Tag Archive | fear of failure

THE PSYCHOLOGICAL RISKS OF WEALTH: GROWING UP RICH

Feb4

In this article I want to touch a psychology effect of wealth. Scientists found that children from homes with an annual income of more than £100,000 were suffering anxiety, depression and somatic symptoms twice as often in comparison to their peers. Also children from multi-generational wealth are more at risk for criminal behavior, eating disorders, and addictive disorders. It is important to emphasize that it is not the wealth per se causing the higher risk of mental disorder development but also the cultural context and environment.

Traps that occur by raising a child in privileged environment
• Unfortunately, many wealthy parents neglect their children. They are too busy to pay emotional attention to their child. The child may have been over indulged with material things while starving for parents love and attention.
• Rich parents may intrude excessively into the lives of their child. Meaning that they are crossing the child’s boundaries and not letting him develop his own ways. They are doing things instead of him and also telling him what and how to do things. Which can later in life lead to a loss of self-sense.
• Impossibly high expectations are transmitted not only by parents but also by the entire community-teachers, schools, coaches, and peers. The child can feel the pressure of succeeding in larger than life terms but on the other hand very little is expected from him in a sense of responsibilities. Parental expectations can be particularly excessive if the family has an established tradition of wealth and position. While this works well for some children it doesn’t for others. This is especially true if the same standards are applied across all the siblings. There is no space for individual identity-family and others sees you as part of the family dynasty.
• Kids aren’t required to support themselves. Which can give you a feeling that you are incapable of such a thing. That makes you dependent on your family even if you don’t want to be. To learn how to provide for your self plays important role in self-esteem.
• Envy from others plays significant role in wealthy child psychological development. We don’t only have pressure from inside of the family but also outer world is putting pressure on our personality development. Wealthy children are often target of envy. They are seen as successful by their peers simply for being born in wealthy family. They can respond with feeling guilty to have so much. Consequently many hold back and stay beneath the radar so that they won’t feel over exposed. Also it is hard to distinguish if people pay attention to you because of your wealth or because of who you are.
• On the other hand they can gain a lot of admiration from surrounding. People don’t admire their true self and accomplishment but what they have. Which makes your personality connected to the family wealth and is hart to feel stable without it. They often feel like they have only one way out-continue the tradition. Also being admired all the time makes you feel lost when someone is not responding to you this way which can show up as anger or self-doubt.

Personal characteristics that wealthy children often develop
To grow up in wealthy family encourages development of certain characteristics that are not excepted well elsewhere. Behind their backs people may resent them for this type of behavior but they are rarely faced with direct disapproval due to their status. It is hard for this children to develop realistic identity if they are not confronted whit their dysfunctional behavior.
Among those characteristics are:
• Lack of empathy/awareness of others. They can believe that they are empathic person and are surprised to learn that people see them differently. They often mix their charity work and materialistic help with empathy. From their perspective this is familiar behavior because in their home they got material things instead of emotional support. At the same time they secretly expect praise for this kind of help and are wearing it proudly.
• Selfish, insensitive behavior which they feel is justified or they are not aware of it. They refuse to face how people respond to them. Although in same level many of them can see that people are not sincere to them.
• Feeling of entitlement.
• Difficulties with taking interpersonal responsibility.
• Elitism and materialism infiltrate their character, their relationships, and their quality of life.
• They can have low capacity for tenderness in close relationships, high capacity for chauvinism and narcissism.
• The wealthier people become, the more they believe that they can control many aspects of their life and design exactly the kind of life they want. They come to expect perfection and submissiveness from others.

Problematic areas that are hidden behind mental disorder
• Lack of self-discipline: Wealthy children have problem focusing and sustained energy, as well as postponing gratification for ultimately higher rewards. Lack of consistency and following the rules (that were agreed ahead) also shows in therapeutic relationship. Last minute cancellations and arbitrary requests to re-schedule are commonplace.
• Delayed maturity. Living in a cocoon of wealth often prevent a person to mature. Most overprotected children eventually do grow up, but many delay or even avoid the process.
• Low self-esteem: Person that was raised in wealthy family describes well how low self-esteem is built: “You’re not taught to do practical things, because everything is done for you. Being denied the opportunity to fulfill developmental tasks and experience the ebb and flow of triumph and mistakes breeds the narcissistic expectation that all things should be simply handed over on a silver platter. But inside it feels like you are incapable to do it alone.” Children that are high in the spectrum of Narcissistic personality disorder doesn’t realize their low self-worth. They are covering it up with narcissistic behavior which is only a symptom of their very low self-esteem.
• Week identity: Children of wealth often begin life with prescribed identities and a sense of social and financial superiority. Expectations of what they should become are preventing them to development a firm identity.
• Suspiciousness or even paranoia: to not to trust others is probably how they were raised. “People want you for money”. It must feel really horrible that you are haunted by the feeling that it is never you but your family money. “What does he or she really want from me?” Consequently there is a fair amount of isolation. “We grew up hearing warnings about every girlfriend and buddy we had. So I learned to be suspicious, and it has been hard for me to overcome that legacy.”
• Fear of failure runs high among inheritors. The child of wealth may feel that nothing they can accomplish will ever match the huge accomplishment of the money makers. They suspect their successes are due to wealth and position. All of this can undermine the self-esteem. It’s hard to be sure they have achieved anything, or are really liked by others.
• Lack of motivation: “My biggest hurdle is my laziness and the fact that I know that I won’t be ruined if my art doesn’t work out.” Available wealth makes it hard to stick to goals in the face of setbacks and frustrations. Sometimes inheritor’s goals are ill-defined, particularly when it comes to career. Inheritors are not driven by life’s necessities. Their motivation is often short-lived and lacks intensity. “You might want to and you might make the effort, but you don’t have the same pressure to earn enough to live on. And that takes away a lot of the incentive to find meaningful work. The biggest curse of intergenerational wealth for me and many other people is the illusion that you don’t have to do much with your life.”

Final words
To rise psychologically healthy children it is essentially to give them emotional and not just material attention. This is far more important for healthy development then material things. Moreover it is important that they take responsibilities suitable for their age. Taking responsibility away have negative influence on positive identity and self-esteem.
Teach your child about finances, responsibility and work. It doesn’t need to be hard work, just work. So they learn to put off gratification and enjoy in their own achievements. Also realize that they are individuals just like you and I. They have their own wishes and they are not obligated to follow your lead as well you are not obligated to support them once they become adult.
For the child raised in wealthy family that feels lack of motivation, anxious, and depressed it is important to find help. In therapy proses with them the privilege is “taken away” which can be really hard for some. Pushing through it brings something far more important-the sense of self.
Base of this article is a book by Madeline Levine: The price of Privilege and my personal experience working with privilege clients. We often think that where is money there is no problems. As seen from this article privileged children have far greater possibility to develop mental disorder in comparison to their peers. Their problems might be different from ours but that doesn’t make them less serious. In therapy it is important to work with them on distinction between them and family inheritance, on feeling that they are capable of taking care of themselves, give them sense of how they come across, on learning to take responsibility and help them to become their true self.

NARCISSISTIC PERSONALITY DISORDER (NPD)

Nov7
  1. Definition of Narcissistic personality disorder (NPD)

The term narcissism was first used in relation to human psychology by Sigmund Freud in his essay “On Narcissism” after the figure of Narcissus in Greek mythology (Golomb 2003: 18).
The Myth: One day Narcissus was walking in the woods when Echo (mountain nymph) saw him, fell deeply in love, and followed him. Narcissus sensed he was being followed and shouted “Who’s there?”. Echo repeated “Who’s there?” She eventually revealed her identity and attempted to embrace him. He stepped away and told her to leave him alone. She was heartbroken and spent the rest of her life in lonely glens until nothing but an echo sound remained of her. Nemesis, the goddess of revenge, noticed this behavior after learning the story and decided to punish Narcissus. Once, during the summer, getting thirsty after hunting, the goddess lured him to a pool where he leaned upon the water and saw himself in the bloom of youth. Narcissus did not realize it was merely his own reflection and fell deeply in love with it, as if it was somebody else. Unable to leave the allure of his image, he eventually realized that his love could not be reciprocated and he melted away from the fire of passion burning inside him, eventually turning into a gold and white flower (Source: https://en.wikipedia.org/wiki/Narcissus_(mythology))
Narcissism is “a pattern of traits and behaviors which signify infatuation and obsession with one’s self to the exclusion of all others and the egotistic and ruthless pursuit of one’s gratification, dominance and ambition.” (Vaknin 2003:18) The narcissist constantly tries to repair his injured self-esteem by adoring and admiring his gilded self. (Golomb 2003: 18)

  • Diagnostic criteria

There is a whole range of narcissistic reactions, styles, and characteristics – from the mild, reactive and transient to the permanent personality disorder. NPD is commonly diagnosed with other personality disorders, such as Histrionic, Borderline, Paranoid, and Antisocial Personality Disorders (Vaknin 2003).
The ICD-10 (International Classification of Mental and Behavioural Disorders) defines NPD as “a personality disorder that fits none of the specific rubrics”. It relegates to the category “F60.8 Other specific personality disorders”, together with eccentric, “haltlose” type, immature,        narcissistic, passive-aggressive and psychoneurotic (ICD-10).
American DSM-IV-TR defines NPD as “an all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy”.
The DSM specifies nine diagnostic criteria. Five (or more) of these criteria must be met for a diagnosis of NPD.
Proposed Criteria:

  • ‘Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognized as superior without commensurate achievements);
  • Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;
  • Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);
  • Requires excessive admiration, adulation, attention and affirmation – or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);
  • Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favorable priority treatment;
  • Is “interpersonally exploitative”, i.e., uses others to achieve his or her own goals;
  • Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;
  • Constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly;
  • Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, being “above the law”, and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.’ (Vaknin 2003: 19)

1.1.2. Short comparison with other personal disorders
As mentioned earlier NPD is commonly diagnosed with other personality disorders. In this chapter I will introduced short comparison with four other personality disorder.
Opposite from patients with the Borderline Personality Disorder (BPD), the self-image of the narcissist is stable, he or she is less impulsive, self-destructive and concerned with abandonment issues. Also they are not as clinging as BPD patients (Vaknin 2003). Borderline and narcissistic patients both idealize and devalue others. But there is a different between them. BPD patient alternates between idealization and devaluation. For example, first they will idealize you, you will be the best therapist they ever had, and in the next session they will devaluated you, you will be the worst person they had ever know.  Nevertheless, the borderline patient cares about others. The narcissistic patient is more exploitative. Idealization is connected with expectation to satisfied patient’s grandiose fantasy. The minute expectations are not met, narcissist abandons you and looks for another one who will meet his grandiose fantasies (MacKinnon and others).
In short, on surface functioning of the narcissistic personality is much better than that of the average borderline patient. In general, NPD individuals are more capable of high, sustained achievement and will have more successful work history than the person with Borderline Personality Disorder. Both kinds seek attention, but unlike borderline, who seek nurturing attention, narcissist feel they deserve admiring attention because of their superiority (http://www1.appstate.edu/~hillrw/Narcissism/differentialdiagnosis.html).
Histrionic Personality Disorder (HPD) and NPD: Both personality types tend towards the demonstrative, exhibitionistic, dramatic and seductive in their behavior. Contrary to the histrionic patient, the narcissist is achievements-orientated and proud of his or her possessions and accomplishments. Narcissists also rarely display their emotions as histrionics do and they hold the sensitivities and needs of others in contempt. While the characteristic distinguishing feature of Histrionic Personality Disorder is coquettishness, the feature of NPD is grandiosity. Person with HPD is warm, playful, and spontaneous and can be dependent on others. These individuals are capable of love, empathy whereas those with NPD are not (Vaknin 2003; look at http://www1.appstate.edu/~hillrw/Narcissism/differentialdiagnosis.html).
While persons with NPD and Antisocial Personality Disorder (ASPD) share tendencies to be tough-minded, glib, superficial, exploitative, and unempathetic, NPD are less impulsive, less aggressive, and less deceitful. All ASPD are assumed to have a narcissistic personality structure, but not all narcissists are ASPD. Unlike a person with ASPD, the person with NPD has not learned to be ruthless or competitively assertive and aggressive when frustrated. A critical distinguishing feature is that in ASPD, there are no feelings of guilt or remorse and as opposed to ASPD, few narcissists are criminals (Vaknin 2003; see http://www1.appstate.edu/~hillrw/Narcissism/differentialdiagnosis.html).
Patients suffering from the range of obsessive-compulsive disorders (OCD) are committed to perfection and believe that only they are capable of attaining it. But, as opposed to narcissists, they are self-critical. However, someone with NPD is more likely to believe that he has actually achieved perfection. Shortly, the OCD seeks perfection, the narcissist claims it. The value systems of these two personality types differ as well: person with OCD has deeply held, rigid but genuine moral and socio-political beliefs. In contrast, the person with NPD might exposed such deeply held values but actually lacks any true commitment to them (Vaknin 2003; see http://www1.appstate.edu/~hillrw/Narcissism/differentialdiagnosis.html).

1.1.3. Defense mechanism
Over all narcissists intended to protect true self from hurt and trauma. He creates False Self which is omnipotent, invulnerable, and omniscient, through which he regulates his self (Vaknin 2003). To maintain that state, narcissists develop different defense mechanisms. There are three defense mechanisms that are the most common for narcissists: splitting, graciosity and isolation/distance.
Graciosity: narcissist creates relationships only with people who admire them or who he admires. Consequently he is afraid that others will disappoint him or demand attention for themselves. When attention is turned away from them, they distance themselves and leaves the relationship (Praper 1996: 180).
Distance and isolation: narcissist doesn’t realize that he is hurt and wounded. When they got the feeling that others don’t see them as perfect, feeling of inferiority is awaken in them. They are unable to take criticism and take a distance when this happens (Praper 1996: 180).
Splitting or black and white thinking can be seen as a developmental stage as well as a defense mechanism, which is also common in NPD. Narcissist believe that they need to be admired by others. The ones who don’t admire them are categorized as bad. Their ego is not capable of accepting good and bad objects in one person (Praper 1996, see http://en.wikipedia.org/wiki/Splitting_%28psychology%29#Narcissistic_personality_disorder).

1.1.4. Types of narcissism
We all go through narcissistic developmental stage in our lives. As infants and toddlers we all feel that we are the center of the Universe and it is impossible to imagine that our needs wouldn’t be met (Praper 1996). Here we talk about primary narcissism, where toddler doesn’t separate the mother from himself and he depends on her to satisfy his primary needs (Lasch 1979: 79). Both self and others are viewed immaturely-as idealizations (Vaknin 2003). Gradually toddler gains experiences that everything cannot be the way he wants. He realize that there are obstacles in the world, which brings him little disappointments and make him overcome primary narcissism (Praper 1996).
Secondary or pathological narcissism is a pattern of thinking and behaving in adulthood. It manifests in the chronic pursuit of personal gratification and attention, in social dominance and personal ambition, bragging, insensitivity to others, lack of empathy and/or excessive dependence on others to meet his responsibilities in daily living and thinking (Vaknin 2003). Lasch says that this type of narcissism tries to destroy painful disappointments in childhood and cover the childs rage towards people that hurtled him. (Lasch 1979: 79)
Manfield differentiates the exhibitionist type and cover narcissism, both belonging to secondary narcissism (Praper 1996: 178):
The first type is exhibitionistic type. Children during childhood get a lot of support in their grandiosity but there is no room for individuality and true feelings. This type is common for families with one child. Investment in one child raises grand expectations. The child should be born genius, and should use every opportunity to demonstrate this to others. When not acting as expected, he can be roughly rejected by his parents. Avoiding rejection, he continues to be brilliant, perfect, sweet. He also requires that others treat him as special (Praper 1996: 178).
The second type is the disguised type. The child has experienced that grandiose ideas are unacceptable. He learns to hide any such feeling and behaviors. However, he still develops perfectionism and hypersensitivity to criticism. The need for superiority is suppressed while suffering from feelings of inferiority. The truth is that he in fact doesn’t believe that he is inferior (Praper 1996: 179). The disguised type appears humble and modest, so impressively weak that it isn’t difficult to overlook the hidden grandiose self (Praper 1996: 223).
Also Millon distinguish 4 subtype of secondary narcissism in the following photo:

Table: Narcissistic Personality Subtypes (available at: http://www.millon.net/taxonomy/summary.htm)

  1. Origins of narcissism 

NPD has been considered as pathology of self as formation of pathological development of identity (Praper 1996: 175). Considering the work of Otto Kernberg, narcissism is an ego distortion. Ego functions enable us to observe our self and environment. With narcissism, the ego is unable to develop observations from environment in to cohesive picture of self (look Praper 1996: 176). Kernberg sees narcissism as a defense against feelings of individual anger and abandonment, stemming from the child’s rejection. As a result narcissists are distrustful and incapable of relying on others. Their relationships are marked by jealousy, control, and withdrawal (Žižek 1987: 118-119).
By Kerenberg, pathological narcissism originates from the serious frustrations in separation phase (Praper 1996). Kernberg points out that narcissism is a result of permanently cold parental figures, which express indifference or hostility towards the child. This inadequacy is reflected in their tendency to inflate their self-image (Otway and Vignoles 2006).
Kohut believes that narcissism is a normal aspect of infantile development. The child’s self-grandiosity is supported by mirroring and idealizing relationship between child and parent. If these needs are not met, the child as an adult may appear poorly adapted to adult forms of narcissism (Otway and Vignoles 2006). He also believes that the loss of the object that would allow binding and idealized mirroring force the person to direct fantasy only to himself. Therefore, the NPD is looking for a person who would idealize him. Hoping that through the binding with others, he will achieve the feeling of coherent self. In reality he is looking for mother’s admiration that was not there (Praper 1996, 177). The secondary narcissism happens because the process of archaic infantile narcissism to a healthy adult narcissism is interrupt. (Otway and Vignoles 2006).
By Winnicottu, the reason for narcissism is the lack of empathy and harmony between parent and child. Another reason can be overly intrusive behavior from the parent. Child develops a false self, which protects the true self from intrusion and damage. Therefore, narcissists always offer impeccable false self and protect himself against feelings of inferiority (Praper 1996:177).
Millon’s theory opposes to mentioned theories which believe that negative relationship between child and parent is reason for narcissism. Instead, Millon says that the reason is the excessive attention of parents, over-pampering, forbearance and admiration. Parents show unrealistic judgment of the child’s abilities, thereby increasing children’s self-image, which the environment does not necessarily support. Despite the differences in the theories, all believe that narcissism is a result of dysfunctional childhood experiences. (Otway and Vignoles 2006)

  1. Personal attributes

Main personal characteristics which are normally found in NPD:
Sensitivity to criticism: patients with NPD feel injured, humiliated and empty when criticized. They often react with devaluation, rage, and defiance to any5 real or imagined criticism. They are incapable to tolerate setbacks, disagreement, and criticism. (Vaknin 2003)
In personal relationships narcissist is not capable of attachment to others. He depends only on recognition from others. He doesn’t t trust people because he has pathological fear of over-dependency on others. That’s why he usually have short love relationships that in his mind shouldn’t be too stressful or emotionally demanding (Žižek, 1987). The relationships are typically impaired due to their lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention (Vaknin 2003).
Narcissist is unable to enjoy because he connects enjoyment with others. Enjoyments starts when others notice his enjoyment. A narcissist is totally external, which indicates inner emptiness and loss of their identity.
Narcissist is incapable of mourning. They are not able to converting rage, because of the loss, to the mourning. He is only able to forget the lost object, or to determine that in fact he didn’t like them anyway. After that he directs his energy towards new person.
For narcissist, the availability of people is taken for granted. To this type of person you are not a person with feelings, you are a ‘thing’ to feed off and sustain their existence.
Narcissist use manipulation to get what he wants. He knows exactly which manipulative tactic is going to work best in which situation. When he wants something from us he pays attention to us but the moment he doesn’t need us anymore he acts indifferent toward us. Narcissists work within win-lose strategy. They believe their world is positioned to serve their insatiable needs. (Žižek, 1987; Tonia Evans 2008)
Being perfect: narcissist has a fear of failure, for example loneliness and aging. That’s why they take care of their body, trying to stay young  and be under the spotlight-so they won’t get lost in the crowd of average people (Žižek, 1987).  They are either “cerebral” (intelligence or academic achievements) or “somatic” (physique, exercise, physical or sexual prowess and romantic or physical “conquests”) (Vaknin 2003). Which means they are trying to be perfect in physical appearance or in intellectual accomplishments.
Narcissist in society: narcissist sees himself as some kind of an exception. He seems adapted to the social norms but he doesn’t take them seriously. He plays this game just to avoid punishment and be successful in the society. He is convinced that everybody else is doing the same-“everyone is wearing masks, social life is just a game” (Žizek, 1987). A narcissist sees the admired person as “an extension of themselves.” If that person refuses them, they “immediate experience hatred and fear, and devaluate previous Idol” (Lasch 1979: 155-156). A narcissist avoids intimacy and associates only with people who are, like himself-perfect (Praper 1996: 180). Žižek mentions three types of other people, separated by the narcissist:

  1. The ideal-other: they expect approval and recognition, he identified with them
  2. Enemies, who are preventing his narcissistic affirmation, so they must be destroyed
  3. All the rest, the mass of people, ”suckers”: a grey average, which is here only to take advantage off and then reject them (Žižek 1987: 111).

 

  1. Narcissist as a patient

Several different approaches to individual therapy have been tried with NPD patients, ranging from classical psychoanalysis to Gestalt therapy. The emerging consensus is that therapists should set modest goals for treatment with NPD patients. Most of them cannot form a sufficiently deep bond with a therapist to allow healing from early-childhood injuries as a matter of fact they rarely turn to therapy at the first place (Frey, 2010).
“As of 2002, there are no medications that have been developed specifically for the treatment of NPD. Patients with NPD who are also depressed or anxious may be given drugs for relief of those symptoms (Frey, 2010).
Kerenberg noticed that narcissistic patients shows excessive self-centeredness, over dependency on admiration from others, prominence of fantasies of success and grandiosity. They avoid facts that are contrary to their inflated image of themselves. A narcissistic patient due to the pain of isolation protects himself with a position of self-sufficiency. They don’t let people emotionally close (Kerenberg, 2007, 505; Praper 1996:223).
They suffer from inordinate envy, which is conscious and unconscious. They show greediness, exploitative behavior, entitlement, devaluation of others, and incapacity to really depend on others. But ironically they need the admiration of others. They show a remarkable lack of empathy, shallowness in their emotional life and lack of capacity for commitment to relationships and goals. Also their self-esteem is regulated by severe mood swings. They have chronic sense of emptiness and boredom which they try to escape through eating, drug and alcohol use. In addition, their tendency to criticize and devalue their therapists (as well as other authority figures) makes it difficult for therapists to work with them (Kerenberg, 2007, 505, Frey 2010).
Patients with NPD may present typical complications of this disorder, including sexual promiscuity or sexual inhibition, drug dependence and alcoholism, social parasitism, severe (narcissistic type) suicidality and parasuicidality (=their aim is not to die). For instance, a patient with NPD tends to become depressed when his feelings are badly hurt, when his defenses have let him down and when he believes his world is collapsing. When wounded, he is at the greatest risk of acting out, either against himself or others. A patient experiencing a narcissistic rage may become homicidal, particularly if he has a need to seek revenge. Under conditions of severe stress and regression, a narcissist can experience significant paranoid developments and brief psychotic episodes (look Kerenberg, 2007, 505; http://www.lmars.com/n-personality-disorder.htm).
Using Heinz Kohut’s self-psychology model, the goal of therapy is to allow the patient to incorporate the missing self-object functions into his internal psychic structure. This process is called transmuting internalization. In this sense, these patients’ psyches are “under construction” and therapy is their building time. Empathy is being the key for making changes in therapy. Without it, the patient whose self is too weak to tolerate more aggressive interpretation, would not benefit from therapy and in fact may suffer more damage (McLean, 2007).
Therapists can recognize narcissistic patients by contratransfer. By feelings of boredom and emotional desertion. The therapist may become sleepy, absent, experiencing shame. He can react as all-knowing expert on life, competing with all the therapists that client had left earlier. When the client devalues him, he feels inadequacy and helplessness (Praper 1996:223).
“The prognosis for younger persons with narcissistic disorders is hopeful to the extent that the disturbances reflect a simple lack of life experience. The outlook for long-standing NPD, however, is largely negative. Some narcissists are able, particularly as they approach their midlife years, to accept their own limitations and those of others, to resolve their problems with envy, and to accept their own mortality. Most patients with NPD, on the other hand, become increasingly depressed as they grow older.” (Frey 2010)

References