Dr. Mazzella (00:00.748):
When working with him, I try to get closer to understanding what triggered his feelings and behavior. He’s not always thinking his wife is cheating, he’s not always angry with her. So, what happened in this particular moment? For example, he often starts talking about how his job requires him to spend long periods of time alone, and it’s during those moments that he starts thinking his wife might be cheating on him.

Dr. Mazzella (00:33.838):
Hello everyone, welcome to the Narcissism Decoder. I'm your host, Dr. Anthony Mazzella. Today, I'm thrilled to bring you part two of my interview with Lisa Taylor-Austin, a highly respected psychotherapist in private practice. Alongside her clinical work, Lisa shares her insights on her video channel, where she educates and empowers a wider audience.

What I'm about to play for you is the second part of our discussion, where Lisa and I move deeper into the therapeutic approaches used to treat Narcissistic Personality Disorder (NPD), focusing on specific techniques like containment, detoxification, and interpretation. Our discussion covers concepts that are crucial to understand if you're dealing with narcissistic characteristics, either in yourself or in someone close to you.

To get you oriented, I'll play a segment where I discuss how I work with what we call the "projective-introjective malignant cycle." I know that sounds like a lot, but don’t worry—I’m going to break it down. If you haven’t listened to the last episode yet, I encourage you to go back and listen, as we ended with an example of how I help someone projecting their negative self-image onto others, including me. Lisa was already a step ahead in this discussion, so let me bring you back into the interview. I hope you find it insightful and thought-provoking.

Yes, I would add one thing: while developing trust is essential, it’s not enough on its own. It’s a good starting point, but for a treatment to lead to lasting change, we need to show them how frequently and automatically they interpret things as if someone always has malignant intent. That’s the projection we are dealing with in psychodynamic psychotherapy.

Dr. Mazzella (02:53.548):
Our work is not necessarily about helping them get along with someone, although that might be a result. It's about creating space for them to begin to reflect on why they see everyone as having malignant intent. They start to realize this isn’t a new relationship pattern. If it keeps repeating itself with different people over time, and then with you in the room, that’s where the real value of the work comes in—when this dynamic comes alive in the therapeutic space.

That's what we call working with transference, and it’s valuable because we may not really know the other characters in their life. Maybe those people do have malignant intent—it’s possible. But in general, I don’t think I do, and if I’m accused of it, I have to slow down and reflect on it. If I determine I don’t have malignant intent, we can help them distinguish between reality and how they imagine I’m behaving. This leads to understanding how they are recreating what we call, using a bit of jargon, an "archaic fantasy object," going back to early caregivers who were abusive, neglectful, or inconsistent.

Remember, we spoke about those "archaic fantasy objects" that get projected. The first order of business is developing trust. However, if you rush into interpreting too early, they won’t trust you; they’ll feel criticized and attacked. Instead, the next step is helping them become aware of the distinction between their internal "archaic object" and the real external person they’re interacting with now. When this process works well, it creates a positive breach in the projective-introjective malignant cycle I described earlier.

Dr. Mazzella (05:14.282):
Now, they have a positive experience to add to their memory bank. We hope they eventually question whether you are truly a malignant person and start to internalize and trust you. For them, recognizing that you’ve enriched their life or made a good point is a developmental achievement that takes time. For a narcissist to acknowledge value in someone else’s input is groundbreaking.

It’s really rewarding to see, even in small doses, when they say, "I thought about something you said last session." I may stop and ask, "What happened there?" because it’s rare for them to think about these things, and I want to get closer to that and reward it. For them to say, "You enriched my life," is an admission that they don’t know everything—that they’re not omnipotent or all-knowing. As you know, Lisa, from interviewing these people, that grandiose sense of self is what holds them together.

Yes, the therapy process is a long one, with a lot of undoing and re-experiencing that the client needs to go through. But can I add one more thing? For your listeners who might not be thinking in therapeutic terms, let’s say they are in a relationship and the woman complains, for instance, that her husband keeps accusing her of cheating. I would talk to her about how she responds when he is so convinced she’s unfaithful.

Dr. Mazzella (07:49.944):
My work with her would involve not immediately arguing or saying, "You're crazy" or "I'm not cheating on you; you’re projecting." That defensive reaction only reinforces the cycle. Instead, I encourage her to get closer to his experience, asking questions like, "What makes you think I’m cheating? What did you see or notice?" Slowly, this helps them recognize that there are no real signs of cheating, and, assuming there’s no history of infidelity, what is it that he’s actually seeing?

Working with him, I try to get closer to understanding what triggered his thoughts. He’s not always thinking his wife is cheating; he’s not always angry with her. So, what happened at this moment? For instance, he might mention how his job involves long periods of time alone, which is when he starts thinking about his wife cheating on him. We discussed this in the previous episode: that’s not real thinking; it's obsessing.

You see, this is how the malignant cycle plays out internally in him when he's alone, and then it gets projected onto her. So, I work with him to understand that he creates this fantasy in his mind. He starts talking about how he doesn’t feel worthy because he works long hours away from home, and this slowly unravels to reveal a sense of unworthiness. We help him own this devalued part of himself, which is crucial for integration.

Dr. Mazzella (11:01.134):
That real-life example is so helpful, thank you for adding it. Many people experience something similar if they’re in a relationship with someone with NPD, whether as an intimate partner or a sibling. The accusations might not be about cheating but something else.

Now, I want to get your thoughts on a therapy approach that isn’t common in the United States, but people might hear about it on social media. This approach suggests re-traumatizing a person with narcissistic personality disorder to help them in therapy. I find this idea very surprising. What are your thoughts, Lisa?

Well, I do EMDR and work with people who have trauma. While not all people with trauma develop NPD, many with NPD have trauma, so the idea of re-traumatizing them seems cruel. I think you might have a more clinical, psychoanalytic response to this.

Dr. Mazzella (13:20.174):
My first reaction is that this approach is incredibly superficial. It suggests that you need to re-traumatize because you don’t see the existing trauma, assuming the narcissist’s grandiosity hides it. But in reality, the trauma is alive every day; it’s just hidden.

Living life with a grandiose sense of self and omnipotence isn’t easy. There’s an underlying anxiety, insecurity, and constant fear of humiliation. You don’t need to re-traumatize them; the trauma is already there. What’s needed is patience, understanding, and an approach that appreciates how these structures take time to unravel.

We then discuss Transference-Focused Psychotherapy (TFP), a psychoanalytic approach that helps patients separate what is real from what is imagined by addressing internal representations within the therapeutic relationship. This technique is particularly useful for people with NPD.

Dr. Mazzella (22:04.066):
Lisa and I are planning a live stream where listeners can ask questions directly, allowing for an open dialogue to deepen understanding of NPD. I hope you find today’s episode valuable and look forward to your participation in our future discussions. Thank you again, Lisa, for this enriching conversation.

Disclaimer (22:51.122):
The Narcissism Decoder podcast is provided for general information purposes only. The content is not intended to diagnose, treat, or cure any psychological condition related to narcissism. It should not be considered a substitute for professional medical advice, diagnosis, or treatment. For specific advice related to narcissism or other psychological conditions, you can reach me directly. I am an experienced mental health practitioner and always open to consultations.