NEW THERAPIST: The Narcissist in Therapy

The Narcissist's View on Therapy

Narcissists typically engage in therapy not out of a genuine desire for self-improvement but often due to external pressures such as relationship breakdowns or legal issues. Sam Vaknin, author of "Malignant Self Love - Narcissism Revisited," shares his personal experiences with therapy, highlighting its ineffectiveness in his case due to his deep-seated investment in his grandiose false self. Vaknin's insights suggest that narcissists often manipulate therapeutic settings to maintain their self-image rather than pursue genuine change.

Challenges in Treating Narcissists

Therapists face numerous obstacles when treating narcissists:

1. Resistance to Emotional Vulnerability: Narcissists prefer intellectualizing problems and avoid discussing their emotions, which can impede the progress of therapy.
2. Manipulation and Power Dynamics: They may use therapy sessions to assert dominance or manipulate the therapist to receive positive reinforcement without real introspection or change.
3. Premature Termination: According to a study in the Journal of Clinical Psychiatry, narcissists are prone to ending therapy prematurely if they feel criticized or not adequately admired, which complicates long-term treatment plans.

Effective Therapeutic Approaches

Despite the challenges, certain therapeutic strategies can be more effective in managing narcissism:

• Cognitive Behavioral Therapy (CBT): This method can help as it focuses on modifying dysfunctional thinking and behavior, which appeals to the narcissist’s preference for structure and logic.
• Goal-Oriented Therapy: Setting small, achievable goals can help in making incremental progress that can be explicitly acknowledged and attributed to the narcissist, thereby sustaining their engagement in the process.
• Therapeutic Neutrality: A neutral, non-confrontational stance helps avoid power struggles and keeps the focus on therapy rather than on winning arguments.

Recommendations for Therapists

Vaknin offers several suggestions for therapists dealing with narcissistic clients:

• Allow narcissists to "win" early power struggles to avoid protracted conflicts.
• Maintain professional boundaries firmly despite attempts at manipulation through flattery or gifts.
• Focus on behavioral changes rather than deep emotional insights or transformations.

Broader Implications for Treatment

The discussion extends into the potential for broader, systemic approaches to managing narcissism, suggesting that, similar to public health initiatives, there could be value in societal-level strategies to mitigate the impacts of highly disruptive narcissistic behaviors. However, this raises ethical and practical questions about privacy, stigma, and the effectiveness of such measures.

In conclusion, while narcissistic personality disorder presents significant treatment challenges, understanding the nuances of the disorder and adapting therapeutic techniques can lead to better management of the symptoms, ultimately benefiting both the narcissist and those around them. Therapists are encouraged to approach narcissists with a strategy that balances empathy with firm boundaries, aiming for incremental improvements rather than complete transformations.