feelings but underneath this apparent self-importance, the sufferer is often deeply depressed and has profound feelings of emptiness” (Holmes, 2001).
I believe that the origins of narcissistic injury can be traced back to the first years of life, and as an early and deep-rooted part of a person’s personality, it is difficult to change. During normal, healthy development, children go through an important phase of normal narcissism in which they experience being the centre of the universe. All they have to do is cry and the world responds. If all goes well, the child’s grandiosity will be gradually deflated as he or she goes through a series of minor narcissistic wounds. There are two main types of narcissistic structure: exhibitionistic and closet. In the case of the exhibitionistic narcissist, the child never goes through the period of narcissistic wounding; for example, the child’s parents need the child to be special to gratify their own narcissistic needs. They indulge the child, teaching him or her that his or her every wish is a command and that he or she deserves prominence without even minimal effort. Exhibitionistic narcissists want others to be their admiring audience. In the case of closet narcissists, narcissism is a defence against feeling abandoned. They see others as special and unique and want to bask in their glory. Joines and Stewart suggest that people with narcissistic structures were “devalued or not recognised when they were being natural and normal children with dysphoric feelings and dependency needs, and only validated when they were exhibiting a grandiose, false self’.
Shame is a central affect of narcissism. Shame, self righteousness as a defence against shame and the movement between the two parallel the self-deprecation and grandiosity evident in the narcissistic process. This process can also be explained by using the transactional analysis concepts of passivity – in particular, minimisation and grandiosity and the existential life positions of “I’m Not OK, You’re OK” and “I’m OK, You’re Not OK,” respectively. Shame and self righteousness reflect the defences used to avoid experiencing the intensity of how vulnerable and powerless the individual is to the loss of relationship. Shame represents an unaware hope that the other will take responsibility for repairing the rupture in relationship, and self righteousness involves a denial of the need for relationship. Unresolved archaic shame increases the pain of current criticism. In fact, one of the main characteristics of narcissism is an acute sensitivity to criticism.
Shame is, in a basic sense, the experience of not being seen. The parental failure goes far beyond a failure of empathic attunement or mirroring; it is as though the child is of no significance or interest to the parent beyond the child’s meeting the parent’s narcissistic wishes and fantasies. Erskine and Cornell also discuss shame in relation to the Script System. They suggest that with shame, the client has a pervasive and tenacious script belief that “there’s something wrong with me.” The intrapsychic function of this core script belief is to maintain a sense of attachment in the relationship at the expense of a loss in natural self and the fusion of one’s self and one’s behaviour i.e. “I am what I do.” Self and ego do not differentiate. Without the consistent, positive internalised experience of self, the shame-bound individual tends to constantly seek and often tries to earn literal evidence of self-worth and selfhood through performance.
How does this play out in the therapy room? The client projects onto the therapist an all good omnipotent self, who is the source of immediate and eternal gratification, as well as an absolute model toward which he or she can strive. P1+ is an idealised image the client has built up of themselves and has assumed as a substitute for the actual maternal image. The client is searching for a mirror of and for his or her own perfection. By projecting his or her P I+, the client enters a symbiotic relationship. Psychotherapy in this phase is aimed at helping the client “reappropriate” the P1+ that he or she has projected onto the therapist. If the therapist does not accept the projection and symbiotic bid, the client will be left without protection against his or her own destructive P I-. The client will then perceive themselves as “awful” or “dangerous” and, as a defense, will perceive the therapist in the same way because they have experienced them as abandoning. The therapist will have failed in his or her function as transference mirror.
Narcissistic clients are exquisitely sensitive to disappointments, and as they perceive further real or imagined “abandonments” by the therapist, they will invest the therapist with all the negative emotions reawakened in their C1 by the presence of PI-. The therapeutic goal in this phase is for the client to reappropriate the projected bad object without permitting its “destructiveness,” that is, the goal is to confront the client’s defenses and acting out, which he or she uses to avoid suffering and to help him or her make contact with the very real feelings of anger, shame and guilt, and finally to accept these feelings.
As a therapist working with narcissistic clients, I have regular supervision to deal with my own countertransferential reactions (e.g., these clients use projective identification, and induce strong reactions in me). In my work, I feel that it is important to help narcissistic clients see themselves in a realistic light by identifying and relating to attributes of their real self rather than to their idealised self as this is manifested in sessions. They need to learn to tolerate negative feedback. disappointment and failure. I encourage them to observe themselves and have empathy for themselves when they act out (e.g., drinking, overeating, promiscuity, etc.) rather than only feeling their disappointments. For example, I use an empathic reframing of acting out by explaining that there is an important reason for the behaviours. In this way, clients develop empathy for themselves as they learn to stay with their painful feelings, which leads in turn to their developing empathy for others.
When working with narcissistic clients it is important that they take permission to be ordinary. That is, like every other human being they have a need for relationship and to accept that will experience successes, failures and disappointments. This is a huge and important task that necessitates the client learning to neither denigrate nor idealise self or others. The treatment of narcissistically structured clients is difficult and challenging, particularly in the case of pathological and destructive narcissism. It takes a good deal of time and energy to help transform the grandiose self and the primitive object relations (both the defensive and the core pain) into the therapeutically needed relationship.