Narcissism: Psychological Theories And Therapeutic Interventions In The
Narcissistic Disorders Essay, Research Paper

Narcissism: Psychological Theories and Therapeutic 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 school has also attempted to deal with

the narcissistic problem, although the available literature is much smaller.

Existentialists postulate that society as a whole can be the crucial factor in

the development of narcissism. The final perspective to be discussed is the

humanistic approach which although lacking a specific theory on narcissism, can

nevertheless be applied to the narcissistic disorder. In many ways the

humanistic approach to narcissism echoes the sentiments of the psychodynamic

approach. The Psychodynamic Perspective of Narcissism

The psychodynamic model of narcissism is dominated by two overlapping

schools of thought, the self psychology school and the object relations school.

The self psychology school, represented by Kohut, posits that narcissism is a

component of everyone”s psyche. We are all born as narcissists and gradually

our infantile narcissism matures into a healthy adult narcissism. A

narcissistic disorder results when this process is somehow disrupted. By

contrast the object relations school, represented by Kernberg, argues that

narcissism does not result from the arrest of the normal maturation of infantile

narcissism, rather a narcissism represents a fixation in one of the

developmental periods of childhood. Specifically, the narcissist is fixated at

a developmental stage in which the differentiation between the self and others

is blurred.

Kohut”s Theory of Narcissism

Kohut believes that narcissism is a normal developmental milestone, and the

healthy person learns to transform his or her infantile narcissism into adult

narcissism. This transformation takes place through the process which Kohut

terms transmuting internalizations. As the infant is transformed into an adult

he or she will invariably encounter various challenges resulting in some

frustration. If this frustration exceeds the coping abilities of the person

only slightly the person experiences optimal frustration. Optimal frustration

leads the person to develop a strong internal structure (i.e., a strong sense

of the self) which is used to compensate for the lack of external structure

(i.e., support from others). In the narcissist the process of transmuting

internalizations is arrested because the person experiences a level of

frustration which exceeds optimal frustration. The narcissist thus remains

stuck at the infantile level, displaying many of the characteristics of the

omnipotent and invulnerable child (Kohut, 1977).

Kernberg’s Theory of Narcissism

Kernberg’s views on narcissism are based on Mahler’s theory of the

separation-individuation process in infancy and early childhood. Mahler’s

model discusses how the developing child gains a stable self concept by

successfully mastering the two forerunner phases (normal autism and normal

symbiosis) and the four subphases (differentiation, practicing, rapprochement,

and consolidation) of separation-individuation. Kernberg argues that the

narcissist is unable to successfully master the rapprochement subphase and is

thus fixated at this level. It is essential, however, to understand the

dynamics of the practicing subphase before proceeding to tackle the

narcissist”s fixation at the rapprochement subphase.

The practicing subphase (age 10 to 14 months) marks the developmental stage

at which the child learns to walk. The ability to walk gives the child a whole

new perspective of the world around him. This new ability endows the child

with a sense of grandiosity and omnipotence which closely resemble the

narcissist”s behavior. However, reality soon catches up with the child as the

child enters the rapprochement subphase (age 14 to 24 months). At this stage

the child discovers that he or she is not omnipotent, that there are limits to

what he or she can do. According to Kernberg if the child is severely

frustrated at this stage he or she can adapt by re-fusing or returning to the

practicing subphase, which affords him the security of grandiosity and

omnipotence (Kernberg, 1976).

The Preferred Psychodynamic model

The Psychodynamic literature in general tends to lean towards the object

relations school because of the emphasis it places on a comprehensive

developmental explanation (i.e. the use of Mahler”s individuation-separation

model). Nevertheless, the theory of Kohut has left a deep impression on

Psychodynamic thinking as is evident by the utilization of many of his concepts

in the literature (i.e. Johnson, 1987; Manfield, 1992; and Masterson, 1981).

Therefore in the remainder of the Psychodynamic section a similar approach will

be taken, by emphasizing object relations concepts with the utilization of the

occasional Kohutian idea.

The Emergence of the Narcissistic Personality

According to Kernberg and the object relations school the crisis of the

rapprochement subphase is critical to the development of the narcissistic

personality. The individual who is unable to successfully master the

challenges of this stage will sustain a narcissistic injury. In essence the

narcissistic injury will occur whenever the environment (in particular

significant others) needs the individual to be something which he or she is not.

The narcissistically injured individual is thus told “Don”t be who you are, be

who I need you to be. Who you are disappoints me, threatens me angers me,

overstimulates me. Be what I want and I will love you” (Johnson, 1987; P. 39).

The narcissistic injury devastates the individual”s emerging self. Unable

to be what he or she truly is the narcissistically injured person adapts by

splitting his personality into what Kohut terms the nuclear (real) self and the

false self. The real self becomes fragmented and repressed, whereas the false

self takes over the individual. The narcissist thus learns to reject himself

or herself by hiding what has been rejected by others. Subsequently, the

narcissist will attempt to compensate for his or her “deficiencies” by trying

to impress others through his or her grandiosity. The narcissist essentially

decides that “There is something wrong with me as I am. Therefore, I must be

special” (Johnson, 1987; P. 53).

The Narcissist”s View of Others

Just as the individual becomes narcissistic because that is what the

environment “needed” him or her to be, so does the narcissist view others not

as they are, but as what he or she needs them to be. Others are thus perceived

to exist only in relation to the narcissist’s needs. The term object relations

thus takes on a special meaning with the narcissist. “We are objects to him,

and to the extent that we are narcissistic, others are objects to us. He

doesn’t really see and hear and feel who we are and, to the extent that we are

narcissistic, we do not really see and hear and feel the true presence of others.

They, we, are objects, I am not real. You are not real. You are an object to

me. I am an object to you” (Johnson, 1987; P. 48). It is apparent than that

the narcissist maintains the infantile illusion of being merged to the object.

At a psychological level he or she experiences difficulties in differentiating

the self from others. It is the extent of this inability to distinguish

personal boundaries which determines the severity of the narcissistic disorder

(Johnson, 1987).

Levels of Narcissism

The most extreme form of narcissism involves the perception that no

separation exists between the self and the object. The object is viewed as an

extension of the self, in the sense that the narcissist considers others to be

a merged part of him or her. Usually, the objects which the narcissist chooses

to merge with represent that aspect of the narcissist”s personality about which

feelings of inferiority are perceived. For instance if a narcissist feels

unattractive he or she will seek to merge with someone who is perceived by the

narcissist to be attractive. At a slightly higher level exists the narcissist

who acknowledges the separateness of the object, however, the narcissist views

the object as similar to himself or herself in the sense that they share a

similar psychological makeup. In effect the narcissist perceives the object as

“just like me”. The most evolved narcissistic personality perceives the object

to be both separate and psychologically different, but is unable to appreciate

the object as a unique and separate person. The object is thus perceived as

useful only to the extent of its ability to aggrandize the false self (Manfield,

1992).

Types of narcissism

Pending the perceived needs of the environment a narcissist can develop in

one of two directions. The individual whose environment supports his or her

grandiosity, and demands that he or she be more than possible will develop to

be an exhibitionistic narcissist. Such an individual is told “you are

superior to others”, but at the same time his or her personal feelings are

ignored. Thus, to restore his or her feelings of adequacy the growing

individual will attempt to coerce the environment into supporting his or her

grandiose claims of superiority and perfection. On the other hand, if the

environment feels threatened by the individual”s grandiosity it will attempt to

suppress the individual from expressing this grandiosity. Such an individual

learns to keep the grandiosity hidden from others, and will develop to be a

closet narcissist. The closet narcissist will thus only reveal his or her

feelings of grandiosity when he or she is convinced that such revelations will

be safe (Manfield, 1992)

Narcissistic Defense Mechanisms

Narcissistic defenses are present to some degree in all people, but are

especially pervasive in narcissists. These defenses are used to protect the

narcissist from experiencing the feelings of the narcissistic injury. The most

pervasive defense mechanism is the grandiose defense. Its function is to

restore the narcissist”s inflated perception of himself or herself. Typically

the defense is utilized when someone punctures the narcissist”s grandiosity by

saying something which interferes with the narcissist’s inflated view of

himself or herself. The narcissist will then experience a narcissistic injury

similar to that experienced in childhood and will respond by expanding his or

her grandiosity, thus restoring his or her wounded self concept. Devaluation is

another common defense which is used in similar situations. When injured or

disappointed the narcissist can respond by devaluing the “offending” person.

Devaluation thus restores the wounded ego by providing the narcissist with a

feeling of superiority over the offender. There are two other defense

mechanisms which the narcissist uses. The self-sufficiency defense is used to

keep the narcissist emotionally isolated from others. By keeping himself or

herself emotionally isolated the narcissist”s grandiosity can continue to exist

unchallenged. Finally, the manic defense is utilized when feelings of

worthlessness begin to surface. To avoid experiencing these feelings the

narcissist will attempt to occupy himself or herself with various activities,

so that he or she has no time left to feel the feelings (Manfield, 1992).

Psychodynamic Treatment of the Narcissist

The central theme in the Psychodynamic treatment of the narcissist revolves

around the transference relationship which emerges during treatment. In order

for the transference relationship to develop the therapist must be emphatic in

understanding the patient”s narcissistic needs. By echoing the narcissist the

therapist remains “silent” and “invisible” to the narcissist. In essence the

therapist becomes a mirror to the narcissist to the extent that the narcissist

derives narcissistic pleasure from confronting his or her “alter ego”.

Grunberger”s views are particularly helpful in clarifying this idea. According

to him “The patient should enjoy complete narcissistic freedom in the sense that

he should always be the only active party. The analyst has no real existence

of his own in relation to the analysand. He doesn”t have to be either good or

bad-he doesn”t even have to be? Analysis is thus not a dialogue at all; at

best it is a monologue for two voices, one speaking and the other echoing,

repeating, clarifying, interpreting correctly-a faithful and untarnished

mirror” (Grunberger, 1979; P. 49).

The Mirror Transference

Once the therapeutic relationship is established two transference like

phenomena, the mirror transference and the idealizing transference,

collectively known as selfobject transference emerge. The mirror transference

will occur when the therapist provides a strong sense of validation to the

narcissist. Recall that the narcissistically injured child failed to receive

validation for what he or she was. The child thus concluded that there is

something wrong with his or her feelings, resulting in a severe damage to the

child”s self-esteem. By reflecting back to the narcissist his or her

accomplishments and grandeur the narcissist’s self esteem and internal cohesion

are maintained (Manfield, 1992).

There are three types of the mirror transference phenomenon, each

corresponding to a different level of narcissism (as discussed previously). The

merger transference will occur in those narcissists who are unable to

distinguish between the object and the self. Such narcissists will perceive

the therapist to be a virtual extension of themselves. The narcissist will

expect the therapist to be perfectly resonant to him or her, as if the

therapist is an actual part of him or her. If the therapist should even

slightly vary from the narcissist’s needs or opinions, the narcissist will

experience a painful breach in the cohesive selfobject function provided by the

therapist. Such patients will then likely feel betrayed by the therapist and

will respond by withdrawing themselves from the therapist (Manfield, 1992).

In the second type of mirror transference, the twinship or alter-ego

transference, the narcissist perceives the therapist to be psychologically

similar to himself or herself. Conceptually the narcissist perceives the

therapist and himself or herself to be twins, separate but alike. In the

twinship transference for the selfobject cohesion to be maintained, it is

necessary for the narcissist to view the therapist as “just like me” (Manfield,

1992).

The third type of mirror transference is again termed the mirror

transference. In this instance the narcissist is only interested in the

therapist to the extent that the therapist can reflect his or her grandiosity.

In this transference relationship the function of the therapist is to bolster

the narcissist”s insecure self (Manfield, 1992).

The Idealizing Transference

The second selfobject transference, the idealizing transference, involves

the borrowing of strength from the object (the therapist) to maintain an

internal sense of cohesion. By idealizing the therapist to whom the narcissist

feels connected, the narcissist by association also uplifts himself or herself.

It is helpful to conceptualize the “idealizing” narcissist as an infant who

draws strength from the omnipotence of the caregiver. Thus, in the idealizing

transference the therapist symbolizes omnipotence and this in turn makes the

narcissist feel secure. The idealization of the object can become so important

to the narcissist that in many cases he or she will choose to fault himself or

herself, rather than blame the therapist (Manfield, 1992).

The idealizing transference is a more mature form of transference than the

mirror transference because idealization requires a certain amount of internal

structure (i.e., separateness from the therapist). Oftentimes, the narcissist

will first develop a mirror transference, and only when his or her internal

structure is sufficiently strong will the idealizing transference develop

(Manfield, 1992).

Utilizing the Transference Relationship in Therapy

The self object transference relationships provide a stabilizing effect for

the narcissist. The supportive therapist thus allows the narcissist to heal

his or her current low self esteem and reinstate the damaged grandiosity.

However, healing the current narcissistic injury does not address the

underlying initial injury and in particular the issue of the false self. To

address these issues the therapist must skillfully take advantage of the

situations when the narcissist becomes uncharacteristically emotional; that is

when the narcissist feels injured. It thus becomes crucial that within the

context of the transference relationship, the therapist shift the narcissist”s

focus towards his or her inner feelings (Manfield, 1992).

The prevailing opinion amongst Psychodynamic theorists is that the best way

to address the narcissist”s present experience, is to utilize a hands-off type

of approach. This can be accomplished by letting the narcissist “take control”

of the sessions, processing the narcissist”s injuries as they inevitably occur

during the course of treatment. When a mirror transference develops injuries

will occur when the therapist improperly understands and/or reflects the

narcissist”s experiences. Similarly, when an idealizing transference is formed

injuries will take the form of some disappointment with the therapist which

then interferes with the narcissist”s idealization of the therapist. In either

case, the narcissist is trying to cover up the injury so that the therapist will

not notice it. It remains up to the therapist to recognize the particular

defense mechanisms that the narcissist will use to defend against the pain of

the injury, and work backwards from there to discover the cause of the injury

(Manfield, 1992).

Once the cause of the injury is discovered the therapist must carefully

explore the issue with the narcissist, such that the patient does not feel

threatened. The following case provides a good example of the patience and

skill that the therapist must possess in dealing with a narcissistic patient.

“?a female patient in her mid-thirties came into a session feeling elated about

having gotten a new job. All she could talk about is how perfect this job was;

there was no hint of introspection or of any dysphoric affect. The therapist

could find no opening and made no intervention the entire session except to

acknowledge the patient”s obvious excitement about her new job. Then, as the

patient was leaving, the therapist noticed that she had left her eyeglasses on

the table. He said, “you forgot your glasses,” to which she responded with an

expression of surprise and embarrassment saying, “Oh, how clumsy of me.” This

response presented the therapist with a slight seem in the grandiose armor and

offered the opportunity for him to intervene. He commented, “You are so

excited about the things that are happening to you that this is all you have

been able to think about; in the process you seem to have forgotten a part of

yourself.” The patient smiled with a mixture of amusement and recognition. In

this example the patient is defending throughout the session and in a moment of

surprise she is embarrassed and labels herself “clumsy”, giving the therapist

the opportunity to interpret the defense (her focus on the excitement of the

external world) and how it takes her away from herself” (Manfield, 1992; PP.

168-169).

The cure of the narcissist than does not come from the selfobject

transference relationships per se. Rather, the selfobject transference

function of the therapist is curative only to the extent that it provides an

external source of support which enables the narcissist to maintain his or her

internal cohesion. For the narcissist to be cured, it is necessary for him or

her to create their own structure (the true self). The healing process is thus

lengthy, and occurs in small increments whenever the structure supplied by the

therapist is inadvertently interrupted. In this context it is useful to recall

Kohut”s concept of optimal frustration. “If the interruptions to the

therapist”s selfobject function are not so severe as to overwhelm the patient”s

deficient internal structure, they function as optimal frustrations, and lead

to the patient”s development of his own internal structure to make up for the

interrupted selfobject function” (Manfield, 1992; P. 167).

The Jungian (Analytical) Perspective of Narcissism

Analytical psychology views narcissism as a disorder of Self-estrangement,

which arises out of inadequate maternal care. However, prior to tackling

narcissism it is useful to grasp the essence of analytical thought.

The Ego and the Self in Analytical Psychology

It is important to understand that the Self in analytical psychology takes

on a different meaning than in psychodynamic thought (Self is thus capitalized

in analytical writings to distinguish it from the psychodynamic concept of the

self). In psychodynamic theory the self is always ego oriented, that is the

self is taken to be a content of the ego. By contrast, in analytical

psychology the Self is the totality of the psyche, it is the archetype of

wholeness and the regulating center of personality. Moreover, the Self is also

the image of God in the psyche, and as such it is experienced as a

transpersonal power which transcends the ego. The Self therefore exists before

the ego, and the ego subsequently emerges from the Self (Monte, 1991).

Within the Self we perceive our collective unconscious, which is made up of

primordial images, that have been common to all members of the human race from

the beginning of life. These primordial images are termed archetypes, and play

a significant role in the shaping of the ego. Therefore, “When the ego looks

into the mirror of the Self, what it sees is always “unrealistic” because it

sees its archetypal image which can never be fit into the ego” (Schwartz-Salant,

1982; P. 19).

Narcissism as an Expression of Self-Estrangement

In the case of the narcissist, it is the shattering of the archetypal image

of the mother which leads to the narcissistic manifestation. The primordial

image of the mother symbolizes paradise, to the extent that the environment of

the child is perfectly designed to meet his or her needs. No mother, however,

can realistically fulfill the child”s archetypal expectations. Nevertheless,

so long as the mother reasonably fulfills the child”s needs he or she will

develop “normally”. It is only when the mother fails to be a “good enough

mother”, that the narcissistic condition will occur (Asper, 1993).

When the mother-child relationship is damaged the child”s ego does not

develop in an optimal way. Rather than form a secure “ego-Self axis” bond, the

child”s ego experiences estrangement from the Self. This Self-estrangement

negatively affects the child”s ego, and thus the narcissist is said to have a

“negativized ego”. The negativized ego than proceeds to compensate for the

Self-estrangement by suppressing the personal needs which are inherent in the

Self; thus “the negativized ego of the narcissistically disturbed person is

characterized by strong defense mechanisms and ego rigidity. A person with

this disturbance has distanced himself from the painful emotions of negative

experiences and has become egoistic, egocentric, and narcissistic” (Asper, 1993;

P. 82).

Analytical Treatment of Narcissism

Since the narcissistic condition is a manifestation of Self-estrangement,

the analytical therapist attempts to heal the rupture in the ego-Self axis bond,

which was created by the lack of good enough mothering. To heal this rupture

the therapist must convey to the narcissist through emphatic means that others

do care about him or her; that is the therapist must repair the archetype of

the good mother through a maternally caring approach (Asper, 1993).

A maternal approach involves being attentive to the narcissist”s needs.

Just as a mother can intuitively sense her baby’s needs so must the therapist

feel and observe what is not verbally e