Interventions in the Narcissistic Disorders

Introduction

Understanding the Narcissistic Phenomenon

The 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 Personality

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.

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 Narcissism

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 narcissists attempts

to steer therapy towards healing the injured grandiose part, rather than exploring

the underlying feelings of inferiority and despair.

Differential Psychological Views of Narcissism

The 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 Freud's psychoanalytic theory in 1914 in his essay 'On

Narcissism'. Freud conceptualized narcissism as a as a sexual perversion involving a

pathological sexual love to one's 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