What It’s Like to Treat Narcissism & BPD | Dr. Karen Jacob
The (2hr 8min long) full interview w/ Dr. Jacob (which includes this topic as well as teaching emotion regulation) is available for Tier 2 channel members.
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Dr. Karen Jacob discusses Narcissistic Personality Disorder (NPD) and Borderline Personality Disorder (BPD) as a clinical psychologist who runs The Gunderson Residence, a residential treatment program for personality disorders. How to diagnose NPD, why narcissism is on the rise, possible treatments (MBT/TFP).
Dr. Jacob’s book “The Feelings Toolbox” is available at https://no-quam.com/
00:00 Tease / Intro
02:20 The Continuum of Personality Disorders / Overlapping ASPD, Malignant Narcissism, Narcissism, BPD / Social Media Influence / Missed Diagnosis
08:58 Diagnosing NPD / Self-worth / External Factors / Standards / NPD Causes / Severity & Impairment
16:57 NPD vs BPD / How Do They Feel Different To The Therapist? / Not Feeling Loveable
24:39 Bringing Your True Self To The Therapy (as a Therapist) / Do You Need to Like or Love Who You’re Treating?
29:07 What’s The Most Important Factor For Improvement?
32:27 Self-Assessment and Getting Help / TFP vs MBT / PDs Are Not a Death Sentence
The Suicide and Crisis Lifeline: 988
For resources about BPD: https://gundersonpdi.mclean.harvard.edu/psychoeducational-resources/
If you or someone you know is considering self-harm or suicide, it’s okay to ask for help. 24 hour support is provided by https://www.hopeline-nc.org (877.235.4525), https://suicidepreventionlifeline.org (800.273.8255), https://kidshelpphone.ca (800.668.6868).
SAMHSA’s National Helpline:
If you or someone you know is dealing with substance misuse or mental illness, call 1-800-662-4357 for free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
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23 Comments
I want her as a therapist.
Nothing will ever convince me that someone with NPD can change! I spent 18 years with one (diagnosed) survived violent abuse and control! He finally discarded me after 18 years which was the only kind thing he ever did for me 😂 He dragged me through 2 years of divorce! It’s taken me almost 6 years before I actually started to feel like myself again! He stopped going to psychotherapy as soon as our divorce was final! He has less than zero desire to change! Anyone who gets through therapy and actually does change does not genuinely have NPD!
Hearing Dr. Jacob say things like “everybody has a little narcissism … just like everybody has a little bit of BPD” and “what we’re seeing more and more are people who struggle with multiple personality disorders” seems to me to really underscore the need for a paradigmatic shift in the way patients, practitioners and the public conceptualize and pathologize mental states and people’s inner worlds. Diagnosing troubled souls with additional highly culturally stigmatized personality disorders seems like it is not a step in the right direction, or a step toward a more holistic understanding.
A diagnostic model like that presented in Psychoanalytic Diagnosis, in which personalities are composed of parts and their organization is described on multiple axes, seems like a much more realistic, flexible and compassionate model than overlapping/multiple personality disorders. The latter approach seems likely to result in even more feelings of shame and alienation.
I understand the DSM exists necessarily as a shared reality between practitioners, researchers and insurers, but I think everyone — and especially the people it’s labeling — would be served well by starting to try to decenter those labels, if the direction it’s headed is toward further ossification of problematic terminology that was never anything better than a best guess to begin with.
It’s rare with someone who has NPD to even go into therapy.. and when they do , and the therapist actually makes progress they often terminate the therapy as it’s too difficult for them to process and can feel like narcissistic collapse
I recommend watching dr mark ettensohn as well as this channel
no
I have Schizoid Pd. I would love to see you bring this PD to light.
I am seeking a TFP therapist to suggest to my 30 year old daughter.
But there are none in and around Singapore .
Will it be advisable to try someone online ?
Thank you so much – so so loved the way BPD and NPD was explained and how one can u see stand the patient and help them .
'maybe you can run the program better than me' sounds a bit passive aggressive no? The person could interpret that the therapist was 'hurt' by something – their ego was bruised- and from then on, the patient could possibly walk on eggshells and feel responsible for the wellbeing of the therapist. I think this position – when the patient has to 'care' for the therapist's emotions in that way, can be very detrimental to the whole thing.
Shame makes us more self-absorbed so yea I get it and have felt it many times to a pathological degree. It’s hard. I have a hard time sustaining friendships and employment and the only reason I have a partner is that they really love me through everything. I know for me it’s post traumatic, I had a really rough and strange childhood. My mom is a conversational narcissist and she really parentified her kids so it’s a lot of complex trauma that ultimately did it for me. I have other traits of BPD but never really cared too much about abandonment itself, more so cared about what it said about me as a person when people didn’t stick around. I felt pretty rotten. Not as much anymore but I still have pretty rough days.
GIIRRRRL POWERRRR COMBIIIINEDDDD!!!! ❤🔥💪💖Love you guys, and all the insights you give!!!!
I wonder if there is a possibility/study that this expectation to be a certain way is actually coming from society and its systems as a whole? I don't see how a supportive parental background is a problem, and not an abusive and neglectful familiar background combined with a society that is built on a lie, that success is money/power/influence/exploitation/conquer when it comes to dudes and submission/silence/caregiving/carrying the emotional and mental load for all those who don't when it comes to women.
Thank you for creating and sharing. <3
So much compassion for cluster B types and none for their victims.
Too often, these treatments make cluster B types feel better but do nothing to reduce their abuse. So they just end up feeling better about being abusers. That's worse.
Mental health is a systemic issue. Assigning names to each condition,as it were, is the stuff for medical administrative facility. That BPD is found in conjunction with NPD is just a matter of syntax and not semantics from a diagnostic viewpoint. Being in session with a good Dr. is one where the Dr. understands the person first before assigning the conditions they suffer. The problem with therapy in general is that Drs.really aren’t trying to fix you more than they are using you as an experiment for scholarship in their practice. Patents who see therapists regularly are more in the practice of buying people/services than they are trying to fix a problem. So don’t make your identity about aligning consumption of these people/services; like “my lawyer, my accountant, my specialist” —-this is an entirely new problem you created for yourself outside of the one you believe your addressing by establishing relationships with these providers. These providers are great articulators of problems, not solutions. You are the only one who can do that. So bring on AI and replace these so called healers. Figure it out for yourself.
You said people recover? Are you saying that people can actually rewire the NPD brain? That's a hard one to see. I know with therapy they learn how to respond better and controller outburst, but can they change what's going on internally and not just wear a more convincing mask? And I have another question if a person now recognizes that they have shown over recognition, sorry I don't remember the phrase you used, a persons achievements, a young person that is becoming a young adult. Is there a way to correct that after it's already been done. Should a person just sit down and talk to that young person and say I recognize this in myself and I'm sorry. I put too much emphasis on your achievements and I know that was a lot of pressure on you. Or should one just change the way they respond to that person's achievements. If the ladder, how do you do that? What do you say?
Great interview,
I always thought narcissists constantly put other people down. The way she describes it, I definitely recognize myself..
Thank you for the great interview!
This could be severe shame too the way narcissism is explained at the start. Shame can make people look outside to get self esteem and also a lot of people with low self esteem look to otjers for self worth
Some people wjtj severe shame can struggle with self worth but don’t have unrealistic standards
It is very hard as I think labels can really just overlap
If u read the dsm u can see every symptom inside ourselves as been human
People with npd cover their shame and low self esteem by getting narcissistic supply that is how they function and get their high
This is a classic bpd or low self esteem you are describing not npd
Borderlines can have narcissistic triats due to shame their shamr is on the surface the narcissists is buried and no access to it. The only time a narcissist will feel shame or low self esteem is if u criticise them then they will gaslight or project or not take accountability and deflect and then their shame low self esteem is gone very quickly
They idolise devalue discard and use people to bring a self esteem and have u mirror back to them now wonderful they are
Narcissists don’t sit in misery for too long as their narcissist supply pulls them out quickly
A person with bdp on the other hand will sit in low self esteem and misery and not feel enough
A narcissist sees themselves as enough whrb tbeh get supply they see themselves as above u even if it is hiding the shame
Theh will never let the shame out
Borderlines are full of shame and are suicidal
I have been researching npd for 12 years and listened to Sam vaknin and this isn’t how he explains npd
No they cant !
WOW.. Videos like this was so helpful to me on my journey of bringing back my husband , to think by this exact same time last year, he left me, and after a period of no contact, i reached out to him and it still didn't work, but then again, i was introduced to a wonderful lady, Gabriela Blanca Lopez , who is a certified spiritual therapist, with her help ,i was able to get him back, and for over a year now, it has been smooth sailing. fellas, if you love her, do not give up on her, show her and act on it, you are not a simp for going all out for the one you love.. xx
The problem is that when you are average or ordinary society does treat you differently. When I had periods of more success people treated me differently. When I was down and without status people often treat you a certain way. On the other hand when you are friendly and approachable people will like you more. But many people care about what you do, how much money you make, how you look, etc. I guess the way is to find people who like you regardless of status.