FREE ESSAY ON PSYCHOLOGICAL THEORIES AND THERAPEUTIC INTERVENTIONS IN THE NARCISSISTIC DISORDER

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; 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 amongst 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 backwards 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 cure of the narcissist
than 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, 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.
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, 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)
In 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
child's archetypal expectations. Nevertheless, so long as the mother reasonably fulfills
the child's 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 child's ego does not develop in an optimal
way. Rather than form a secure 'ego-Self axis' bond, the child's ego experiences
estrangement from the Self. This Self-estrangement negatively affects the child's 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). 
Since 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 narcissist's
needs. Just as a mother can intuitively sense her baby's 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).
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 society's 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).
The 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 treatment of the narcissist is in general no different from the humanistic
treatment of any other client. The humanistic therapist wants the narcissist to
rediscover his or her individuality, which was suppressed by the conditions of worth
imposed by significant others. In order to accomplish this, the proper environment must
be set in therapy, free of any conditions of worth. The narcissist must feel that
whatever he or she does is all right with the therapist. The therapist therefore gives
the narcissist unconditional positive regard. There is no judgment of the narcissist,
instead the therapist honestly and caringly tries to see things through the eyes of the
narcissist. When the narcissist comes to accept his or her true needs he or she will be
congruent with the personal self and the narcissistic front will no longer be needed.
Each of the psychological approaches discussed above contains both strengths and
weaknesses, in attempting to solve the narcissistic puzzle. Nevertheless, the
psychodynamic model possesses a big advantage over the other approaches in its ability to
offer both a comprehensive theory of etiology and a detailed description of treatment.
With respect to etiology the other approaches suffer from: a lack of concrete
observational validity (the analytical approach), lack of clarity in capturing the
essence of narcissism (the existential approach), and lack of continuity in predicting
narcissism (the humanistic approach). The analytical model of narcissism depends on too
many hypothetical concepts, such as the collective unconscious, which are not supported
by any concrete evidence. By emphasizing the narcissist's tendency to withdraw into the
pleasures of the self, existentialists overlook the immense suffering which so
characterizes the narcissist. With respect to treatment the major advantage of the
psychodynamic approach is that it goes beyond the exclusive use of emphatic means to
treat the narcissist. By limiting treatment to emphatic understanding the other
approaches fail to address the underlying issues inherent in narcissism. Therefore, the
other approaches might shore up the narcissist's damaged self-esteem in the short run,
but it is doubtful if they will be able to transform the narcissist. Possibly the only
weakness of the psychodynamic approach lies in the length that it takes to treat
narcissism. Recall that a successful psychodynamic treatment requires the therapist to be
very careful about maintaining the narcissist's delicate self-perception. Only gradually
can the psychodynamic therapist direct the narcissist's attention towards the real
underlying emotional feelings. 
No matter which approach is utilized in the explanation and treatment of narcissism it is
important to recognize that the narcissistic individual is a complex and multifaceted
human being. Deep inside narcissistic individuals experience tremendous pain and
suffering, for which they attempt to compensate for by the projection of the grandiose
front. These people are not character disordered. They are people tortured by
narcissistic injury and crippled by developmental arrests in functioning which rob them
of the richness of life they deserve. They are good people, who are hurting. They are
living and suffering the narcissistic style. 
Bibliography 
References
Asper, Kathrin. (1993). The abandoned child within. New York: Fromm International
Publishing Corporation. Carson, Robert C & Butcher,
. Johnson, Frank A. (1977). Narcissism. New York: International Universities Press Inc
. Manfield, Philip. (1992). Split self/split object Understanding and treating
borderline, narcissistic and schizoid disorders. New York: Jason Aronson Inc.
. Monte, Christopher F. (1991). Beneath the mask: An introduction to theories of
personality (Fourth edition). Fort Worth: Harcourt Brace Jovanovich Publishers
Schwartz-Salant, Nathan. (1982). Narcissism and character transformation. Toronto: Inner
City Books