Narcissistic Personality Disorder

With compassion and elegance the guest on today’s episode, Dr. Nancy McWilliams, helps listeners understand the following and more:  

• What is healthy versus pathological narcissism? 
• Can certain parenting create narcissistic personalities?
• What are some practical suggestions for those in a romantic relationship with a partner with narcissistic tendencies?
• What does it feel like if you have narcissistic personality disorder and what can help?
• What is overt, covert and psychopathic narcissism?
• What if you work for someone with narcissistic tendencies? 
• How can companies spot narcissistic tendencies when hiring leaders?

Dr. Nancy McWilliams (nancymcw@aol.com) teaches at Rutgers University’s Graduate School of Applied & Professional Psychology and practices in Lambertville, New Jersey. She is author of Psychoanalytic Diagnosis (1994, rev. ed. 2011), Psychoanalytic Case Formulation (1999), and Psychoanalytic Psychotherapy (2004) and is associate editor of the Psychodynamic Diagnostic Manual, 2nd ed. (2017). A former president of Division 39 (Psychoanalysis) of the American Psychological Association, she has been featured in three APA videos of master clinicians, the most recent being “Three Approaches to Psychotherapy.” Her books are available in 20 languages; she lectures widely both nationally and internationally.

Enjoy!  

Transcript

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SPEAKER_01 0:45

I'd like to introduce our guest today, Dr. Nancy McWilliams, the author of three books, including psychoanalytic diagnosis. And her books are available in 20 languages. Nancy is considered a master in the field of psychology. She lectors nationally and internationally educators at Rutherford University Graduate School of Applied and Professional Psychologists, which is where I got my doctorate and where I met Nancy. In our field, we have many different types of theoretical orientation like psychodynamics or cognitive behavioral. Your book, Psychoanalytic Diagnosis, is so good, Nancy, that it crosses lines and everyone loves it. And I'm very excited to have you on the show today. Yes, and we are going to talk about narcissism. I recently had an episode on dementia with Dr. Michelle Popka. And she talked about how no one wants to talk about dementia. They don't want to diagnose dementia. And I had the same feeling about narcissism. I think it's a term that's used loosely, but in actual medical and therapeutic settings, people are very cautious to diagnose someone with narcissism. So I'm hoping that we could begin with talking about what is the difference between healthy narcissism and pathological narcissism.

SPEAKER_03 2:36

All right, let me first describe what I understand and what the literature understands to be healthy narcissism, or some people simply call this robust self-esteem. In healthy narcissism, we have realistic self-esteem. In other words, what we value ourselves for is true of ourselves. There are actual qualities or achievements, and reliable self-esteem, meaning that when we suffer a criticism or when we get ignored, our self-esteem doesn't go into the toilet. It's reliably internal that we feel good enough. So realistic and reliable self-esteem is uh one criterion for healthy narcissism. Another is realistic ambition. Uh it's normal to want to achieve something in your life and to be ambitious about achieving it. Of course, when this becomes pathological, it means you follow your ambition, everyone else be damned, and that's a very unattractive quality. But having realistic ambition to do something good for the world, it serves a narcissistic function in a way, and that it supports your self-esteem, but it's not pathological. Um the third thing is we all have ordinary needs for validation. We need occasionally to hear that somebody thought that we were making sense or felt that we were attractive or considered us bright enough or having made an interesting argument, or in other words, we have m needs to be somewhat mirrored in terms of our value to other people. Again, where this would get into the pathological realm is that we if we are so constantly craving affirmation that we're okay, that we can't think about anything else, then our personality is a bit crippled. And finally, there are certain life stages in which it's simply normal to be somewhat narcissistically focused. In other words, to worry more than in other life stages about how people see you, what you value in yourself, whether you're acceptable to the group, and so on. And those would be in early childhood when kids first hit school and want to be a part of the group. Certainly again in early adolescence, where people can be obsessed with the idea of popularity, and that's a kind of a normal developmental obsession here.

SPEAKER_04 5:31

That's a brain thing, right?

SPEAKER_03 5:33

Well, all of this is a brain thing. Because uh you can find the neurology of all of this in the brain. But yeah, early adolescents have certain kinds of immaturities in their brain that make it particularly important that once the peer group becomes their sort of their the pool in which they swim, they desperately need mirroring, the same way a very young child needs parents to give them the message that you're okay. We think you're beautiful, we think you're adequate, we enjoy you, uh, you're all right. The other time that you get a kind of spike in normal narcissism is if you're in training for some kind of position that is highly difficult or responsible. Certainly that would be true of people in training to be a therapist. It's true for people in training to be an artist or uh uh uh for a skill or a craft or um any place in which your adult professional identity is in process, you become hyper alert to whether people think you're good enough or not, whether you're getting good feedback from the world, whether you're making the grade. So you can look kind of narcissistically preoccupied at different developmental levels, but that's normal. If you're that way throughout the lifespan and to the exclusion of all other concerns, then we think you had a problem.

SPEAKER_01 7:09

Right. I do find myself being more forgiving of narcissistic behavior of people in their twenties as well.

SPEAKER_03 7:18

Yeah, especially in this culture, because first of all, they're being bombarded with images of perfection, which you know, anybody who tries to be perfect in order to have a good enough self-esteem is in trouble because perfection isn't possible, but we we get exposed to all these beautiful people, images of wealth, images of power, and so on. But also just because adolescence stretches out very long now. People hit puberty earlier and they hit later in most people's growth, the point at which their surrounding society tells them they're really a grown-up now. I mean, that can stretch into the 30s in some professions, that you don't really feel like you're valued as an adult who has something to offer until your 30s. So we didn't even have the word adolescence until the 1890s, when the Industrial Revolution ended up producing a gap between when you attained biological maturity and could procreate, and when your society said now you were really a grown-up. And that gap has gotten bigger and bigger and bigger. And adolescence is simply a a life phase in which you're going to be preoccupied with how you look to other people.

SPEAKER_01 8:44

Some people refer to concern, uh, the teenage concern with how they appear as the invisible audience. They feel that there's always an invisible audience watching them.

SPEAKER_03 8:57

Yeah, and what a burden that must be if if you're that way all your life, the constant self-consciousness, am I am I looking okay? And that's must be horrible.

SPEAKER_01 9:09

And folks that are narcissists will always feel that way. Am I correct?

SPEAKER_03 9:15

Well, I don't like to use the term narcissists because it kind of objectifies something. I can say people diagnosable with narcissistic personality disorder, or people who are in a narcissistic state, or people who are narcissistically driven. Um, but I kind of resist making it into a noun because it's uh you know, everybody's complicated and everybody isn't easily reducible to a DSM category, even if they are diagnosable as having a personality disorder. But yeah, the the gist of what you said is what's important there.

SPEAKER_01 9:54

Yes. Thank you for that. So can you help listeners to understand what Carl Jung meant by the persona as it relates to this topic?

SPEAKER_03 10:05

The persona, as I understand Jung, is the self you present to the world. And that can be fairly integrated with who you believe you are, but it's modified by things like whatever your sense of privacy is or your concern for other people's feelings. In other words, your persona is what people see about you. And if it's very congruent with who you feel like inside, only it's just a little bit more careful than who you'd be in a completely uncensored situation, that's not pathological at all. In fact, people who have no filter strike us as really a problem. Um, but for many people, their persona feels radically different from who they experience themselves as really being. At some level, they feel like a fraud. Like I'm trying to show a person to the world who is confident and uh on top of stuff and wealthy and uh attuned to all the newest uh trends, but I really feel kind of like an uncertain, ugly, uh, fearful person, then the persona is very much at odds with the self. And that that would be closer to what Winnicott called the false self, that the person has has found a way to be in the world that's at variance with their deeper feelings, sense of reality, sense of of what they value.

SPEAKER_01 11:51

And that would be a lot of work to keep up.

SPEAKER_03 11:55

Absolutely. It's hard to love narcissistic people because they have trouble loving, they're so busy trying to keep themselves together and looking good to the world that they don't think a lot about other people. But despite the fact that they're not lovable, you can have a lot of compassion for them if you really get inside their world and realize how desperate they are and how constantly hardworking they are.

SPEAKER_01 12:24

To keep up the image of looking good?

SPEAKER_03 12:28

Yeah. The kind of narcissist person that is defined by the diagnostic and statistical manual of the American Psychiatric Association is an arrogant version of this psychology. Um it's the entitled, I'm wonderful, you should all understand that I'm perfect, I'm better than you are, I'm wealthy, I'm beautiful, I'm powerful, I'm popular, and everyone should defer to me. That's only one side of it. The other side of it, and therapists often see this side, is the person for whom that persona isn't working. They can't pull that off. And instead they come to therapy saying, I just feel this horrible internal emptiness. I mean I know I'm just inadequate and ugly, and if only I could be popular and wealthy and beautiful and famous, then I'd be okay. And the former kind of narcissism is more visible. Um it's also less likely that those people come for treatment because as long as that persona is working for them, you don't see the terrible emptiness underneath it. But if something happens to them, like they get physically ill and have to depend on other people, or if they get fired from a job that was a big part of their sense of self-esteem, you'll see the flip side of it. You'll see the empty craving, desperate help me. I just want to be rich and famous and powerful and on and contemptuous toward everybody again. So we see those two versions of narcissistic preoccupation as clinicians, and unfortunately, only one of them is really represented in our diagnostic manual.

SPEAKER_01 14:21

But what they have in common is they both feel emptiness, which is different than someone who's feeling depression has a lot of dialogue of beating themselves up. Or can you explain the difference between these?

SPEAKER_03 14:39

Yeah, it's interesting because we didn't have a literature on narcissism till starting in the well, with a few exceptions, till the middle of the last century. And the reason for it was that the kinds of patients who used to come for treatment, the kinds that the early psychoanalysts treated, for example, tended to have what you know Freud would have called or been translated as calling a harsh superego. They were too hard on themselves. They were always attacking themselves. That's a more depressive kind of psychology where I have a sense of self, but it's like bad. I feel guilty. And then in the 50s, we began seeing patients that didn't seem to feel like they had an active inner badness or a problematic inner conflict between what their conscience or superego was telling them and what they wanted. Instead, we started hearing complaints of emptiness, of I don't know who I am. I'm trying to be what everybody else seems to value, but I don't have internal values at all. And we began getting a whole literature on the difference between guilt, for example, and shame, because narcissistically driven people feel shame and not guilt. They may call it guilt, but it's all about how they're seen. And between having an actively bad sense of the self at a deep level, and having a kind of ugly, empty vision of the self at a deep level. And those are very different kinds of people. And if therapists don't understand that difference, they're limited in how much they can help people.

SPEAKER_01 16:20

So when someone feels shame, it's more about feeling of embarrassment about how they appear to others or fear of nothing.

SPEAKER_03 16:30

I think your listeners, if if you just think of a time when you felt because we all feel shame, uh think of a time when you felt shame. You want to disappear. You know, you you feel exposed, you feel uh mortified, it's very different from feeling guilt. And and in shame, the one interesting thing about it is you can't do much about it other than hide. With guilt, presumably you could make reparation of some kind. So in some ways, shame is a more helpless feeling than guilt.

SPEAKER_01 17:03

But those diagnosed with narcissistic personality disorder might feel a lot of shame all the time. And they hide all the time. Okay.

SPEAKER_03 17:13

And they defend against it or they compensate for it with efforts to be perfect and look perfect.

SPEAKER_01 17:20

There's a lot of overlap with I I did an episode on the topic of imposter syndrome. And there's so much overlap. I think it's just different vocabulary.

SPEAKER_03 17:32

Yes, definitely. You know, again, all of these things we can all find bits and pieces of them in ourselves, but people who feel like they are always imposters live a very bleak inner life.

SPEAKER_01 17:45

There was a concept that you've written about which is fascinating to me, and it's the idea that parents can groom a child to become narcissistic extension of themselves.

SPEAKER_03 17:58

Yeah, that term narcissistic extension is not mine. It came from the clinical literature before me, but I like it because it captures something about the histories of most of the narcissistic people that I have treated and my colleagues have treated. Namely, their parents use them to make the parents feel good about themselves. Now, we all do that to our children to a small degree. We like our kids to reflect well on us, but narcissistic people get a constant message that you have to look good for the family. And it's a little confusing because you can get that in one of two ways. You can get it from the kind of parent who's always saying, Why did you get an A minus? Why not an A? Why not an A plus? You're making me look bad. It's important for the family that you don't shame us. And the constant you're not good enough, the constant criticism can create a narcissistic personality. But the opposite of that can too. We see this more in the United States, partly because people in the United States were trying to raise their kids without the harsh super egos that the psychoanalysts were saying were so difficult. So parents started telling children, you're wonderful, you're perfect, you're beautiful. You know, when teachers would say, you know, I think your child is um is not behaving quite right, instead of the parents saying, Well, let's think about what the teacher said and what you could do. They come into school and they say, There's nothing wrong with my kid, and they tell the child, your teacher's just an idiot, and I told them a thing or two. When children are raised that way with this kind of inflated idea of how wonderful they are, they certainly feel like imposters because they know they're not perfect. They know they're not beautiful and wonderful and flawless. So either being overly critical or being overly complimentary, you know, everybody has to get a prize. Uh which, you know, that kind of behavior that was often done with the idea that you're supporting the child's self-esteem. If you're flattering them for stuff that isn't true or stuff that's trivial, they don't build healthy self-esteem. They built a sense of fraudulence.

SPEAKER_01 20:21

They're going to notice that it's not congruent with reality. And it reminds me of Carol Dweck's work on fixed versus growth mentality.

SPEAKER_03 20:32

Yes, it's a different language for exactly that. We see a lot of narcissism in the United States because we're the kind of culture that's mobile and it's a mass culture. You can invent yourself in a mobile culture. And, you know, if you if you grow up in a small, pre-literate or traditional culture, people know who you are. You can't decide to have an image. But in this kind of culture, you don't have the sense that people know who you are. So you may not get mirroring of who you really are. You may be able to reinvent yourself, and you're also in a mass society constantly compared to images of perfection, as I said before. So the United States, it's partly our ideology of individuality and how everybody should be able to pull themselves up by their own good steps and not need other people and some of the other tropes that we hear in this kind of culture. If you grow up with that and you have any kind you run into any kind of limits, you think it's because you have some kind of lack. Well when I go to other countries, they frequently say they volunteer for me what they think is their national character. Like the Russians told me they were masochistic and the Swedes told me they were schizoid, and the Poles told me they were post traumatic, and in South Africa they told me they were given to paranoia and I mean I This people self-diagnose their culture. The Japanese told me they were obsessive, compulsive, and so on. If I asked them, how would you describe the American culture generally? They tend to look at their shoes and then they say narcissistic. Because they're reacting to the American sense of superiority and entitlement and also to the American insecurities about I need you to like me. Americans are famously friendly, sometimes in a kind of desperate way, to other people.

SPEAKER_01 22:36

Yeah, I heard that the French can get annoyed that we're just so friendly.

SPEAKER_03 22:41

Yes. They experience it as insincere.

SPEAKER_01 22:44

Yes.

SPEAKER_03 22:45

And they're slow to make friendships. Yeah, they I I I remember when I was in France, I'd been told that the French are arrogant, and I didn't find them arrogant. I find that they just weren't gratuitously friendly.

SPEAKER_01 23:00

I didn't find them arrogant either. I thought everyone was great when I was there. So um Is the concept of narcissistic appendage the same thing as narcissistic extension?

SPEAKER_03 23:15

Yes. Okay. Just a different metaphor.

SPEAKER_01 23:18

Is that used more for romantic relationships?

SPEAKER_03 23:21

I don't know. I've heard both, and one of the problems with the psychoanalytic tradition is we like to keep inventing new language for things and new metaphors. It partly keeps it fresh for us, you know. When you work with narcissistic patients, it's often kind of a slog because they hate the fact that they need anything. If you're trying to preserve a sense of yourself as already perfect and wonderful, the fact that you need to go to a therapist is a terrible narcissistic injury. So they often spend the session either bragging or complaining rather than working on problems that the therapist can see is a big problem in their life, like their relationships aren't very good. They're critical of their partner all the time, or they're desperate for approval all the time. And it's hard for them to get into that territory because of the shame. So it can feel like a slog. So we have a lot of ways in our literature of helping us understand these things via metaphor and imagery and theory that allow us to maintain our ongoing positive regard for the patient.

SPEAKER_01 24:38

So you do like to give them ongoing positive regard. You don't like to point things out.

SPEAKER_03 24:44

Yeah, but it has to be honest. You don't want to be part of the nameless audience that's just feeding them, feeding their addiction to uh to what's really not good for them. What you want a narcissistic person to be able to do in therapy is show you all the stuff they're ashamed of and realize it's not necessarily so shameful. You also want them to be able to feel good enough about themselves that they can reach out and care about other people, which they often use other people the way they were used as um mirrors for their own self-esteem needs rather than being curious about them as separate individuals. I I've often worked with people who are in relationships with narcissistic people and they can't quite articulate what it is they're not getting, but they don't get what feels like love. They may be idealized for a while, but then the partner starts criticizing them. And nothing they do in response to the criticism seems to help. And they often feel this pressure that they're supposed to figure out what the narcissistic person needs and offer it so that the narcissistic person doesn't have to face the shame of asking for anything because asking for something means they had a need and they're trying to preserve a sense of self as not needing anything. So that that's a terrible pressure to put on your partner. You're just supposed to know what I need and offer it without my asking. And it's hard for ordinary people when they're on the receiving end of this to articulate why this relationship seems to be drying up.

SPEAKER_01 26:30

I think people that are in a relationship with people diagnosable with narcissistic personality disorder will feel empty as if uh they're not really being looked at as an individual person with feelings and needs. They might feel like they're marginalized. Because their partner's needs are more important.

SPEAKER_03 26:58

Yes, exactly. They and they feel looked at as an object, not a subject. Like the I thou relationship that uh Martin Buber talked about. They don't feel like a thou. They feel like an it, you know, they're arm candy for somebody.

SPEAKER_01 27:14

That's a great way to say it.

SPEAKER_03 27:17

They're the deep pocket for somebody.

SPEAKER_01 27:20

So they help their partner look good and they're they are an object that helps them to look good.

SPEAKER_03 27:27

Yeah, and some of them try very hard to play that role, but it's kind of a loveless role.

SPEAKER_04 27:34

Yes.

SPEAKER_03 27:35

So they they feel over time weary and they know there's something that they're missing.

SPEAKER_04 27:42

Yes.

SPEAKER_03 27:43

In fact, narcissistic people themselves feel that there's something missing, but they've never experienced it. You know, they never have experienced enough interest in who they really are, uh, and valuing of who they really are to really have a concept of love. But they they know often that there's something wrong. I remember a man who came to me a few years ago and he said, I don't know what I'm doing wrong. I'm richer than God, I have uh a beautiful house and three vacation houses, I have a yacht, I hobnob with celebrities, I've had three beautiful wives. And then he went on to tell me that the plumber in his town had a wife who was overweight and they seemed happy, and he couldn't understand it. So he knew something was wrong. But he was going by the playbook of if you're just you know rich enough and powerful enough and well connected enough and carrying a beautiful woman on your arm, you should feel great about yourself.

SPEAKER_01 28:45

Yeah, so again, it was that persona, it was the image that he was building. But was he really looking into her eyes and enjoying her, adoring her?

SPEAKER_03 28:58

I don't think so.

SPEAKER_01 28:59

Yeah.

SPEAKER_03 28:59

I don't think so. I mean, uh that's the I think the major tragedy of narcissistic people is that they don't fully love. They think idealization is love. And it's true that when we fall in love, there's a normal period of idealization. But in mature love, once the honeymoon is over, you start realizing what your partner's limitations are, you adapt to them, you love the person as they are. You are not on a mission to transform them into your ideal. And for narcissistic people, when they get past that early phase of idealization, they just get disappointed and they start criticizing, and pretty soon they're off to the next relationship because they don't know how to make that transition from idealization to mature caring for a real other person. And when this happens with a parent and child, you can see how crippling it would be for the child to feel like, you know, mommy loved me until I started talking to her about what I was really feeling, and now she's distracted and not interested in me, and she keeps either criticizing me or or or giving me this feedback that doesn't feel right. It would be the same empty experience.

SPEAKER_01 30:20

So that would be a child that a parent wanted them to realize their own unrealized dreams, let's say.

SPEAKER_04 30:30

Yes.

SPEAKER_01 30:31

And they were putting the child in the direction of becoming the lawyer that they never became, let's say. Or going to you know, they went to a college they weren't proud of, and now they're gonna direct their child to go to the best school only.

SPEAKER_03 30:46

Yes. I have an example in my diagnosis book of a person I know who she knew that her son would she knew intellectually that her son would be a much better fit for a small school where he could feel like he had a kind of meaningful, reasonable size community, but she was determined that he was going to go to Harvard. And he got accepted by several really good schools, but he was not accepted by Harvard, and she spent the whole year beating down the door at Harvard, nagging them so much that by his sophomore year they let him in. Of course, by that time, when he enters college, he's entering as a new guy in his sophomore year. He's not gonna have the same experience, and none of that mattered to her. It was he had to go to Harvard. It was it was painful to watch.

SPEAKER_01 31:41

One of the things that you mentioned is teaching people how to ask for their needs.

SPEAKER_02 31:48

Yes.

SPEAKER_01 31:49

They need to learn how to express their needs. Yes. How do you do that?

SPEAKER_03 31:54

Well, when it's a person in therapy with me who's narcissistic, when they're complaining about someone else, what I tend to say is, Well, did you make your needs explicit? And what I get back is typically, what do you mean needs? Because they don't like the idea of having needs. And then we can get into it. Sounds like you have shame for having ordinary human needs. I mean, what's the problem with saying I wanted to eat earlier tonight rather than being in a snit because your spouse didn't notice that you were hungry and didn't make dinner sooner. So eventually they will experiment with that. They will just try asking for something. And when it goes well, then you've got reinforcement of a real self.

SPEAKER_05 32:43

Yeah.

SPEAKER_03 32:44

When I'm working with somebody who lives with or works for or is a child of a narcissistic personality, I kind of coach them to do something similar. Uh, like let's say, just for purposes of exposition, it's a narcissistic husband and a wife who is cooking the dinner, and he comes in, he sniffs around the kitchen and she says, Are you hungry? And he says, No, no. And then she realizes he's hungry. She's trying to and you know, divine what he needs and offer it unasked because she's learned that that's how he thinks the relationship should go. She speeds up the dinner and he's critical of it anyway. What I will coach such a woman is to say, if he hasn't asked you to make the dinner earlier, take your time, make it the same time you would have usually made it. He will get real critical of you and say, You should have known that I was hungry. And then you say to him, If you had just said that, I would have been happy to make the dinner an hour earlier. Next time just ask. And that can have the the same effect. I mean, people people need some help with how to deal with narcissistic people. They don't express gratitude and they don't express remorse. They can't really apologize. Instead of gratitude, they will sometimes praise, like, hey, you did a nice job with that, as if they're from a position of superiority, rather than thank you so much for what you did for me, which acknowledges that you needed something. And instead of apologizing, they'll say things like, I'm sorry you feel that way. Or they will try to undo, like uh, you know, a woman who's been horrible to her husband the night before will um make him uh some kind of really nice gift and she just hands it to him. It it's one thing if she says, I'm giving you this gift because I feel bad about how I treated you yesterday. But if she just hands it to him and he's supposed to understand that this is an apology, he's not gonna feel warm toward her. When I'm working with this the people who have to deal with narcissistic people in their environment, I and they say, you know, I know this is her way of apologizing. I will say to them, but you didn't really get an apology. Maybe you need to explain to your partner that you really need to hear your partner's pain that you were hurting, that just undoing it with a gift isn't gonna do it.

SPEAKER_01 35:24

Isn't it delicate the way uh that she should do that because narcissists will get angry when confronted or held accountable?

SPEAKER_03 35:34

Yeah, you have to know your person and if you're working for a narcissistic person, that it's dangerous to do that. You you can't take that position. You have you have much more leverage if you're actually in an equal partnership relationship. But one of the chilling things I learned from a friend of mine who used to work for a politician who will be nameless long before that person was a politician was that everybody around that person who appears to me to meet the DSM criteria for narcissistic personality disorder was afraid ever to tell them he'd made a mistake. And they actually, these high-priced lawyers would sit around in private trying to figure out how they could talk in this guy's presence so that he would figure out he made a mistake. Because if they said it, um, they'd get fired. So they hung around role-playing, like, what if you say this and I say that, and maybe he'll get it.

SPEAKER_01 36:41

To get him to think it was his idea.

SPEAKER_03 36:44

Right. Because they were dependent on him literally for their for their income. So I would not counsel them the same way.

SPEAKER_01 36:54

Hmm. Another piece is I I'll speak for myself as far as I noticed that an important milestone in my development was when I, in I would say in my early 30s, allowed myself to admit my imperfections. Yeah, and to admit how much I didn't know and that in fact I didn't know anything. And when I when I could admit that and admit it out loud, I found it really freeing. And I can get that like just from experiencing that myself that with someone diagnosed with narcissistic personality disorder, if they could do that, it will be freeing too.

SPEAKER_03 37:40

Yes, and that's what we all hope for, but it's it's so delicate. You know, it's so hard. I I kind of hope for each session with a narcissistic person for one moment of real authenticity where they show me something that's not perfect about themselves.

SPEAKER_01 37:58

Yeah.

SPEAKER_03 37:59

And have that experience. I had that too in my therapy. Uh, there are many sources of perfectionism and they're not all narcissistic, but all of them are greatly relieved by giving that up, you know.

SPEAKER_01 38:13

Mm-hmm. Yeah.

SPEAKER_03 38:15

Girls who try to be perfect are in a you know, they often do that out of a depressive dynamic. They're just trying to be as good as possible. And it's a great relief to them to say to patients, you know, I think I made a mistake there.

SPEAKER_01 38:29

And then you're being a good example, right? Of of not beating yourself up for being imperfect. You can you can model it for patients, right?

SPEAKER_03 38:41

Right. And that's particularly important for narcissistic patients.

SPEAKER_01 38:45

Yeah, I you know, I have a problem with coming in late. I was even late for starting this podcast, right? Um not by too much. Nine minutes or so. But I can reframe it that me not beating myself up for starting my sessions late is being a good example.

SPEAKER_03 39:06

Yes, there are many things about which I've said to patients, I'm sorry, that's one of my worst qualities as a therapist, and I'll probably do it again. Thank you for sticking with me anyway.

SPEAKER_01 39:18

Yeah.

SPEAKER_03 39:19

Because that models that my self-esteem doesn't depend on my being perfect.

SPEAKER_01 39:24

Yes.

SPEAKER_03 39:25

They often really don't have that concept that you can feel good enough, that you can acknowledge your own failings and limitations.

SPEAKER_01 39:34

So it would be a victory to get them to say that they are good enough, or even to say that they're average, which we all are.

SPEAKER_03 39:44

Yeah, right. Right. And that not everybody has to be number one or the leader. I I remember I was in a different country and they said to me, What is this about? You always have to be the leader. You know, le there's such a thing as being a good follower, and uh what is this having to be number one all the time? What a pressure.

SPEAKER_01 40:05

It's true. I think a lot of business programs, it's all about leadership, but they can't all be leaders. They have to get along.

SPEAKER_03 40:12

Yes.

SPEAKER_01 40:13

Yeah. Good point.

SPEAKER_03 40:15

Yeah, you you probably know Carl Rogers was onto these dynamics way before psychoanalysts were about how important it is for people to feel, you know, fully known and mirrored. When the psychoanalysts got hold of that idea, the person who really promulgated the centrality of empathy was Heinz Cohort. And one of his most important contributions to the theory of therapy was the idea that if you make a mistake with a patient, you simply apologize. Prior to that, psychoanalysts would treat their own mistake the way they treated everything else by being quiet and saying, Well, what comes to mind about that? What are your feelings about that? You know, what are your images about that? Without going the extra mile and saying, Yeah, you're right. I can see I hurt your feelings. I'm so sorry.

SPEAKER_01 41:06

Yes. And uh people can do that if they're in a relationship with someone um showing narcissistic traits. They can they can model that as well.

SPEAKER_03 41:16

Yes. And since they're often criticized, it's a very good, is another thing I sometimes coach them about is to say, okay, the content of what your wife is saying is uh maybe accurate, but the process is pretty damaging. So, you know, why don't you just say something like, yeah, I think there's some truth in what you say, but if you said it in a different way, as if you were really interested in helping me with that, rather than just feeling good that you're superior to me, I think our relationship would be much improved.

SPEAKER_01 41:52

That's said that's said very sweetly. Yeah.

SPEAKER_03 41:57

You don't have to fight off some of the criticism. You can say, Yeah, you're probably right. You know, you're stuck with a spouse who. And you know, I hope you make allowances for that about me the same way I make allowances for your quirks.

SPEAKER_01 42:11

You mentioned that some people will only learn from a rock bottom experience.

SPEAKER_03 42:17

Yeah, it's interesting. Narcissism and its most extreme version, which is over toward the antisocial spectrum, what Otto Kernberg calls malignant narcissism, people with that kind of personality type are the only clinical group that has a better prognosis the older they are. Uh, with most patients, you want to get them young because if you can help them change a few things, their whole life trajectory might be different. But if you are an arrogant version of a narcissistic person and you're smart and you're privileged, let's say in this culture, you're a heterosexual white male from an upper middle class to upper class family who went to the best schools, you can get a long way feeling like there aren't really any limits. All of the things that you've done are your own achievements. You're just fine, and everybody else should mirror that. But by the time you hit your fifties, you're balding. The young guy on the way up knows more about the tech part of the job than you do. Uh, maybe you've gotten an illness, maybe you've had several failed relationships, and you start getting interested in, like the guy I told you about with the three beautiful wives.

SPEAKER_04 43:42

Yeah.

SPEAKER_03 43:42

Um, you you start getting interested. I've had people get interested in changing their basic uh narrative about life from AA and other twelve step programs. You know, very often narcissistic people do develop substance use disorders because it Their life is all about feeling good now. And so they'll go for a substance, whether it's booze or other drugs or sex or gambling, things that make them feel high. And they eventually find themselves in twelve-step programs when they get into enough trouble. And they realize that these are programs in which people tell the truth about themselves. And people depend on each other. And people acknowledge that they're out of control.

SPEAKER_01 44:30

Yes.

SPEAKER_03 44:38

Yeah. And this is this is such a um whiplash for them. They they start getting, if they're suffering enough, they get curious about how they might think about life or behave in a different way that would have protected them from what they've just gone through. So they really they do better in therapy once they've had some real hard knocks. I think women, the period of time is a little younger when they can be helped. They don't get as much confirmation that they're on top. And also if you're female, life reminds you of limitation all the time. You know, you men straight, you have to deal with that. You can get pregnant, you have to deal with that. If you are pregnant, the any fantasies you ever had that you're totally in control of your own body are out the window. And being a parent, if you're the primary parent, is very humbling as well. So I think it's more likely that you can help narcissistically organized women a little bit sooner, and they're more likely in their forties. Not that you can't help some people in their teens, twenties, thirties. You can. It's just much harder if their narcissistic stuff is working for them. It's much harder to find the part of them that sees that there's any problem with living this way.

SPEAKER_01 45:59

So you find it easier for men if they're in their fifties or later.

SPEAKER_02 46:04

You know, making a gross generalization, yes.

SPEAKER_01 46:08

And they may have had success from their behavior, but it's a problem if they've been injuring others along the way.

SPEAKER_03 46:17

Definitely. And I think for ordinary non-narcissistic people, and even for some people trained as therapists, it's sort of stunning to realize that there are people who are very bright, very high achieving, very successful, that are psychologically kind of primitive.

SPEAKER_01 46:41

Yeah.

SPEAKER_03 46:42

You tend to equate, especially again in this culture, we equate intelligence with the most important thing. If you're very smart, how could you be this crazy? But narcissistic people can be extremely primitive in in the sense of it's my way or the highway. And anything else is sort of collateral damage because I'm entitled to do whatever I want. Petty tyrants tend to have this kind of psychology, and everybody reinforces it because they have the power.

SPEAKER_01 47:18

The term petty tyrants? You mean like someone who owns a small business and they're a tyrant of their own world?

SPEAKER_03 47:25

Yeah, that and all the way up to people who run countries. Small countries and who tyrannize over. There's an interesting book, um, Snakes in Suits, about the sort of malignant end of narcissism in high-functioning people.

SPEAKER_01 47:43

There's something called covert narcissism, right?

SPEAKER_03 47:46

Yes.

SPEAKER_01 47:47

What what is that?

SPEAKER_03 47:49

Well, that's usually that that term is is to describe the more I want to be popular version of narcissism. There are different words for those distinctions. The arrogant narcissist has been called the overt narcissism, or the thick-skinned, or the oblivious, or the exhibitionistic, or the arrogant narcissist. And the the person who's always craving, always looking, am I good enough? Am I getting the right kind of reflection? has been called thin-skinned, hyper-vigilant, closet, depressed, depleted, or covert because they're not so obviously narcissistically preoccupied. You know, the guy who tells you, I'm wonderful and I'm perfect, and you should all look up to me, is pretty obviously a narcissistic person. But there are many people out there who have the same concerns and don't feel they've quite achieved that level of public uh mirroring for their their grandiosity who have those same covert preoccupations. You know, if only I were perfect then.

SPEAKER_01 49:02

And what's the Snakes and Suits book about?

SPEAKER_03 49:05

It's about people on the more psychopathic end of the spectrum, or what we tend to call antisocial or the malignant narcissistic spectrum, which is that you can be very antisocial and not necessarily get in trouble. I mean, the DSM description of antisocial is all about you know people who go to jail or get in trouble or get diagnosed as conduct disordered. But there are high functioning versions of the same psychology where you just use people. I think there was a study by Harvard University Business School that found that the modal kind of CEO in the United States used to be someone with an obsessive compulsive style of personality, and that it has shifted in recent years to narcissistic verging on psychopathic personality.

SPEAKER_01 49:59

Wow.

SPEAKER_03 50:00

That does not bode well for us.

SPEAKER_01 50:02

No, no, but they're getting rewarded. They're being rewarded with the position.

SPEAKER_03 50:07

They are. They are. This is a this is a really important kind of personality to understand, both on the ordinary day-to-day level and um at at a a larger level. I I've sometimes consulted to military places, and once when I was consulting in San Antonio, they had a day where they just had people um invited to have an hour or a half an hour with me if they wanted to, and they just put me in an office and had people come to sign up to see me. And most of the people who did that wanted to talk about the fact that they were a therapist for the Air Force and they were, you know, treating the general's daughter or something, and they couldn't talk to anybody else about it. But the commander of the base came to me and said, What I want to ask a psychologist is how do we keep narcissistic and psychopathic people from becoming generals? And it was a very interesting conversation because what we figured out together was that the way the military promotes people has to do with the evaluation of your superior. And if you're really good at your narcissism, you can charm your superiors. You know just what to say and how to look to them. The people you won't charm are your peers who know that you're an operator, and especially people who work under you, they know who the psychopaths and narcissists are.

SPEAKER_01 51:36

But um, above you can't see it. Like a 360.

SPEAKER_03 51:49

And he said, Oh, the military would never go. That's too much of a paradigm shift. But the question was interesting to me that in other words, any role that has a lot of power and visibility is going to attract people with pathological needs to be seen and be seen as powerful. So narcissistic personality is not uncommon in people who are in leadership roles.

SPEAKER_01 52:19

Nancy, how could people find you if they were interested in learning more about your work or working with you as a consultant or even within your private practice?

SPEAKER_03 52:29

They can email me at I'm an AOL dinosaur, uh Nancy M CW. All one word, at AOL.com.

SPEAKER_01 52:39

Okay. Thank you so much for spending time with us on Psychology America.

SPEAKER_03 52:46

You are very welcome, and this has been a lot of fun.

SPEAKER_01 52:49

A lot of fun for me too. I'm truly grateful. Thanks, Alexander.

SPEAKER_00 52:53

If you enjoyed this episode of America, Alexander,