narcissist Archives - Brighton and Hove Psychotherapy

September 18, 2023 by BHP Leave a Comment

Can psychotherapy help narcissists?

In my last two blogs on the topic of narcissism, I have covered off what narcissism is (and is not), and provided my perspective on whether we are, collectively, becoming more n arcissistic.

In this final blog (for now) on this topic, I shall offer my perspective on the commonly asked question of whether psychotherapy can help narcissists? As with pretty much every question relating to mental health and psychotherapy, the answer to this seemingly simple question is ‘it depends’.

First off, what is mean by narcissism? Has the person in question received a diagnosis of having a narcissistic personality? And if so, by whom?

The clinical definition of narcissism is one that differs significantly from how the term has been hijacked and is now used in popular culture. Clinicians are far less concerned with outward behaviour that pop culture seems to label as narcissistic and instead think about how the personality of the patient is organised. We are all capable of selfish and inconsiderate behaviour at times, however, this does not mean that we all have narcissistically structured personalities.

I shall not revisit the detailed clinical definition in this blog as for those of you who are interested, you can read more here. However, in summary, someone who has a narcissistic personality style ‘scaffolds’ their sense of self through constant external validation. They therefore have a very fragile sense of self – of who they really are – and instead define themselves by their purchases, conquests or achievements. How most narcissists portray themselves to the outside world (and to themselves) is in direct contrast to how these folks feel on the inside – insecure, inadequate and unlovable.

There is a second type of narcissistic personality which is generally overlooked and often misdiagnosed and that is the deflated or collapsed narcissist. On the face of it deflated narcissists seem to be the opposite to their grandiose counterparts in that they present as depressed and as if nothing they have ever done is any good. However, unlike people with depressive personalities, deflated narcissists are filled with a sense of rage and injustice that they have not been afforded the life and opportunities they believe they deserve – in other words, their internal world is grandiose and consumed by fantasy, whilst externally they seem collapsed.

OK, so now we know what we are dealing with, I can return to the question of whether narcissism can be treated?

The successful treatment of any patient in analysis or psychotherapy is dependent on that patient’s desire to change. As treatment unfolds, it often becomes clear to the patient what change involves and that all change on a structural level is slow and painful. Whilst many people successfully engage with psychotherapy, most if not all harbour a secret wish that change can happen without them actually having to change! This is generally an even stronger fantasy in the world of the narcissist.

Unlike other conditions, people rarely if ever present for therapy because ‘they are narcissists’ – after all, why would they? They are not the problem – everyone else is!

As long as the narcissistic person’s defences (systems of external validation) are working, then they simply will not see that there is a problem. If someone with a narcissistic structure does attend therapy it is either because their defences have failed and they want help putting them back in place, or they have reached an age (usually middle-age) where they realise that the quality of their relationships is limited to non-existent and they want to understand why. The latter is the hopeful position.

In clinical language, there are couple of formulas that enables us to evaluate how successful psychotherapy is likely to be for someone with a narcissistic personality: firstly, how rigid is the personality – the more rigid and towards the realms of personality disorder, the less likely treatment will be successful; secondly, whether there narcissistic personality is combined with elements of psychopathy (anti-social personality). Where someone has a strong combination of narcissism and anti-social traits (or sadistic traits) then treatment outcomes are very poor.

Assuming we are dealing with someone who has a dominant narcissistic personality, but one that is neither too rigid nor mixed with sadism or anti-social traits, then there is hope.

The two approaches

There are two main schools of thought in the psycho-analytic community around how best to treat narcissism which were put forward by two of the main thinkers in the field – Kohut and Kernberg.

Kohut proposed that because what has been lacking in the narcissistic patient’s childhood was an empathic and attuned parent who could see the child’s needs, the work should therefore focus on an empathic and attuned approach of validating the patient’s feelings and working to enable the patient to both bear their ordinary vulnerability as well as to combat their shame about having emotions.

Kernberg, who it has been argued focuses more on the pathological end of the spectrum, takes a more confrontative approach to the narcissistic patient and advocates (in the context of a robust therapeutic relationship) the need to challenge the perspective of the narcissistic patient and to push them to consider the experience of those with whom they are having a relationship. Kernberg’s theory centres around challenging the narcissists central tenet that everything and everyone revolves around them.

So which is right?

The correct approach to treating a patient with a narcissistic personality will be tailored to that patient by the clinician – just as it is for every patient.

My perspective on treating patients is that where there is genuine will on the part of the patient, treatment outcomes are often successful.

Psychotherapy, whether for someone with a narcissistic personality, or indeed any presenting issue, is a courageous endeavour. What brings most of us to therapy is a need for change and change is frightening and painful.

Whilst it is a part of my role to assess and evaluate whether a patient is suitable for psychotherapy, I do this from a clinical and ethical position, rather a moral one. If I cannot help someone, or believe therapy will exacerbate their symptoms or push them into psychosis, I have a duty to not take them on and to refer them for other treatment.

Narcissism, contrary to TikTok and other social media platforms, is not a trait that can be diagnosed just on how someone behaves or treats us. Often it takes a fair number of sessions before I fully understand that someone is developmentally stuck with a narcissistic personality that dominates. However, as long as they want to attempt to enter into a relational world of others then I believe there is hope.

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy. Mark is available at the Lewes and Brighton & Hove Practices.

Further reading by Mark Vahrmeyer

Are we becoming more narcissistic?

What is narcissism?

The medicalisation of mental distress

Can chatbot companions relieve our loneliness?

What are feelings anyway?

August 14, 2023 by BHP Leave a Comment

Are we becoming more narcissistic?

We are living in the age of narcissism – or so the media would like us to believe. People in The West seem to be focussed largely on themselves and the pursuit of happiness – the answer to which for increasing numbers of the populace is to be found in the soundbites of TikTok celebrities or from the wisdom of other social media ‘influencers’.

But are we collectively becoming increasingly narcissistic and what does this mean?

In my last blog I dispelled some of the myths around this condition and explained rather than it being a description for a set of behaviours, it is a personality style and in its more rigid manifestations, a debilitating one from a relational perspective. I shall therefore not be revisiting all that again and you can read my in-depth blog on what narcissism actually is here.

The argument that behaviour tells us anything much about a person’s personality structure – particularly when it comes to narcissism – is naïve and reductive.

Changes in behaviour online

We know that people behave differently in online interactions as compared to when they are face-to-face with another human being. It is the actual, as well as the perceived distance, from the other’s humanness that seems to give many licence to behave in selfish and thoughtless ways.

Whenever we cease to view the other as human and objectify them, we are not acting relationally as the very word ‘relational’ implies a willingness to understand another’s perspective and to be able to tolerate difference, even if we don’t much like their views.

Is modern man (and women) less able to tolerate differences than prior generations? I am not so sure. What I do know is that the internet, and specifically social media, provides platforms to both those who rather like the sound of their own voice (but arguably have little actual wisdom to impart) and it provides a huge scope for attracting an audience.

Where not so long ago an individual may have believed that they held the key to a successful life (whatever that means), they may have attracted a few lost souls in their tribe, village or town. Now, with expert ‘curation’ of their message and image, they can reach the whole world.

On narcissistic personalities

Behaving in a selfish or egocentric way does not mean that someone is a narcissist. Certainly narcissists can be grandiose, self-centred, entitled and enjoy the sound of their own voice, however we can all at times behave in this way.

Narcissism is a personality style, and we all have a mix of personality styles, generally with one or two that dominate a little more than others. If someone has a narcissistic personality then this particular style of personality is dominant and can be viewed on a continuum (of rigidity) from pathological through to personality disordered.

In psychoanalytic theory, clinicians view these personality styles as being primarily laid down by our early infant and childhood experiences (generally up to around the age of two).

Someone who has a narcissistic personality has not been related to as a separate individual but rather has learnt from a very early age to adapt their behaviour to the needs of their caregiver. In essence, they have internalised the message ‘do not exist’. As a result of learning that their role is to meet the needs of others (their primary carers), the child in question develops a ‘false self’ to compensate – they present a front to the world suggesting that they are perfectly fine.

Beneath this front is a vulnerable child who cannot show his or her feelings for fear of abandonment by the parent. For narcissistically structured people, others – relationships – are a major problem. They need others, however, they also profoundly fear being used or ‘taken over’ by others and so to defend themselves by objectifying those around them. Relationships are about doing or being done to, rather than love.

How might this apply to the collective?

My sense is that it is unlikely that there is now a sudden increase in parents who are failing their children and raising narcissistically structured personalities. However, as the old adage goes, ‘it takes a village to raise a child’ – no child is solely influenced by their parents.

The clinical research would suggest that we are not becoming more narcissistic in terms of personality style, however, what has exponentially changed are two major factors: we have lost collective meaning because the world is changing too fast for us to cultivate and uphold meaning, and secondly, technology is playing an all encompassing role in dehumanising us.

The role of meaning

Human beings are meaning making creatures and we live in a symbolic universe which is probably what renders us unique amongst animals. I have previously written a piece on the role of Culture and the need for belonging in enabling us to have healthy self esteem, which you can read here.

Essentially, as traditional values and means of making meaning either fall away or are dismantled, we are left with two problems: higher anxiety and less collective means of gaining self esteem.

This may then cause us to both behave in more individualistic and hedonistic ways to feel alive but without substance – we deny our vulnerability by becoming more narcissistic.

The role of technology

We are at the start of a technological revolution where only our imagination can predict what the world, and by extension, our relationship to it and others in it, will look like.

Technology is not intrinsically good nor bad – it depends on how we use it. And to date how we have used it is in a rather dehumanising fashion. Convenience has trumped connection and this can be seen in the proliferation of parasocial relationships (where we have relationships with influencers or YouTubers and believe they are real and personal, when they are in fact one-way), and the evolution of dating through online apps whereby we have commoditised ourselves.

On the symbiotic relationship between Echo and Narcissus

The origins of narcissism were taken, largely by Freud, from the 2,000 year old myth written by Ovid. This Greek myth – a myth being a story that reflects a collective truth – is entitled ‘When Echo meets Narcissus’ and whilst most people are to some degree familiar with the myth, it is often misconstrued: many believe that Narcissus fell in love with his reflection in a pool of water; And few even know of the role of Echo.

Narcissus is someone who is admired by all and who cannot tolerate intimacy. Echo, meanwhile, is a river nymph whose voice has been taken by Juno, the Goddess, for gossiping. Echo can therefore only repeat the last words she hears.

This is how the stage, and the symbiotic relationship, between Narcissus and Echo is set both on the myth and for all time: Narcissus needs Echo just as much as Echo needs Narcissus but neither can have a relationship with the other – they are in symbiosis.

Returning to the question of whether technology and specifically how online relationships are being shaped is rendering us more narcissistic, if it is it is, it also rendering us more like Echo – willing to sacrifice our voice to be in the shadow of those we admire; we believe that there is a relationship happening but there simply is not.

Narcissistic people need echoists; we are collectively responsible for admiring those who need to be admired rather than having something of substance to offer. Human beings are adaptable to our environment – it is why we have been able to colonise every corner of the globe. Equally, we absolutely need relationships, as we are shaped and formed not only in childhood by relationship, but throughout our lives.

My view is that as a result of a combination of both a loss of meaning and the ease of online interactions, we dehumanise both ourselves and others and thus become more narcissistic, or at least egocentric. However, unlike those with true narcissistic personalities, it is reversible and as a clinician I know only too well the power of change that comes from a therapeutic relationship.

Further reading by Mark Vahrmeyer

What is a narcissist?

The medicalisation of mental distress

Can chatbot companions relieve our loneliness?

What are feelings anyway?

Client or patient; patient or client – does it matter?

The psychological impact of the recession

July 3, 2023 by BHP 2 Comments

What is narcissism?

Since the time of Sigmund Freud, clinical terms around psychology have made their way into everyday language. Narcissism is no exception to this and yet it stands in a category of its own for both how ubiquitous it has become in popular culture, alongside also being so misunderstood.

Frequently used as a term of insult or abuse to describe someone who displays little regard for others, narcissists are defined in society by their outward displays of behaviour. However, for a ‘condition’ that evokes so much of a backlash, collectively we seem to secretly admire the fantasy life we attribute to narcissists and envy the way they glide through life unaffected by the trials and tribulations of us mere mortals. Narcissism and narcissists are envied and denigrated in equal measure.

Alongside the ubiquity of the term, there is no shortage of material available to enable us to navigate a world filled with narcissistic others. From podcasts to YouTube seminars, TikTok videos to old fashioned books, narcissism is everywhere. Many titles suggest an extreme danger or risk of being near or around narcissists with titles such as ‘surviving narcissism’, ‘narcissism epidemic’ and ‘defeating narcissism’ being common. And yet most of these resources fundamentally fail to understand the essence of narcissism and what constitutes a so- called ‘narcissist’.

Indeed, it is interesting that of all the personality styles, such as depressive or obsessive-compulsive, it is this personality style that has become a label for the entire human being: rather than having a narcissistic personality, people are simply labelled as narcissists.

Popular culture
In recent years few clinical terms have been adopted and taken on a life of their own outside of the clinical context above and beyond narcissism.

When popular culture references narcissism or labels an individual as narcissistic, this is generally based on witnessed behaviour, rather than on any deeper understanding of what may have driven that particular behaviour. Popular culture is not wholly to blame for this as the field of mental health has for years been steadily shifting to diagnosing and labelling based predominantly on outward behaviour, rather than from an understanding of personality dynamics.

The problem is that the word that in a clinical context is used to describe traits or the style of a person’s whole personality, is being used as a description of behaviour – ‘he is behaving really narcissistically’ – which may or not have anything to do with the person’s personality; the behaviour tells us very little. In fact, I am not really sure what ‘behaving narcissistically’ even means!

It is not that there is no truth to the ‘watered-down’ formulation of narcissism in the mainstream, it is just that like so many other mental health terms, the nuance and balance has been lost, not least in the context of the ‘narcissists’ experience of being this way. Fundamentally, what’s lost is empathy.

Narcissism is not an illness, it is a personality style
I would suggest that the psychoanalytic field provides us with the most accurate understanding of narcissism and its impacts, as rather than focusing on external patterns of behaviour, psychoanalytic theory considers both the inner world of the patient – what it is like to be them – and their relational world – how do they relate to themselves and others. In other words, when clinicians talk about narcissism they are referring to a particular type of personality that has ‘narcissism’ as its dominant style.

What is a personality?
Personalities are something we all have and whilst we generally have a mix of styles, most of have a dominant one. So, when we consider somebody’s personality style, we are thinking about what trait is dominant and how rigid their personality is – this can be imagined as a scale from healthy functioning, through to personality disorder (and just to further muddy the waters, there is little agreement on at what point someone is personality disordered).

However, there is a further complication when considering narcissism: narcissism like all more dominant personality styles, one that has come about through relational injury during the first two years of development. It rarely appears in isolation to other personality styles and the other main personality styles frequently, if not always, show elements of narcissism in their foundations. It is therefore not always easy to spot.

What are the traits of a narcissistic personality style?
Most people who have a narcissistic personality present outwardly as grandiose, entitled, selfish and are constantly looking for external validation. However, what presents externally as grandiosity belies an internal world characterised by a deep sense of inadequacy and fear.

People with narcissistic personalities fear ‘being found out’ – they fear intimacy and vulnerability as they imagine everyone will see what they see: that they are unlovable.

There exists in the narcissist a constant drive to shore up their fragile self esteem through the external world – what they buy, who they are seen with, what they achieve. Whilst we all garner external validation to some extend in these ways, most of us have a solid enough sense of self to hold onto a real sense of self esteem that does not need scaffolding.

When it comes to relationships narcissistic people face an enormous dilemma as they desperately need others – to both tell them how wonderful they are, as well as to avoid their primal feelings of abandonment. However, they cannot relate in a two-person manner, meaning that whilst they need greatly, they love shallowly.

Narcissistic people protect themselves at all costs against ‘narcissistic injury’ which comes about when their feelings of shame are triggered. And feelings of shame arise when narcissistic people are challenged or called out – it is unbearable for them and they respond with shame which is transformed into rage. This holds the key to why narcissistic people cannot have real relationships: they cannot content with difference which is what we encounter when we are in a real relationship with another ordinary complex human being.

There is one other ‘type’ of narcissistic style which often gets missed in clinical diagnoses and that is the depressed, or collapsed, narcissist. On the face of it this person would seem to be the opposite of the grandiose narcissist and this is in fact correct! However, what looks to be collapsed, depressed and an outward expression of worthlessness, hides an inner world where this character feels utterly entitled to far more than they have and are. They are rageful that the world has treated them in this way and secretly feel entitled to specialness.

Final thoughts
Narcissim is a complex topic to grasp and even clinicians often struggle to fully make sense of whether someone if a narcissist or not.

One of the problems is that people with this structure tend not to present for psychotherapy and if they do it is never because they feel ‘narcissistic’. It is therefore not a condition that is in their awareness.

There are no dependable tests to check for narcissism and just because someone behaves in selfish or egocentric ways, it tells us nothing about their personality structure – after all, can’t we all be selfish at times?

Ultimately, a skilled clinician works out through the therapeutic relationship whether someone is narcissistic. It is a combination of understanding the clinical theory as well as relying on their felt experience. Being in relationship with a narcissistic personality does not feel like an ordinary relationship. They may greatly need you or ‘brush you aside’, or a combination of both but what they cannot do is relate in an equal two-person manner. Their vulnerability and humanness is hidden for fear of shame and abandonment – the narcissistic injury.

Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy. Mark is available at the Lewes and Brighton & Hove Practices.

Further reading by Mark Vahrmeyer

The medicalisation of mental distress

Can chatbot companions relieve our loneliness?

What are feelings anyway?

Client or patient; patient or client – does it matter?

The psychological impact of the recession

July 11, 2022 by BHP Leave a Comment

Antidotes to Coercive, Controlling and Narcissistic Behaviour

There have been many more articles written on Narcissism in recent times, as it seems to be the age we are living in.

Narcissistic political, organisational, and religious leaders who lack accountability, manipulate information, and deny any wrongdoing has become a normal phenomenon across the world. This is not a new problem – narcissists have always existed and will continue to do so. In fact, every one of us has some degree of it, which is not necessarily a bad thing. A healthy degree of self-belief and self-confidence is in fact necessary. Narcissism of a more problematic kind exists on a spectrum, ranging from higher- than-usual degree of self-centredness to a deluded idea of omnipotence and specialness.

These characteristics are problematic because when the focus is on oneself only, the other simply becomes a means to an end, rather than a relationship between two human beings with differing needs. Clearly, relationships with narcissists can be very difficult. Unless the other is a good reflection of the narcissistic self and helps sustain their self-image, then the relationship will go smoothly. In fact, it can feel good to be a part of this ‘narcissistic bubble’. However, if the person disagrees, has their own opinion, or wants to assert their difference, then things can quickly take a turn for the worse.

The narcissistic character will do everything they can to maintain a good image of him/herself, which often involves projecting anything that is perceived as bad onto the other.

This is usually paired up with an inability to take responsibility, emotional immaturity, and the portrayal of a false sense of self-confidence. The key here is that the person is operating from a self that is idealised, inflated and false, rather than a real self which incorporates good and bad aspects, and is realistic about its limitations.

Deep down, the narcissist feels vulnerable but will do all it takes to protect themselves from this feeling. Unfortunately, people with a strong narcissistic disposition will prey on the vulnerable, using them to achieve their own gains, project uncomfortable feelings onto them, attack, undermine, and belittle them.

At this point you might be asking yourself “why would anyone choose to be in a relationship this bad?” Those in a relationship with a narcissist can go from feeling very special to feeling persecuted, manipulated, intruded upon, and objectified. A typical example would be a situation of domestic violence. It is usually very hard to leave because one is either kept in fear or hopes for the return to a time when things “felt really good”.

The Antidote

Building up self-esteem and self-confidence is an important aspect of making healthy relationship choices. We all have self-doubt, but excessive self-doubt leads to a vulnerability to manipulation and control. A healthy degree of self-belief and self-esteem can help in asserting needs and act as a protective mechanism against self-doubt that can feel paralyzing in the face of coercive, manipulative and controlling behaviour. It also sends a strong message out that your mind is your own and you are not vulnerable to control.

Setting strong boundaries is another vital antidote. Taking more ownership of your physical and psychological space, sending the message that you will not be intruded upon without consequences, and reasserting your boundaries again and again will go a long way towards self-protection. If this isn’t respected, then trusted others may need to become involved in helping you create a strong self-protective shield around you. In the extreme case of violent intrusions, criminal and abusive behaviour, reporting the crime might be the only way to set those boundaries. Even in less severe cases of manipulation and intrusion, it is going to be helpful to set strong boundaries and stick with them.

Don’t be seduced by an illusion of specialness. There are different ways to feel special – are you being seen and respected for who you really are, or because you conform with who the other wants you to be? Do you feel valued or seen for your own virtues, feelings and thinking? Are you being encouraged to be who you are, even if you disagree with them? Do you feel you can be different, separate, do your own thing? Are you often put down, belittled, or told that you are no good?

Psychotherapy can help with assertion, boundary setting and improving self-esteem. Most importantly, it is a space to examine the motivation for relationship choices and unhealthy beliefs about self and others.

Sam Jahara is a UKCP Registered Psychotherapist, Superviser and Tavistock Certified Executive Coach. Sam has recently been interviewed by Talk beliefs on the harmful impact that cults have on children, drawing from her personal and professional experience. See the link to Sam’s interview.

Further reading by Sam Jahara

An in-depth approach to leadership coaching

Demystifying mental health

Women and Anger

Why all therapists and mental health professionals need therapy now more than ever

Fear and hope in the time of Covid – part 2