As the wave of Narcissism has taken over the modern world, this series can’t move on without looking at the workplace. The workplace is where narcissistic wounds are found regularly. With constantly shifting hierarchies, opportunities for stalking, and leverage manipulation, this is the largest source of supply second only to romantic relationships. Treatment of Narcissistic Personality Disorder is often at the behest of human resources, when the narcissism switches from productive to malignant.
Treatment of Narcissistic Personality Disorder
Stress
Victims end up living with a constant release of stress hormones. This leads to illness and employee turnover. Remember, in the past installment, narcissists gain sadistic pleasure at your squirming. They feed off your stress. This strength of theirs, is also their weakness. Like any situation where there is exploitation, the abuser goes too far. Employee morale disappears and eventually the company suffers. As the best employees disappear, and companies grow tired of the complaints. The narcissist is cajoled into therapy.
Where is the self?
For the narcissist, they often have little contact with their true self until they face death, and sometimes not even then. If they do have a chance to confront the true self before death, it is with a therapist trained in dealing with fractured selves. If anyone thinks that Psychologists have an easy job, they will have to change their mind after the conclusion of this article.
Nothing is good enough
What therapists often find when they meet a person with Narcissistic Personality Disorder, is someone who endlessly idealizes and devalues people, including the therapist. Often with barrel-chested body language of domination, the devaluation is already beginning. They may make derogatory comments about the décor of the therapist’s office. They may have made an extensive investigation of the therapist’s credentials, and relationship history. These are bullets to load up their machine gun of devaluation.
Transference
This is where we have to introduce Transference. In psychology, transference is a highly complex web of attitudes that people project onto each other based on past experiences with other people. Counter-transference is the reaction of the transference of others that therapists encounter. Therapists can be so affected by the negative put downs, a devaluing transference, that they unconsciously try to speed up and terminate the sessions with the narcissist personality disordered individual. There can also be idealized transferences projected on the therapist. Then the therapist’s need to help people gets manipulated. The therapist thinks that the patient is getting better, when really they are just getting attention. See: The ‘Ratman’: https://rumble.com/v1gu9qj-case-studies-the-ratman-freud-and-beyond.html
Childhood defenses
To avoid these entanglements the psychologist has to put a light into the patient’s thinking. They have to parse out how these projections are defenses developed in childhood, to protect the self. The ideas of people, or fantasies have to be seen for what they are. They are human needs arising in the mind that haven’t been satisfied. Then the patient has to learn ways of communicating with people and achieving need fulfillment, in healthy ways.
The floodgates open
When the patient is ready to let go of protecting themselves, all these grandiose dreams and ideas come out. The therapist must reserve judgment about how grandiose they are. Many grandiose ideas are so unrealistic to the person’s situation in life, that they can only cause suffering. By allowing the patient to talk about these dreams, and validating them, it increases the trust the patient has with the therapist. What is necessary is to come up with realistic plans that can be achieved to make those dreams come true.
Reconstructing the self
Healthy goals that are achievable and that meet human needs, create a self-image that is more grounded in reality. This develops until the patient becomes grounded. If their need to be grandiose, and to devalue others continues, it is because the scaffolding of self-love is still not there. In the meantime, the therapist, and significant others in the patient’s life, are providing this scaffolding unwittingly.
Lack of mirroring
Remember in our prior installment, the patient in childhood needed that mirroring long enough for the child to internalize a healthy self. If that doesn’t take place then the child grows up needing others to bolster their self-esteem. Narcissists need examples of their good works to feel good about themselves. By creating impossible and unrelenting standards, they need to excessively bolster their grandiose behaviour, and to devalue others to maintain this façade of superiority.
Projection
Hidden in the devaluation is a form of projection, when they can find unacceptable features of themselves in others. This makes them feel less ashamed and alone in their weaknesses. This dynamic creates opportunities for rage if the world exposes weaknesses in the narcissist. Shame being the unconscious feeling, before the rage. This rage can continue in a clinical setting because the patient’s need for validation. By showing off, it can backfire and irritate the therapist, thereby denying what the patient wants.
The therapist experience
Projection can be very forceful. An example is when the patient tries to make the therapist fit a role. This is a mental representation in the mind of the patient. Most human beings, including therapists, need some validation. Therapists say of the experience of treating narcissist patients, that they feel ignored. They say they are only there to play this role for the narcissist’s validation. A series of yawns and displays of boredom from the therapist can in turn cause irritation in the narcissist. This then motivates more devaluation of the therapist. If this cycle persists, then the therapy will be a dead end. These experiences are similar to what the child went through with their caregivers.
Reaction formation
Another vicious cycle can be a therapist doing a reaction formation. A reaction formation is feeling a particular way, but trying to hide that feeling by expressing the opposite emotion. The therapist may come across as glib and false in trying to idealize the patient to disguise irritation. The patient may then become angry, because they are not getting an emotional demonstration of the therapist feeling incompetent. Then the narcissist continues devaluing, while the therapist continues providing empathy. When the unexpressed negative emotions build up in the therapist, they may show off their knowledge, to demonstrate their authority. The narcissistic patient can enjoy a “gotcha moment”, and point out that the therapist is the same as them.
Understanding the source of the devaluation
Therapists need to recollect themselves. They can do this by reminding themselves that all this contempt is based on the patient’s feelings of inadequacy. The therapist’s position and knowledge is a threat to the patient, so they naturally perform a leveling practice with devaluation. This is to prove to themselves that there is nothing to envy in the therapist. Their credentials, their office décor and other areas of weakness are there to mock. The mocking is used to dissipate the anxiety feelings of inferiority of the narcissist. When someone is an omnipotent God then they have nobody to envy. This is how the self-narrative of the narcissist is maintained, and how that narrative becomes more and more distorted.
Basking in the glow
Once the therapist understands this they can shake off those same feelings of inadequacy and envy that were just projected. Understanding and consciousness are what awakens the therapist to what’s going on. On the other hand if a therapist is considered “the best” then the narcissistic patient may just enjoy basking in their abilities, knowledge and empathy as a form of attention supply with no need to develop further. A mutual admiration society. If the therapist is not careful, they may think the patient is just practicing good sense. The therapist can snap out of it by noticing that the patient is basking in this idealization.
Imprisoned between idealization and devaluation
The therapist is stuck between idealization and devaluation, and must interpret what is happening to help the patient. This is the omnipotence and control factor in relationships with narcissists. Therapists can feel subjugated to comply with both these tendencies for fear of punishment from more devaluation. Like an addiction, the vice of needing attention leaves the therapist in utter exploitation.
Boundaries
In response, therapists have to be able to control their outbursts. They do this by allowing themselves to be used in service of the therapy. This is because patients don’t have the skill of self-satisfaction and need others to provide it. Therapists have to move into interpreting and communicating how narcissistic tendencies are counterproductive in their relationships. The patient gains knowledge while seeing these transferences happen in real life. This is a form of understanding boundaries, for both the patient and therapist. When boundaries are absent, both the patient and therapist are wanting people to behave in a particular way, limiting the autonomy that is necessary for patient recovery. Recovery requires the patient to have a realistic assessment of their skills and attributes, without the enormous pain from the self-criticizer of the super-ego. They learn to tolerate their True Self.
Healing
As patients accept their good and bad parts of themselves, they are more empathetic towards others and their struggles. This way they have more freedom of choice and can enjoy their lives without the need for constant narrative control. To be a source of happiness to oneself, unshackles the dependency on others for validation. When one can tolerate failure in oneself then one doesn’t need to blame the world. This is due to the ability to self-soothe and parent oneself.
Who benefits from therapy?
As delightful as this outcome is, it is mostly patients who have less severe narcissistic tendencies that benefit. Firstly, because they have enough awareness from others that they need to change. Secondly, they have some sense of self. For more severely narcissistic patients, they require force from others to go into therapy. Therapy rarely works on them, and is geared towards using their narcissistic tendencies in favor of treatment. For example, the carrot is that their improved behaviour will give them more of what they want. The leverage that the therapist has is to remind them of their relationship losses, and the threat of further loneliness. When patients want to go too far then they have the tools to redirect energies towards goals that serve them.
Realistic outcomes
The worst outcome is when the pathological narcissist uses what they learned in therapy to hurt others with more accuracy. They remain with The False Self. When you have a culture that rewards narcissism, it’s easy for the patient to continue being narcissistic. From birth the narcissist is trained into a shell of a person that is just there to perform for society. Unfortunately they never leave the stage. The sad loss is for the patient to never really know themselves throughout their entire lifespan. With an increasing reliance on reactions from others, a narcissistic culture becomes made up of people feeling empty. This emptiness is because they can’t really know other’s True Selves or know their own True Self.
Understanding and Treating Pathological Narcissism by John S. Ogrodniczuk: https://www.isbns.net/isbn/9781433812347/
Narcissism at Work: Personality Disorders of Corporate Leaders by Marie-Line Germain: https://www.isbns.net/isbn/9783319868370/
Psychology: https://psychreviews.org/category/psychology01/