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Interview granted to The New TherapistBy Sam VakninAuthor of “Malignant Self Love – Narcissism Revisited”

Q. Have you ever been in psychotherapy? If so,NEW THERAPIST: The Narcissist in Therapy Articles was it with a view to managing your narcissism? If not would you consider psychotherapy to be potentially useful to yourself or not?

A. I have attended therapy twice. Once in an attempt to pre-empt the breakdown of the first romantic affair I have had and the second time, I was compelled to by a court order. The first time around, I was not even aware that I had a personality disorder, let alone that I should manage it. The second time around – in the throes of a total meltdown of my world – I finally grasped that something was seriously amiss and was, indeed, in quest for a cure. Alas, psychotherapy proved utterly useless. In my case, it failed to even modify the more egregious forms of misconduct and ill-adaptation. This has to do with the fact that my pathology involves heavy emotional investment (cathexis) in a grandiose, inflated, omnipotent, omniscient, and brilliant False Self. I perceived therapy to be a direct and assaultive challenge to this entrenched self-image.

Q. If forced to choose a therapeutic modality, what would you consider the most potentially valuable for yourself and why?

A. I would opt for CBT (a cognitive-behavioural therapy). It strikes me as cerebral, analytic, and “intellectual”: precisely the traits I admire and which form the dimensions of my self-imputed identity. I feel less threatened when I can avoid directly confronting my emotions. Additionally, CBTs propagate, however subversively and inadvertently, a mechanistic (almost behavioural) view of the psyche. I like it. I often compare myself to a machine or a robot. Positive reinforcements, verbal cues, the emphasis on cognition, inner tapes and narratives (the equivalent of programming) all strike a cord within me.

Q. Pathologically narcissistic clients, it would seem, often end up being forced into therapy more by a difficult context in which they find themselves (a narcissistic wound, the end of a relationship, court-mandated clients, etc.) than as a result of their soul-searching or awareness that their narcissistic pathology is something that would warrant further understanding. Research also suggests that they are prone to early termination of psychotherapeutic treatments because of the narcissistic wounds they suffer when the therapist will not serve solely as a source of narcissistic supply, but attempts to get beneath this constant need for affirmation. In short, pathological narcissists appear to be difficult to get into therapy and, often, very difficult to keep in therapy. In light of the above, and with reference to the understanding you have of what is of value to you in preventing your own narcissistic impulses from causing you longer-term difficulties, light therapy equipment for sale can you look at a few ideas that you might recommend to therapists who wish to be of as much value as possible to their pathologically narcissistic clients? You have suggested that pathological narcissism cannot be cured. I suspect many therapists might agree in large part with that idea on the basis of their disappointing results with narcissistic clients. But, as you suggest, therapists might be able to help manage their expressions of narcissism to help moderate the damaging effects of too rampant a narcissistic engagement with other parts of their world. What, if any, are the therapeutic techniques/approaches/ ideas that you think might be most effective in this more humble goal of managing narcissistic pathology.

A. I see most of the problems with the therapist, not with his or her narcissistic client. Therapists must learn to moderate their expectations and control their own narcissistic defences and impulses. Here are a few tips: (1) it is not possible to establish a therapeutic alliance with the narcissist. Equally impossible is to set the agenda. The therapist must learn to let the narcissist win the inevitable power plays and mind games early on, so as to get them out of the way; (2) the therapist should not let the narcissist corrupt him or the therapeutic settings. Narcissists often offer rewards or “bribes” in return for acquiescence and obsequiousness; (3) the aims of the therapy should be modest and infinitesimally incremental. Progress should be marked and attributed to the narcissist, not to the therapist; (4) the therapy should emphasize adaptive behaviour modification, not reinterpretation, reframing, or “healing”. The therapist should let the narcissist identify areas of dysfunction and discomfort zones and, thus, to direct the therapy towards these sore points; (5) The therapist should never take sides (e.g., sympathize with the narcissist’s long-suffering wife), should never challenge the narcissist’s delusions, grandiose fantasies, and False Self, and should never used the reality test as a measure of the narcissist’s accomplishments in therapy. Narcissism is, by definition, a variant of fantastic realism. It is useful to regard the narcissist as an artist, an auteur: his life is his masterpiece. Narcissism is not merely a mental health disorder: it is also an organizing principle and an exegetic framework; Finally (6) Wherever and whenever not detrimental to therapeutic goals, the therapist should provide the narcissist with narcissistic supply in the form of affirmation, acceptance, deserved accolades, sympathy, and appreciation (but not adulation!)

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