Narcissism is a very common trait in humans. In the following post, we discuss the basic considerations when addressing it in a consultation.
The Narcissist and Their Identification as Such
Narcissists can be charming and fascinating. They possess a power of seduction that fills any space they are in. Always impeccable, they strive to appear surrounded by signs of wealth, beauty, prestige, or power. They know how to make an impact and stand out, dropping the right names and constantly trying to impress their surroundings, always seeking the spotlight and influence. All of this is nothing less than a “disease of our time” as Alexander Lowen said, and it’s because we live in a society that approves certain qualities and goals inherent to narcissism, albeit subtly and indirectly, paying obsessive attention to certain aspects that we later disapprove of. If I had to give an example of this, it would be like a television show breaking audience records day after day, but then no one ever admitting to having watched it.
Narcissism has aspects that cannot be attributed to a histrionic trait or some eccentric personality quirk, but rather configure as a genuine disorder, which entails inevitable suffering for the narcissist’s environment, generally leaving behind a disastrous trail of manipulations, betrayals, paranoia, cruelty, and uncontrolled anger, and concealing at its core a great inner emptiness, an inability to give and receive affection, with the narcissist remaining in an insatiable search for fantasies of glory, power, brilliance, beauty, or ideal love that they tirelessly elaborate (DSM-IV-TR).
Differences Between Narcissism and High Self-Esteem
Firstly, it must be noted that it is a mistake to confuse narcissism with having high self-esteem. Although, undoubtedly, a certain narcissism is necessary and essential if we understand it as a sense of self-worth (McNeal 2008). In fact, in a healthy person, this contributes to them feeling worthy and valuable simply for being themselves; they feel valued and persist in achieving their goals and dreams. This is a sound and healthy development; self-esteem is a process and should be understood as such. However, for the narcissist, this process becomes an end in itself, the ultimate goal of their existence, and being so vital, it is maintained at anyone’s expense, degenerating into a constant search for external validation, in which others often become obstacles or objects to manipulate, serving their craving to be recognized as truly grandiose and unique.
Does the Perfect Narcissist Exist?
But, paradoxically, the perfect narcissist does not exist except in the pages of diagnostic manuals: their characteristic points are often mixed, configuring comorbídly with criteria typical of histrionic, antisocial, and borderline personality disorders (Kernberg 2007), with the prognosis being much more negative if configured with the latter.
The Narcissistic Personality
Nor should we confuse their behavior with antisocial personality disorder, since, although it is true that the narcissist uses people to ascend and stand out, their life philosophy ultimately depends on other people, on their flattery, their praise, and the physical, emotional, and economic satisfactions these can provide them. In fact, on many occasions, they move in circles of privileged people in some aspect with the aim of “luring” new admirers, whom they consider to be “at their same level.” They also coincide in the lack of empathy, but in narcissism, a truly convincing pseudo-empathic mask is displayed. The main difference with antisocial disorder from this perspective is that the latter do not require the admiration or applause of other people, but rather use them and transgress their rights without intending to obtain any recognition, only benefits.
Much has been written about the genesis of narcissism, mainly from psychodynamic approaches. In principle, we could assume that all this display of self-glorification and lies comes from an inferiority complex, as Adler postulated, used to compensate for a feeling of deficiency, probably the result of emotional deprivation in childhood. However, this position, despite being attractive, has little empirical support. In fact, the consequences of this type of childhood tend more towards apathy, avoidance, poor development of social skills, and null or scarce interaction, almost always leading to a depressive state (Harrow 1959, Yarrow 1966).
A more promising position that also places its origins in the narcissist’s childhood emphasizes the concept of self-esteem, viewing it as something learned early on and accepting that it has a decisive weight in human behavior. It is possible, then, that the influence of the child’s parents is crucial. Indeed, there is a characteristic parenting pattern for personalities that later reveal narcissism: a lack of transmission of that “healthy narcissism” to which we referred. That is, instead of helping the child develop a positive self-image and a correct sense of self, which will help them in the future to develop a correct perception of their abilities and limitations, an exaggerated modeling of the child’s abilities and achievements occurs, without giving them realistic feedback that would later help them develop proper frustration tolerance, or by setting totally unrealistic goals. In this way, the potentially dysfunctional and overvalued self is progressively reinforced through the privileged equation, endless privileges, and self-fulfilling prophecies in the form of “mandates” to their children (Van der Waals 1962 Sharp 1980). Thus, later in adult life, the slightest frustration will translate into completely out-of-place fits of rage; there will be no acceptance, no recognition, nor any humor possible in the face of mistakes made. Only resentment and desires for revenge will accumulate. This, coupled with the sensation of superiority and uniqueness, of deserving everything in the world, so characteristic of narcissistic personalities, will lead to the constant inability to distinguish between image and self, resulting in a life not lived, but acted.
What recommendations can be made when working with these patients? My university education, the subsequent Master’s in Clinical and Health Psychology from ISEP, and my experience (and being completely honest) assure that the attendance of this type of patient in psychological consultations is scarce or null. If they do attend, it will generally be out of obligation or pressure from their closest environment. One must consider that in the narcissist’s logic, he or she is already practically perfect, and one of the typical considerations they may hold is to think that those who go to therapy are inferior or mentally weak individuals.
How to Treat a Narcissist?
As we have said, fortunately, the “pure” narcissistic personality does not exist; therefore, certain criteria can be met by very diverse patients. Here are a series of basic considerations when addressing narcissism in consultation:
– Leverage tendencies of self-contemplation to begin and attract interest towards therapy; do not focus on attacking or ridiculing illusions of grandiosity, or any opportunity to create a sustainable therapeutic relationship will be lost.
– Never try to aggrandize yourself before the patient by commenting on how good a therapist you are. This fact, a priori, is not a correct practice in the relationship with any patient, but in the case of the narcissist, it is a fatal move, as instead of convincing them, it will lead to an ego battle, in which both trust and respect will be lost. If you start this way, you will probably become just another person on their list to overcome or devalue, and the narcissist is an expert at pointing out deficiencies and reasons why people around them are inferior.
– If you are not specialized in personality disorders, or do not have adequate experience, it is best to refer to another professional who has experience in the field. The narcissistic character is deeply draining, and one must be an especially persistent and resilient professional to obtain the desired results.
– We will use Socratic dialogue derived from cognitive restructuring techniques, but we will especially ensure that this tool does not become a way to “feed” the patient’s ego. There is nothing that pleases the narcissist more than being asked about themselves; this can trigger self-justification and aggrandizement discourses and devaluation of those around them of such magnitude that they can block therapeutic progress.
– Establish boundaries; this is perhaps the most important intervention. The narcissist will try to break the therapeutic setting from minute one: we may encounter requests that demand special treatment, a different spatial arrangement, more time, a certain privilege of schedule, contact, treatment, etc. If you give in, you will not only not be helping the patient but will reinforce the illusory aspects you want to treat.
– Confront, subtly and at the opportune moment. Confrontation is one of the basic duties of a good therapist, and in the case of narcissism, one must be very cautious, as there is a risk of triggering the highly elevated narcissistic susceptibility, both for real and imaginary reasons.
– Set realistic and achievable goals; do not try to dismantle all distortions, as that pretension will surely lead to failure. Using techniques like exposure to anxiety in imagination and achieving small practical adjustments towards a more realistic position is a good therapeutic goal.
Good training for psychologists, such as ISEP’s Master’s in Clinical Psychology, helps therapists confidently and effectively face a case of narcissism in consultation.