I was closing down my Manhattan office late last Friday afternoon when my phone began ringing. I looked at the caller ID to see if it was someone I knew, but I only recognized the Aspen, Colorado area code. Thinking it was a friend with whom I skied last winter, I eagerly answered the call.
“Well hello!” I said with more enthusiasm than appropriate for a professional encounter. The silence that followed indicated my caller was a bit put off.
“Um. I’m calling for Dr. Hokemeyer,” a soft-voiced woman tentatively responded.
I pooled out the professional composure I had tucked away for the weekend and responded as officiously as I could, “This is he.”
“Oh.” The woman sounded shocked. “I wasn’t sure I had the right number. I’m calling from Aspen.”
“Yes, I recognized the area code. What can I help you with?”
“I need to hire you.” Now she spoke with the strength and confidence of a seasoned trail lawyer.
“Ok. But you’re in Aspen and I’m in Manhattan. I only do phone sessions after we’ve had some time to establish a face-to-face relationship. But before we even get to that point, why don’t you tell my what prompted your call. What are you struggling with?”
The tone of my caller’s voice suddenly turned frosty. “I’m struggling with my complete jerk of a husband— soon to be ex-husband I hope. He’s a complete narcissist and falling down drunk. I’ve gathered from your work that you’re an expert on both topics and I need you to testify at our pending divorce trial that his narcissism led to the demise of our marriage— that he’s an alcoholic and unfit to have custody of our two boys.”
Now it was me who was taken aback. Yes, I’m an expert on a whole host of personality disorders that are endemic to men, women and families of wealth and power and that fuel a variety of addictions; and yes, narcissism typically heads the list, but the notion of testifying at an out of state trial for a couple I’d never treated was definitely outside my comfort zone. As a result, I graciously declined the engagement and referred her to several local resources that could help her navigate her anger towards her husband, and deal with his alcoholism and her frustration with the divorce process.
[Her call] made me appreciate the frustration that family members and partners feel when narcissism stands in the way of their loved ones’ recovery from a variety of addictions, including alcoholism, drug addiction…-Paul HokemeyerBut her call made me stop and think about the incredibly destructive toll narcissism takes on relationships and families. It also made me appreciate the frustration that family members and partners feel when narcissism stands in the way of their loved ones’ recovery from a variety of addictions, including alcoholism, drug addiction, sexual compulsivity, and disordered eating. So what exactly is narcissism and how is it most effectively treated?
Narcissism is a character trait that defines a person’s self view and view of others. Like the narrow lens in a microscope, it causes a person to focus on the world in a very self-centered way. It causes them to lose sight of notions like we, us and compassion for others. It’s a trait that takes hold early in a person’s life – typically as the result of a major breach of trust by a primary caregiver. Through this breach of trust, the person vows never to be vulnerable again and sets out to be a self-sustaining, autonomous entity.
Although narcissism is resistant to change, it can be “softened” through a variety of clinical interventions to a point where it no longer has a negative impact on the quality of the person’s life and relationships. Through this softening, the person can then embrace a comprehensive program of recovery for life, rather than feeling distant and detached from the healing force of others.
Recently, the diagnostic criterion for what constitutes narcissism was revised in the DSM-V. In looking for pathological narcissism, clinicians look for people who evidence the following traits:
- They are what they possess: The person defines himself or herself from the outside in. They find their self worth in objects, external recognition, and adoration from others.
- They are emotionally volatile: The person is only happy when they are being praised and acknowledged as special. They can’t tolerate being criticized and react with anger when they’re questioned.
- They are externally driven: The person lacks a moral or intuitive compass. They are driven by commercial notions of success rather than spiritual principles.
- They are emotionally shut off: The person lacks empathy and compassion. They only concern themselves with others when they feel their concern will advance their own narcissistic agenda.
- They are manipulative: The person can be highly charming and charismatic, but only to manipulate and exploit others for their own gain.
- They are grandiose: The person feels they are unique and special. Their condescending and critical attitude towards others is a tool they use to build themselves up.
- They are entitled: The person feels they are deserving of special treatment and rewards without having to pay dues or earn them.
- They need constant attention: The person is constantly seeking external validation and needs to be the center of attention.
Although narcissism is difficult to treat, there are some highly effective clinical approaches that enable narcissistic patients to gain insight into their characteristics and learn new ways of relating to themselves and others. Unfortunately, the greatest obstacle to getting effective care is the very personal traits that got them into trouble in the first place.
Unlike other patients, who ask for help and are open to suggestions from professionals, narcissistic patients have a hard time admitting they are anything less than perfect.-Paul HokemeyerUnlike other patients, who ask for help and are open to suggestions from professionals, narcissistic patients have a hard time admitting they are anything less than perfect. They have difficulty being challenged and frequently fail to attach to the clinical team who is treating them. As a result, it’s important that the professionals treating narcissistic patients possess an above average intellect, a persistent and compassionate heart and a deportment that will allow them to challenge the patient in a firm, yet flexible manner.
The most effective forms of psychotherapy for the treatment of narcissistic personality disorder include the following psychotherapeutic approaches:
- Interpersonal psychoanalysis: Through the patient and therapist relationship, the patient begins to explore his or her significant relationships and gains insight into how they perceive and are perceived by people.
- Family therapy: An extremely effective form of therapy that involves the patient’s family. As a team, the family works to resolve conflicts and relationship problems.
- Cognitive behavioral therapy: Gives the patient tools to change their thought distortions and negative beliefs. Through these tools, the patient replaces unhealthy and negative beliefs with healthy, positive ones.
- Group therapy: Occurs in a group of other patients who share the same emotional and personality issues. Provides the patients with insights into how they relate to other people and as a member of a group.
Ideally, these treatment interventions will occur simultaneously and continue for as long as clinically indicated. In my experience, it takes at least one year for patients receiving treatment in a private office setting and at least 60 days in an intensive and comprehensive in-patient setting before they will begin to experience an improvement in their personalities and their relationships.
Is it worth the time and effort? Absolutely. Narcissism fuels the addictions that destroy lives and families. Are narcissists lost causes? Absolutely not. They are human beings who in spite of their external bravado are incredibly sensitive and terrified of being hurt. With the proper clinical care they can transform into loving partners and parents, sober men and women, who add great value to the lives of others and the world around them.
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