Can You Treat Narcissism and Narcissistic Personality Disorder?

Can You Treat Narcissism and Narcissistic Personality Disorder?

hi my name is dr daniel fox licensed psychologist in state of texas and an expert in the personality disorders and today we’re going to talk about treating narcissism and you’ll notice that there are exclamation points and question marks in the topic because there’s a lot of differing views and different perspectives on how or if it’s even possible to treat narcissism so in this video what we’re going to do we’re going to discuss that and one of the big issues that narcissism is majorly misunderstood most of the time it’s lumped into a picture of an extreme conceptualization of resistance demonstrative behavior and a grandiose type of individual however the reality is that it’s on a continuum like all other disorders this means mild moderate severe and extreme now in this video we’re going to do we’re going to unpack the concept of narcissism the two types and the question can these individuals benefit from treatment the big question is is it possible that they could benefit from treatment and can it be done so hang out let’s unpack it and let’s explore let’s see what we can do here and don’t forget like share and subscribe and please leave any comments that you may have in the comments section i do encourage folks to make it positive and trying to create a very positive environment for people that either have a personality disorder personal disorder traits as well as those who may have loved ones who have personality disorder or personalities or traits so let’s get into it most individuals along the narcissistic spectrum do not seek treatment now recall i said most and most is not all now to understand this we need to talk about the two sides of the same coin of narcissism so that’s kind of what i call it right and on the one side is this grandiose type and the other side is this vulnerable type of narcissism now this is also called overt and covert narcissism as well now these two forms of narcissism they share several characteristics in common such as self-centeredness exaggerated sense of self-importance and entitlement disagreeableness and a tendency to interact with others in an antagonistic manner now the difference though in how these manifest and that’s what we’re going to do here so your grandiose type is what most people think of when they hear narcissism these individuals tend to have a grandiose sense of self-importance a lot they exaggerate achievements talents expects to be recognized as superior without commensurate achievements and what that means is that right they don’t really do amazing things but they constantly want to be told that they’re amazing they are preoccupied with fantasies of unlimited power success brilliance beauty and ideal love they deserve ideal love and if you will ask them what is your ideal love typically they can’t describe it or if they do describe it’s very general terms it’s very hard to get specific details out of these folks that’s because if they’re specific they can be held more accountable if it’s operationally defined then they can be held accountable in a much more clearer fashion everyone get ahead of myself let’s keep going now for your grandiose individual with narcissism so this of course is also your overt narcissism right and now this individual they believe that he or she is special and unique can only be understood by or should associate with other special people of high status or be affiliated with high status institutions like universities or companies things like that so middle of the road stuff they’re going to avoid it because it doesn’t really allow them to bask in that reflected glow and they require excessive admiration all the time i like to refer to it like pet petting the kitty right is that you have to always be petting the kitty you always have to go back and the kitty always wants to be pet and you’re constantly petting the kitty and that’s just this admiration you know they also have a sense of entitlement this is that unreasonable expectation of especially favorable treatment or automatic compliance with his or her i’ll get it expectations but again these tend to be very vague non-specific so you’re supposed to figure it out because if they were specific then they could be held accountable and they don’t want to do that so they speak in very vague terms they’re often interpersonally exploited they take advantage of others to achieve their own ends so if there are a lot of passive aggressive tactics so they could trip you up to their own advantage they’re certainly likely to do that your failure somehow is their success that’s kind of their conceptualization of the world they lack empathy in many cases they’re unwilling to recognize or identify with the feelings and needs of others and this specific trait is often where that confusion comes between anti-social personality disorder and narcissism now antisocial personality uh just for a moment that they tend to have this very broad conceptualization right so that lack of empathy tends to be just so massively pervasive and they’re out to get power and profit whereas for your narcissist that lack of empathy is again it’s not necessarily power and profit but it’s recognition it’s this ability to see that i’m special that i’m unique the things that i can do the things that i bring to the table constantly constantly constantly so that becomes a lot of the confusion and that overlap but it’s not as destructive and pervasive as it is an anti-social personality disorder it doesn’t mean it’s not destructive and pervasive what that means is it’s not as destructive and pervasive but you can have folks that have narcissistic personality disorder with antisocial traits you can have individuals with antisocial personality disorder with narcissistic traits so it depends and it gets really confusing which is why it’s so important that we tease these out right very carefully when we’re talking about diagnosis and treatment so let’s keep going though don’t want to digress too much all right so these folks are often envious again we’re back to the overt type of narcissism that grandiose so often envious of others believes that others are envious of him or her even though there may be no evidence in the environment they’re often arrogant haughty their behaviors are very you know sort of snooty and they have this snooty-like attitude in dealing with others particularly if they perceive those others to be beneath them now let’s compare and contrast with vulnerable narcissism your your covert narcissism now in these individuals they’re very defensive very avoidant a lot of insecurity and they wear it more on their sleeve both types are insecure but the way that it manifests they’re hypersensitive they’ll tell you how much they’re hurt they’ll tell you how much they’re wounded very vigilant for criticism always on the outlook of being insulted being hurt being seen as less than they also need people’s recognition all the time remember pet and the kitty that’s a common one they like to go back and pet the kid is a kitty petting that kitty right to bolster their sense of self-worth now they feel underestimated and when they feel underestimated this can result in withdrawal and passive attitude passive aggressive even right attitude and interpersonal relationships they have very low self-esteem they tend to be solitary and reserved detached from others critical chaos in a lot of ways selfish cold resistant to participate in situations as well as very sensitive and nervous okay they also hold a negative view of the past and tend to see it as a very fatalistic manner very pessimistic nothing will ever work out poor me poor me and the way this is a narcissistic component is that and i hear this a lot in the folks along the narcissistic spectrum that i have worked with and what they say is you know no one suffers as much as me no one knows how much i suffer no one knows the extent of how much i suffer in pain and that i go through it’s again remember narcissism they want to shine they want to show so your covert narcissist wants to say i start i shine and show by how much i hurt by my level of vulnerability by my degree of brokenness now that we’ve talked about the two types let’s let’s kind of put them together what about treatment right because there’s a misconceptionalization that is in either or and it is not so in treatment here is kind of how it works out and there really aren’t a lot of research studies there aren’t efficacious approaches to treat narcissism like there is a borderline personality disorder but if you think you’re perfect and that you have no flaws or problems which is that inherent issue even even for for that covert narcissist although my brokenness although i want to shine by how much i hurt there isn’t that drive to seek treatment because it’s a perfect sense of brokenness and if you remove that sense of brokenness right with therapy which which is the therapy that i do is guided towards repairing that core content right we’ll talk about that briefly in a moment but it’s about repairing that but why would they do that because then what happens where’s my coping strategy see a lot of personality disorders are maladaptive coping strategies so it’s about learning to do it differently becoming more adaptive and moving away from those male adaptive strategies that we call personality disorders so again if you’re perfect and have no flaws whether it’s covert or it’s over right why would you seek treatment or why would you participate in research studies they don’t okay now also though they get such a reward from their maladaptive patterns right like we talked about they don’t seek treatment such as uh typically it’s due to avoidance they’re sensitive detachment from others causes others to seek them out in a poor baby moment so you know when when they’re hurt someone may come up to them and say oh my god you know you went through this and all this and that that that’s petting the kitty right that feeds their sense of narcissism doesn’t mean you’re making their narcissism worse but what it does is is that it reinforces that sense of narcissism and what they get out of it but you’re not making the narcissism worse that’s a whole nother video and a whole whole another issue but those with narcissism do come to treatment now when they incur a narcissistic wound so what is a narcissistic wound so a narcissistic wound is something has occurred something has hurt them to such a degree that their narcissism that conceptualization of their world fractures so when that fracture occurs they’re unsure of themselves they’re frightened now underneath that core content for your narcissistic individual tends to be guilt shame doubt inferiority is often what is what is underneath so imagine that something happens you get fired from a job right that gives you a lot of status uh your boyfriend girlfriend right breaks up with you and he or she was wealthy or he or she had a high social status in your social group then they break up with you so then you get this fracture so what do you do that narcissistic wound has to be repaired now typically what you see is you see a maladaptive approach to repair that narcissistic wound and the way they do this is very maladaptive sometimes if it’s a significant other or a spouse whatever it’s something and in that case then you might hear you’re not going to leave me if you leave me you know uh something horrible and drastic right or no one else can have you you know you have to be with me no one else will ever be with you or anything like that those are very narcissistic maladaptive statements and but what happens is once that are paired with that narcissistic wound they have to put that back together so sometimes what happens is you are put on and i’m not being flippant i’m i’m using this as a to explain is that what happens is is that you are put in an aggravation installment plan okay which means that you have to be put through the paces of pain in order for that narcissistic individual right to again feel safe so that their narcissism is restored which really if they worked to restore their narcissism it would be quicker it would be easier right you wouldn’t have to suffer so much they wouldn’t have to suffer so much but remember personality disorders are maladaptive so they engage in maladaptive behavior strategies to repair that ego state to repair that narcissistic wound now also it’s important to recognize that the wound may drive them to treatment but when it heals to the point that their ego is stabilized they usually leave treatment early so it’s hard for them to commit to stay the paces to stay the course through treatment so one of the things that typically happens is that the individual with that narcissistic wound will then exhibit a lot of covert narcissistic traits right the ones that we went through this hurting and this pain and so on and so forth so then they may come and see someone like me or a psychologist or mental health provider whoever it is and there’s no medication to restore it i mean there’s no medication to restore or to repair guilt shame doubt inferiority it doesn’t work that’s why medication only treats surface structure content not core content and if you want more about that that’s in a ton of my other videos you check those out but so what happens is so they come to treatment right and this is not your typical standard grandiose presentation so they come and the therapist in many ways doesn’t know that what they’re doing is that they’re restoring an ego state in someone that has a narcissistic personality disorder that tends to be covert type so what is you work with them then that ego gets restored right then that sense of hurt or that sense of conceptualization of their world that becomes maladaptive gets repaired to the point that they can go back to what i call default behaviors right default patterns which is our immediate go-to behaviors thoughts patterns right which in the case of a personality disorder are maladaptive which reinforce the personality disorder so you go back to that they go back to that then like i don’t need to go to treatment buy and then they bail that’s typically the course that’s typically what happens but despite the lack of treatment outcome research on narcissistic personality disorder there is a wealth of clinical treatment reports those are like case studies or stories and things like that that clinicians have written to help other clinicians get a conceptualization now these reports share two common similarities narcissism is difficult to treat right and the treatments are often not effective bummer right for the very reason that i just described and one key in treatment is to form a strong alliance with the client the alliance is crucial it is central it is so important to encouraging the client to remain in therapy because if they can remain and that ego right gets restored but if you can speak to them and i call this speaking narcissism when i teach other mental health providers how how to work with folks with these personality disorders i call it speaking narcissism you have to speak to them in a way that they’ll hear you that they’ll understand and then if you can do that you can build that alliance they might stay with you so we want to encourage them to stay and treat because if they stay in treatment maybe we can attenuate some of those narcissistic patterns right and go from maladaptive strategies to adaptive and healthy strategies and you do that by not only confronting that core content but also giving them adaptive strategies to get their needs met in a much more healthy way you don’t have to put somebody through the paces of pain in order to feel good about yourself in order to show proof that that person genuinely loves you cares about you so on and so forth so for the narcissistic individuals who do and have stayed in treatment i have found the classic core content of the narcissistic individuals right regardless of which side of that narcissistic coin they’re on so that’s important right and they have to stay in treatment it’s important that they stay in treatment that they like the person that they’re working with and interestingly enough many people call me and say hey you know no one will treat narcissism you know do you know anybody who does so and so forth there are not a lot of people out there who do most of them are in big cities but it is possible to find them but i think what’s critical is if you’re an individual who believes that they’re along that narcissistic spectrum it’s important then to be evaluated by a mental health provider to determine if those traits are present don’t worry necessarily about the whole disorder right putting that stamp on there we want to see as those traits are present that are causing problems in your life because then what we can do is we can hone in on treatment and we can attenuate lessen the severity of those maladaptive patterns that keep causing these narcissistic wounds in yourself causing disruptions in relationships causing you to lose jobs so on and so forth it is possible to do this it is possible i can tell you i’ve worked with folks with narcissistic personality disorder and i’ve had i think a lot of really good success with them it takes a long time it’s a difficult process it’s a very slow process but they can learn adaptive strategies if they are willing to do it you’re not going to talk your partner who’s a long narcissistic spectrum into treatment to change you’re just not gonna they’re gonna bail early just like i said earlier for those very reasons so they have to make the choice to do it differently they have to make the choice to confront that negative sense of self that core content guilt shame doubt inferiority so that is where they have to come in to treatment that recognition is so so important and i hope you enjoyed the video please like share and subscribe leave any comments you might have and thank you for your time and attention take care bye

Narcissistic Personality Disorder Toolbox: 55 Practical Treatment Techniques for Clients, Their Parents & Their Children (IPBA Benjamin Franklin Silver Award Winner):: https://goo.gl/sZYhym

Narcissism is majorly misunderstood. Most of the time it’s lumped into a picture of an extreme conceptualization of a resistant, demonstrative, grandiose individual. However, the reality is that it’s on a continuum like all other disorders. This means mild, moderate, severe, and extreme. In this video were going to unpack the concept of narcissism, the 2 types, and the question, can these individuals benefit from treatment? The big question is it possible and can it be done? Watch to find out.

Most individuals along the narcissistic spectrum do not seek treatment.
To understand this we need to talk about the 2 sides to the same coin of narcissism. On one side is the grandiose type of narcissism and on the other is the vulnerable type of narcissism. These two forms of narcissism share several characteristics such as self-centeredness, exaggerated sense of self-importance and entitlement, disagreeableness, and a tendency to interact with others in an antagonistic manner. The difference is in how these manifest.

The grandiose type is what most of think of when we hear narcissism:
grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

Individuals with vulnerable narcissism are described as defensive, avoidant, insecure, hypersensitive and vigilant for criticism but they also need people’s recognition (e.g., admiration) to bolster their self–worth.
They have very low levels of self-esteem, tend to be solitary and reserved, detached from others, critical, callous, selfish, cold, resistant to participate in situations, as well as sensitive and nervous.

The reality is that those with narcissism do come to treatment when they incur a narcissistic wound. It is important to recognize that the wound may drive them to treatment but when it heals to a point of ego stability, they usually leave treatment early.

Despite the lack of treatment outcome research on NPD, there is a wealth of clinical treatment reports. These reports share two common similarities: (1) narcissism is difficult to treat and the treatments are not often effective, and (2) one key in treatment is to form a strong alliance with the client. This alliance is crucial to encouraging the client to remain in therapy.

Daniel J. Fox, Ph.D., is a licensed psychologist in Texas, international speaker, and a multi-award winning author. He has been specializing in the treatment and assessment of individuals with personality disorders for over 15 years in the state and federal prison system, universities, and in private practice. His specialty areas include personality disorders, ethics, burnout prevention, and emotional intelligence.

He has published several articles in these areas and is the author of:

Antisocial, Narcissistic, and Borderline Personality Disorders: A New Conceptualization of Development, Reinforcement, Expression, and Treatment. Available at: https://www.drdfox.com/books

The Borderline Personality Disorder Workbook: An Integrative Program to Understand and Manage Your BPD. Available at: https://goo.gl/LQEgy1

Antisocial, Borderline, Narcissistic and Histrionic Workbook: Treatment Strategies for Cluster B Personality Disorders (IPBA Benjamin Franklin Gold Award Winner): https://goo.gl/BLRkFy

The Clinician’s Guide to Diagnosis and Treatment of Personality Disorders: https://goo.gl/ZAVe9v

Dr. Fox maintains a website of various treatment interventions focused on working with and attenuating the symptomatology related to individuals along the antisocial, borderline, narcissistic, and histrionic personality spectrum (www.drdfox.com).

YouTube: https://www.youtube.com/c/DrDanielFox
Dr. Fox’s website: http://www.drdfox.com/
Facebook: https://www.facebook.com/appliedpsychservices/
Twitter: https://twitter.com/DrDanielJFox1
LinkedIn: https://www.linkedin.com/in/drdfox/
Instagram: https://www.instagram.com/drdfox
Amazon Author’s Page: amazon.com/author/drfox

Videos edited by Emil Christopher: emilchristopheredits@gmail.com

Citations:
Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual review of clinical psychology, 6, 421-446.
Campbell, W. K., & Baumeister, R. F. (2006). Narcissistic personality disorder. In Practitioner’s guide to evidence-based psychotherapy (pp. 423-431). Springer, Boston, MA.