2. Disarming the narcissist Narcissism and Schematherapy Bali 2017 Marjon Nadort
1) Schema-focused conceptualization of Narcissism 2) Assessment, Goals and General strategies 3) Specific Schema-focused Techniques 4) Common obstacles to Treatment of Narcissism 5) What is triggered inside of you? 6) Guidelines for responding to the Narcissist

3. How do you recognize a narcissist or narcissistic behaviour?
Men:
Modern day Sir Lancelot: the noble knight,
Prince Charming
Mr. Entertainer

4. Wendy Behary (2008)
‘A Knightmare in Shining Armor’

6. How do you recognize a narcissist?
Men:
The Bully: who do you think you are, I pay for the bill, I can do what I want, I don’t have to take this from you, you don’t know what real life is outside your office!

8. How do you recognize a narcissist?
Women:
Divas in distress
Prima Donnas
Drama Queens
The great martyr: you don’t know what I have suffered, you don’t know what real problems are….

12. Typical examples from childhood
Doting and devoted, spoiling parent, who treats the child as special, with few limits (project their status and recognition needs onto the child, sets very high expectations, can be manipulative and controlling, no genuine unselfish love, lack of empathy for child’s needs

13. Childhood (2) Rejecting, absent, distant, critical or abusive parent
Gifted child – often with a special talent
Family is perceived as special (wealthy or with status)
Socially rejected by peers

14. Development of dysfunctional schemas of the narcissist
Loneliness and Isolation: development of emotional deprivation, social isolation and defectiveness
Used or manipulated: the child is used for the gratification needs of parents: development of mistrust/abuse and subjugation
Conditional love: defectiveness, unrelenting standards and recognition-seeking
Insufficient limits: the child has to be special: development of entitlement and insufficient self-control

15. Once upon a time……
There was a lonely boy or little girl who felt very lonely, who didn’t have friends, who had to be perfect, who couldn’t trust anyone, who had to be special, who had to be beautiful, who had to work hard….to excell…

17. Schema Modes of the Narcissist

18. Selfsoother: workaholic, addiction, sensation-seeking Enraged Child
Healthy Adult
Self Aggrandizer: overcompensates: entitled, competitive, status-seeking
Demanding Parent
Selfsoother: workaholic,
addiction, sensation-seeking
Enraged Child
Lonely Child: isolated,
unloved, rejected, inferior
empty, average

19. Lonely Child Feels lonely Feels inferior
Nobody accepts me when I show I’m vulnerable
Feels empty
Feels isolated and rejected
Has no contact with peers
Undertakes solitary activities

20. Self-Soother
Goal
To avoid feelings of loneliness and emptiness of the Lonely Child
Behaviour
Workaholism
Stimulation/sensation seeking
Addiction behavior (drinking, sex, drugs, shopping)
Solitary interests
Compulsive exercising

21. Self-Aggrandizer Goal
To avoid feelings of loneliness and emptiness of the Lonely Child

22. Self-Aggrandizer Behaviour
Present themselves as unique, special and very important
Fantasies of success, power, brilliancy, beauty or ideal love
They deserve special treatment
Require excessive admiration
Sense of entitlement: rules are for other people
They exploit others (treat others like servants)
Lack empathy
Arrogant behaviour/charming behaviour

23. Bully and Attack Behaviour
Present themselves as unique, special and very important
They deserve special treatment
Require excessive admiration
Sense of entitlement: rules are for other people
They exploit others (treat others like servants)
Lack empathy
Arrogant behaviour

24. Enraged Child
The pain of the lonely child is intolerable, so they become enraged:
Behaviour
Others are not allowed to criticize me
I have special needs
Others must respect me
I will destroy others
Narcissistic temper tantrums

25. Two examples: Exercise 1
Film Extract:
Vicky, Cristina, Barcelona (male), (Woody Allen, 2008)
Make a schema/mode conceptualization in groups of 4

26. Two examples: Exercise 2
Film extract: Blue Jasmine, female (Woody Allen, 2013)
Make a schema/mode conceptualization in groups of 4

27. Blue Jasmine Woody Allen 2013
youtube.com/watch?v=tWLtj4LY5CA

28. Assessment
Reasons for entering treatment, leverage, meaningful consequences
Assessment through patient’s behaviour in therapy sessions
Through history
Imagery
Schema Questionnaires (YSQ, SMI, YPI)

29. Goals of Therapy
You can’t change them completely, but you can weaken them
In general: to increase vulnerability with less compensation and avoidance
To create a Healthy Adult capable of nurturing the Lonely Child, and able to fight the Self-Aggrandizer and Detached Self-Soother
To set limits to Enraged Child

30. Punitive Parent/Demanding Parent
Healthy Adult
Self Aggrandizer: overcompensates: entitled, competitive, status-seeking
Punitive Parent/Demanding Parent
Selfsoother: workaholic,
addiction, sensation-seeking
Enraged Child
Lonely Child: isolated,
unloved, rejected, inferior
empty, mediocre

31. General Strategies
Help Lonely Child to feel nurtured and to nurture others
Confront Self-Aggrandizer, help patient give up need for approval and validation, as Lonely Child takes in more genuine nurturance
Help Detached Self-soother give up maladaptive behavior in favor of true nurturance
Help enraged child

32. Specific Techniques Imagery Rescripting Lonely Child
Empathic Confrontation
Multiple Chair Technique Self Aggrandizer and Detached Self Soother
Limit setting Enraged Child
Limit setting Bully and Attack

33. Lonely Child
Explore childhood origins of schemas/modes through imagery
Imagery rescripting, help patient identify feelings of loneliness and vulnerability and rescripting by therapist
Express anger towards parents for lack of nurturance, for using child to advance their own needs, or for excessive criticism and high expectations (by therapist in the image)

34. Demonstration and Exercise

35. Empathic Confrontation
Tactfully confront condescending or challenging style
Tactfully express your own rights when violated
Help patient recognize difficulty accepting and giving genuine care
Confront approval-seeking behaviour without devaluing patient: goal is to create relationship in which the patient feels cared for, without being perfect or special
I care about you, not your perfomance or appearance

36. Demonstration and Exercise

37. Bypassing the Self Aggrandizer
Label Self Aggrandizer
Explain development in childhood &
Empathize with its adaptive value
Link to trigger events
Review pros and cons of self aggrandizing in the present & motivate patient to reduce this protection
Practice dialogues between Self Aggrandizer and Healthy Adult or Vulnerable Child Mode
The detached protector: this is one of the most difficult modes to work with or to breakthrough. First there has to be an agreement about the detached protector. What is important that you notice it in the session and point it out to the patient. Then you explain the development in childhood en empathize with its adaptive value. You don’t send the protector mode away but negotiate with it. What is important that it becomes clear what the triggering events are that activate the protector mode.
There are different techniques we can use:
You can review pros and cons of detaching ni the present and motivate patient to reduce this protection
You can do imagery exercises
You can do a multiple chair techniques in which we practice dialogues between the Detached protector and the healthy adult

38. Multiple Chair Technique
With Self-Aggrandizer

39. How to do it:
Lonely Child mode or Healthy Adult mode sits next to therapist
Self-Aggrandizer on other chair
Conduct dialogues among the modes
Therapist helps the Lonely Child or Healthy Adult

40. Demonstration and Exercise

41. Bypassing the Detached Self Soother
Label Detached Selfsoother
Explain development in childhood &
Empathize with its adaptive value
Link to trigger events
Review pros and cons of self soothing in the present & motivate patient to reduce this protection
Practice dialogues between Detached Self Soother and Healthy Adult or Vulnerable Child Mode
The detached protector: this is one of the most difficult modes to work with or to breakthrough. First there has to be an agreement about the detached protector. What is important that you notice it in the session and point it out to the patient. Then you explain the development in childhood en empathize with its adaptive value. You don’t send the protector mode away but negotiate with it. What is important that it becomes clear what the triggering events are that activate the protector mode.
There are different techniques we can use:
You can review pros and cons of detaching ni the present and motivate patient to reduce this protection
You can do imagery exercises
You can do a multiple chair techniques in which we practice dialogues between the Detached protector and the healthy adult

42. How to do it:
Lonely Child mode or Healthy Adult mode sits next to therapist
Detached Self-Soother on other chair
Conduct dialogues among the modes
Therapist helps the Lonely Child or Healthy Adult

43. Demonstration and Exercise

44. Limit-setting Enraged Child or Bully and Attack Set limits
Connect to the Lonely Child

45. Demonstration and Exercise

46. Ideal therapist behavior
Therapist can reparent
Therapist can correct in an empathic way
Therapist can respond appropiately – when patient engages in compensatory behaviors in session
Therapist can tolerate strong affect of patient
Therapist has realistic expectations of self and pt
Therapist is satisfied with self, own life
Therapist can set limits on own behavior and patient’s behavior
Therapist can handle therapeutic crises appropriately
Therapist maintains appropriate boundaries

47. Schemas of the therapist
Defectiveness/shame
Failure
Unrelenting standards
Entitlement
Emotional Deprivation
Emotional Inhibiton
Insufficient self-control
Self-sacrifice
Subjugation

48. Interaction between schemas of the therapist and schemas of the patient
When therapist and patient have the same schemas: clash, overidentification or withdrawal
When therapist and patient have schemas that are complementary: no progress, abuse
Not only schemas also coping strategies can be triggered

49. Exercise Split up in groups of 4
Give 4 personal examples of combination of dysfunctional schemas of the therapist and client or coping strategy:
Are they symmetrical?
Are they complementary?
What happens in the therapeutic relationship?

50. Common obstacles to treatment of narcissism
Anger when therapist frustrates entitlement or sense of specialness
Avoidance of experiencing pain of Lonely Child
Difficulty trusting therapist’s unselfish motives
Patient tries to make therapist a servant
Patient’s tendency to point out therapist’s flaws, devalue therapist and then leave
Insufficient leverage: level of pain is not that high

51. Demonstration Alex (In Treatment, 2008)
What schema’s are triggered in you?

52. Guidelines for responding to the Narcissist
Don’t defend yourself or attack back
Assert your rights non-punitively
Don’t agree to something you’re uncomfortable with
Therapy relationship is mutual, based on reciprocity, not on a master-slave principle
Acknowledge when your feelings are hurt
Admit mistakes readily
Empathize with the narcissistic point of view, and be tactful in confronting entitlement

54. Guidelines….
Look for evidence of underlying vulnerability and point it out as a possibility, whenever possible
Rise above the specific incident and ask the narcissist to explore the motivation behind the statement
Look for common narcissistic themes and point them out in the form of a question:
Condescending, one-up, competitive behavior
Judgmental, critical and evaluative comments
Status-seeking statements
Label statements that seem to represent Self-Aggrandizer of Detached Self-Soother

55. Goal of today for the therapist
Therapist is very real, very human
It’s your Healthy Adult that mirrors them, not your Vulnerable Child
You and the Narcissist are in a microcosmos
To be aware what is triggered inside of you
When you walk out, you feel stronger
You feel sturdier

56. Goal for the therapist and client…..

57. Goal for the client