Treating narcissism, part II

Yesterday I read through some teaching materials by some psychology professor (Prof. Sachse) who talked in detail about how to treat people with Narcissistic Personality Disorder. It´s all in German, but I´ll post the link anyway. I´m anankastic when it comes to citing sources. You´ll have to go to the “Downloads” section of the site, and then look at “Folien PS”. Here is the link:

What he said was about this: People with NPD have one side to them where they have huge self-esteem and think highly of themselves, and they have another side which makes them believe that deep down, they are worthless as a person. They rely on others´ praise and approval in order to compensate  their lack of genuine self-worth, but that only reinforces the message that if it wasn´t for what they achieve and how great they are, they would be worthless. They often try to compete with the therapist, they might have read psych books. Also, these persons are very distrustful and suspicious of others.

Such a person might present for therapy saying that nothing is wrong with him, he just needs a bit of coaching or something the like. Sachse says that in order to keep him in therapy, you must not correct him on this. Never call his problem a problem, but use praise and compliments (“I think it´s great that you are trying to improve your situation, but a person as special as you sure wants a thorough treatment, so we need to figure out exactly what is not alright at the moment…”) to steer him into a “therapeutically useful” direction. You´ll know what I think about this if you read my last post.  Also, Sachse says, one must make it clear to the patient that everything is up to him. All you can do is inform him of the price he might pay if he doesn´t comply with one or the other therapeutic measure. Ah, yeah. That complete freedom of decision, once again. Sachse advices the therapist to tell the patient whenever possible that the therapist thinks the patient is great, clever, accomplished.  He shall always put emphasis on the patient´s resources and strengths. And I even thought it was a good idea to treat all patients like that…

If, at some point, the patient is on the verge of admitting that there might be something wrong with him after all,  the therapist shall facilitate this by playing down the problem and telling the patient it is great that he is trying to solve his issues. He shall not ever let the patient know how mistaken his self-image is.

Huh. There is so much wrong with all this I don´t even know where to start. I´ll just start somewhere, then. In the very first paragraph, I said that according to Sachse, people with NPD are suspicious of others and highly distrustful. So, dear Professor, do you think that anyone with NPD will just buy all you flattery and compliments?! Also, they tend to have read a psychology book or two, so they might just have read your materials as well! If these folks confront you with the fact that you think they have NPD, how will you react? You will probably deny it. You don´t flatter them to keep them in therapy. You mean what you say. Well, how might that feel to the person with NPD?

I´m really not shit? That is so comforting. But *pang of distrust* what if this is just a psychological trick? He will tell me that I´m great, just so I let my defenses down, and then he will have proof that I´m really a narcissist, and then he will attack and tear me apart. *Feeling distress* I must protect myself somehow. *Cold rage* We´ll see about that, Doctor! I´ll prove that you are just being manipulative, and then you are the one who looks silly! 

It is, of course, nearly impossible to prove, unless you demand to see his notes on you (there is just a limited possibility to do so in Germany). In my own struggles with Dr. Stoneface, I sometimes asked him openly if he wasn´t just manipulating me, as if he would suddenly tell me the truth if only I asked sincerely and nicely enough. Like: “Okay, Dr. Stoneface, according to the rules of our therapist-patient-relationship you may not tell me this, but outside of this we are two grown-up people who can cut the crap and talk like adults, aren´t we? So, for real now, what are you trying to do with me?” Blessed naivety… like it worked that way! “Okay, time-out, we´re not playing anymore because we need to clarify the rules.” There´s no time-out in therapy.

His persistent denial that he was manipulating me led me to the following two options: Either he means what he says and then my perception is completely distorted and unreliable, or his denial is just another means of manipulation and in that case I am 1) stupid and gullible for even doubting my own perception and 2) a truly pathetic person who cannot even be told the truth about how pathetic she is.

And here we arrive at another thing that is wrong with Sachse´s approach. The empty, calculating praise he offers has a devastating effect on people. Even according to his own theory, it would confirm their view that only their success and general awesomeness matter, not them as a person.  But that´s not all.

If your therapist praises you whenever possible, and for the smallest, tiniest things, what kind of self-image do you get? Not that you are great. But that you are hopelessly fucked up. Because if you get praise for good behaviors which are so self-evident that, if performed by other people, they are taken for granted, then your normal behavior (or even worse: character) must be really horrible. Seriously, you don´t boost peoples´ self-esteem by praising them for showing behaviors that everybody should naturally show. If he thinks that he has to praise you for such things, then he must think the worst of you. And what if he is right?!

The fact that your therapist seems to think that this will make you feel good about yourself, or even proud of yourself, is even more insulting. How dumb, arrogant and easy-to-please does he think you are?! Does he think you have no higher standards? And now you will be even more ashamed when he manages to make you feel good about yourself. Because to you it means that your standards must really be low. How pathetic, right?

All this gave me some ideas which might be worth exploring at some point. Looking at myself, I realized that praise does feel good. It does. But it also scares me a great deal. Praise is also dangerous. Feeling good about being praised makes me vulnerable. To what? Huh. To manipulation, obviously. But also to starting to feel really great about myself, and really proud of myself, and not seeing anymore how others might look at me. Like, with cruel intentions. They might want to burst my bubble, they can do so with any ease, and if they do, I´ll be completely exposed. Worse than being naked in front of your whole class.

Want an example? There is no shame in not being intelligent. But there is shame in not being intelligent while believing one is intelligent. And letting others see this bubble in which you live – the belief that you are intelligent, and that it makes you feel good and that it is important to you – makes you very, very vulnerable. You only need to be wrong once, and immediately that bubble bursts and you feel like an absolute fool. I get intrusive memories of moments when I made a fool of myself (like using the word “serotonine” instead of “endorphine”^^), and they make me want to slap myself. Sometimes I actually do.

But I don´t even brag to others that I´m intelligent. I don´t like to talk about my grades in school, for example. (I admit that by talking about the issue on here, I´m contradicting myself.) I feel an urgent need to pretend that I don´t want others to think I´m particularly intelligent (oh, but I do. Trust me. But at least I´m honest, huh? XD). I don´t just need to deliver this message to others, I need to believe in it myself, because otherwise the shame when I get something wrong is unbearable.

I wonder where this is coming from. This fear that I will be attacked. Given how much shame even a small correction evokes in me, almost everything is an attack and I need to be on guard all the time. With such a definition of being attacked, of course, I´ve been attacked many times in my life. I´ve made the experience of this crippling shame many times. But why is there so much shame in being wrong? Because I believe I´m sooo clever (not rationally, but somewhere deep down). But why am I so sure of that? I am not really sure of it, am I? Otherwise I wouldn´t mind mistakes. Maybe I´m just sure that others think so? Sometimes I feel like my mind is just a collection of things that have been said about me, and those in favor of me are in a constant war with those who despise me. Where am I in all this, if I even have a self?

I´m really down at the moment. I feel like a complete piece of garbage. And I cannot even allow myself to feel that. Because straight away my mental representations of Dr. Stoneface and all other kinds of persons jeer with triumph. Yeah, you fuckers, there you have it: Another window of opportunity to destroy me.  I´m vulnerable, my defenses are shaky, and I´m “finally” open to self-doubt, reflection and honesty.  Think quickly, how could you make therapeutic use of the fact that I feel like crying? 

Isn´t it interesting? I´m not just unable to just enjoy praise, I also feel unable to admit to feelings of shame and worthlessness. The reason is similar: It makes me vulnerable. People can use it to manipulate me. “Now that you see you were mistaken on A, you could use the opportunity to also correct B, C, and D! And if you don´t, you´re making the same mistake again, you are just too dumb to see it!” Yes, it´s lovely here inside my head. Nice, caring atmosphere.


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