Narcissism: Psychological Theories and Therapeutic Interventions in the
Narcissistic Disorders


Introduction

Understanding the Narcissistic Phenomenon


The so called "narcissistic personality disorder" is a complex and often
misunderstood disorder. The cardinal feature of the narcissistic personality
is the grandiose sense of self importance, but paradoxically underneath this
grandiosity the narcissist suffers from a chronically fragile low self esteem.
The grandiosity of the narcissist, however, is often so pervasive that we tend
to dehumanize him or her. The narcissist conjures in us images of the
mythological character Narcissus who could only love himself, rebuffing anyone
who attempted to touch him. Nevertheless, it is the underlying sense of
inferiority which is the real problem of the narcissist, the grandiosity is
just a facade used to cover the deep feelings of inadequacy.

The Makeup of the Narcissistic Personality

The narcissist\'s grandiose behavior is designed to reaffirm his or her
sense of adequacy. Since the narcissist is incapable of asserting his or her
own sense of adequacy, the narcissist seeks to be admired by others. However,
the narcissist"s extremely fragile sense of self worth does not allow him or
her to risk any criticism. Therefore, meaningful emotional interactions with
others are avoided. By simultaneously seeking the admiration of others and
keeping them at a distance the narcissist is usually able to maintain the
illusion of grandiosity no matter how people respond. Thus, when people praise
the narcissist his or her grandiosity will increase, but when criticized the
grandiosity will usually remain unaffected because the narcissist will devalue
the criticizing person.

Akhtar (1989) [as cited in Carson & Butcher, 1992; P. 271] discusses six
areas of pathological functioning which characterize the narcissist. In
particular, four of these narcissistic character traits best illustrate the
pattern discussed above. " (1) a narcissistic individual has a basic sense of
inferiority, which underlies a preoccupation with fantasies of outstanding
achievement; (2) a narcissistic individual is unable to trust and rely on
others and thus develops numerous, shallow relationships to extract tributes
from others; (3) a narcissistic individual has a shifting morality-always
ready to shift values to gain favor; and (4) a narcissistic person is unable to
remain in love, showing an impaired capacity for a committed relationship".

The Therapeutic Essence of Treating Narcissism

The narcissist who enters therapy does not think that there is something
wrong with him or her. Typically, the narcissist seeks therapy because he or
she is unable to maintain the grandiosity which protects him or her from the
feelings of despair. The narcissist views his or her situation arising not as
a result of a personal maladjustment; rather it is some factor in the
environment which is beyond the narcissist"s control which has caused his or
her present situation. Therefore, the narcissist expects the therapist not to
"cure" him or her from a problem which he or she does not perceive to exist,
rather the narcissist expects the therapist to restore the protective feeling of
grandiosity. It is therefore essential for the therapist to be alert to the
narcissists attempts to steer therapy towards healing the injured grandiose
part, rather than exploring the underlying feelings of inferiority and despair.

Differential Psychological Views of Narcissism

The use of the term narcissism in relation to psychological phenomena was
first made by Ellis in 1898. Ellis described a special state of auto-erotism
as Narcissus like, in which the sexual feelings become absorbed in self
admiration (Goldberg, 1980). The term was later incorporated into Freud"s
psychoanalytic theory in 1914 in his essay "On Narcissism". Freud
conceptualized narcissism as a as a sexual perversion involving a pathological
sexual love to one"s own body (Sandler & Person, 1991). Henceforth, several
psychological theories have attempted to explain and treat the narcissistic
phenomenon. Specifically, the most comprehensive psychological theories have
been advanced by the psychodynamic perspective and to a lesser extent the
Jungian (analytical) perspective. Essentially, both theories cite
developmental problems in childhood as leading to the development of the
narcissistic disorder. The existential school has also attempted to deal with
the narcissistic problem, although the available literature is much smaller.
Existentialists postulate that society as a whole can be the crucial factor in
the development of narcissism. The final perspective to be discussed is the
humanistic approach which although lacking a specific theory on narcissism, can
nevertheless be applied to the narcissistic disorder. In many ways the
humanistic approach to narcissism echoes the sentiments of the psychodynamic
approach. The Psychodynamic Perspective of Narcissism

The psychodynamic model of narcissism is dominated by two overlapping
schools of thought, the self psychology school and the object relations school.
The self psychology school, represented by Kohut, posits that narcissism is a
component of everyone"s psyche. We are