 Why should the narcissist attend therapy? What's wrong? Maybe it's just an a-hole or a jerk or maybe like Lens Perry says he has a narcissistic style But not a full-fledged narcissistic personality disorder So what so why should he waste resources this time his money on utterly unnecessary treatments I Thought that I would give someone else the right to speak for a change It's a woman who had written to me Hello, Sam I'm watching many of your recent videos indeed as I type I had to pause halfway through one to write to you How the narcissist sees you as to women? Nothing has hit that bullseye with such clarity. I Have to tell you that I've written before at the beginning of leaving my fragile or covert narcissistic partner I thought I had enough resources to keep me determined in my run to the hills. I failed Seven months later. We reunited we then married Are the delicious blaring of reality in that back to the start phase of our resurrected relationship? I thought to myself How did I ever doubt this man? He loves me. He's so generous and kind and present He falls on one knee in a hebridian sunset and proposes. Of course the answer was yes Slowly ever so slowly Like the proverbial frog in that pot of water brought to boil. I Wake up after three more years and realize nothing has changed That feeling of being invisible That old niggle of disconnection feeling as though I'm irrelevant. I Mean nothing to him That void he can't physically touch me. No laughter. No joy. He's like a kettle Furiously boiling inside where you can see the lead jumping, but you know you will be scolded if you try to remove it The verbal abuse where he totally lacerates my character wounds me deeply It's as though I'm merely a household appliance functional I Attempt to discuss how I feel and he reacts with disinterested best at worst fury My feelings just don't matter He's the hero the provider. We both work by the way How dare I put him down when he's working so hard. I Feel ugly insecure Pointless and completely invisible. I Know this is not true. Of course, but I feel this in his company. I feel completely stuck. I Would not like just to be free. This has gone on for 13 years. I Constantly tell myself out, but he was kind to me then he bought me a meal out We had that holiday, etc. And I end up flailing between extremes Please feel free to quote my email if my words make others go me too and recognize that insidious sorcery That's subversion into the frog pan enough to act That's good My previous partner was a grandiose narcissist. It was evident who he was as he crashed around center stage There was nothing underhand about his aggression like blowing a trumpet in your face this one However, he's like walking barefoot in lush grass Not seeing the snake How do we get here? Well more to the point. How do we escape? I mean truly escape. I think this letter speaks for himself the nice assistant flicks in Insurmountable Harrowing suffering on everyone around him and I'm not only referring to insignificant insignificant others Or to non intimate partners. I'm referring to his business associates his neighbors Everyone around him suffers one way or another ultimately the narcissist himself sets himself up for failure his Standards of perfection can never be attained. So he's constantly dissatisfied and tortured and then When he does succeed his sabotage is his own success. He undermines his self defeats. He self-destructs Because of his inner critic sadistic superego the narcissist Is the narcissist? largest biggest victim the narcissist tends to regard the therapeutic relationship as yet another shared fantasy and Here too within the therapy the narcissist confuses internal and external objects via a process called transference He transfers his internal objects. He projects them onto the therapist some of these internal objects are parental figures So he begins to treat the therapist or regard the therapist as a surrogate father or surrogate mother and there is an almost psychotic confusion in the first stages of therapy My name is Sam Vakny. I'm the author of Malignan self-love narcissism revisited and your professor of psychology Today, I'm going to offer you an overview of the psychotherapies and Treatment modes and modalities that had been proven to work with cluster B personality disorders most notably narcissistic antisocial and borderline Personality disorders I have omitted purposefully on purpose a few of these therapies for example, I Will not analyze or mention EMDR, which is a form of cognitive behavior therapy coupled with eye movements Generally, I will not dwell on body-mind therapies Although in the case of EMDR for example, there's a good track record with cluster B Still, I'm excluding body-centered therapies I'm also excluding humanist humanistic therapies Carl Rogers. I'm excluding transactional analysis I'm excluding all psychodynamic therapies and psychoanalysis, etc. I said and the reason I'm doing all this is because there is insufficient data To prove or to show or to demonstrate conclusively or even just convincingly That these therapies with the exception of of EMDR into some extent gestalt the these therapies are Efficacious with cluster B, so I'm going to focus only on therapies backed by studies and published peer-reviewed papers Now I encourage you To do your own research Go and read Go and read on EMDR EMDR go and read on gestalt therapy go even and read on psychodynamic or therapies or psychoanalytic psychotherapy It's all these are all laudable therapies and they make claims regrettably these claims are not supported by research So now evidence-based therapies First of all, I refer you again to Lens-Paris S P E R R Y Book handbook of diagnosis and treatment of die of DSM 5 personality disorders assessment case conceptualization and treatment published by Rutledge in 2016 it's a third edition previous to Relate to the DSM 4 text revision this one Incorporates the latest insights and changes in the DSM 5 and on we go We start with behavior therapy Behavior therapy is a group of therapies actually which replace problem behaviors with constructive behaviors via Conditioning or more precisely counter conditioning and Reinforcement so they use very primitive tools of operant conditioning and Reinforcement positive and negative reinforcement to sort of channel the patient towards more constructive more productive Lace up less abrasive and less antisocial behavior as a whole family and They date back to the 1950s Out of behavior therapy this there came a second family of therapies. They are known as cognitive therapies cognitive therapies seek to change negative automatic thoughts and Shemas that lead to attributional and other biases as well as to errors in thinking So cognitive therapy focuses on as the name implies cognition Cognition how to change your thinking By changing your thinking you change your frame of mind change your frame of mind. You change your state of mind Remember all these therapies are used extensively in the treatment of personality disorders and more specifically in the treatment of Class to be personality disorders now the idea in cognitive therapy Is to alter to change problematic behaviors and dysfunctional feelings and behaviors by Focusing on the way you think about yourself the way you think about others and the way you think about the world It seems that you're thinking Shapes molds your behavioral choices and these Create reactions and the the whole conglomerate the whole complex Generates negative emotions So there's a vicious cycle negative emotions Create actions create reactions create negative emotions and it's a self-perpetuating self-enhancing vicious cycle the latest The penultimate reiteration of cognitive therapy is of course the world-famous cognitive behavior therapy or CBT There is a third wave of behavior therapy. It's a it's a wave that combines CBT with other elements What are these other elements? Number one the primacy of the therapeutic relationship the therapeutic relationship For the duration of the therapy becomes the main relationship of the patient Overriding even his intimate relationship Overriding his workplace overriding anything the therapeutic relationship becomes the main relationship because it is within The therapeutic relationship the change is induced actually. It's the relationship itself that creates the change by having finally a Healthy relationship with another adult who happens to be therapist the personality disordered person experiences a monopoly of new Experiences so secure attachment. He feels safe He can express negative of activity and negative emotionality without being punished He can he can be dysfunctional the therapist will contain him and channel him and regulate him So he acquires regulation, etc. The the primary therapeutic relationship is a prototype for a healthy Functional relationship prototype platform template that the patient can then take and apply to all his other Relationships remember. We are talking about third wave of behavior therapy Combining CBT with other elements. We'll discuss a few of these therapy shortly the second principle in the third wave is learning Analyzing triggers analyzing environmental cues Exploring shamans will discuss shamans a bit later exploring emotions and then the third element is utilizing Modeling homework Animatory now. Okay, all these principles are abstract. I'm going to show you how they are manifested How they are used in specific therapies and let's start with my favorite by far dialectical behavior therapy Dialectical behavior therapy was developed by Marsha Leinehan in 1993 Recently Several elements were added to it. For example spirituality mindfulness Not for me. I think it's a contamination a Contamination of the original the original was bright and brilliant There was no need to combine combine it with new age in order to make it more marketable and to increase profits So I regret this development not only in dbt dialectical behavior therapy But in numerous other for example in shema therapy. They also have mindfulness shema therapy and so on these are Indian gurus and mystics translated via Western gurus and one of the yogis who didn't understand the word of the of the original Indian teaching and it's a bloody mess So I'm going to describe the original dialectical behavior theorem Leinehan developed it developed it in 1993 to treat borderline personality disorders But gradually over the decades the efficacy of dbt had been proven with other personality disorders And with disorders of mood anxiety eating disorders and substance abuse disorders. So it is Widely widely applied to a variety of disorders, but the experience hitherto has been almost exclusively with female patients and in large part in inpatient or residential settings in other words in hospital settings Mental asylum settings to be less politically correct People committed or hospitalized women Committed or hospitalized and have undergone Dialectical behavior therapy. So at this stage we have no proof That it would be useful or applicable to men or to children. I Have just come up with a new diagnosis for men suggested diagnosis for men covert borderline If I'm right the covert borderline is a combination of antisocial narcissistic borderline Typical mostly to men not to women. This would explain Why dbt doesn't work well with men or has it hadn't been applied to men because men happen to Men gravitate more Towards the primary psychopathy poem while women Gravitate more towards the secondary psychopathy pole. In other words women borderline Women borderlines would tend to become secondary psychopaths under conditions of stress and Men covert borderlines would tend to become primary psychopaths under the same conditions for example anticipating rejection humiliation and abandonment Or going through actual breakup or disintegration of an interpersonal meaningful interpersonal relationship so There is a substantial difference between the way Borderline personality disorder is expressed and manifested in men and the way it is expressed and manifested in women Which would explain why dbt is much more efficacious with women dbt emphasizes emotional and affect Regulation not cognitions it in this sense diverges from classic cognitive therapy and goes back Harks harkens back to the very beginning of behavior therapy when it was combined with emotive therapy so it is concerned dbt is concerned with how Your shema how the shamans of the patients were formed via dialectical conflicts shamans are simply combinations of beliefs cognitions Emotions when you put them together in reaction to a set of specific circumstances or A relationship is a set of specific circumstances and we have shamans that pertain for example to relationships We will deal with shamans at length a bit later But dbt is asking the question. How did your shamans form? how how did How did you how was your affect? How were your emotions involved in generating these shamans? dbt seeks to connect affect and need because every Shema responds to a need and involves emotions. So we have shema need affect emotions and dbt tries to connect all of them and There the dbt tries to demonstrate to the patient that there are processes of inference deduction analysis There are belief systems which which put together with the need that the affect had generated the shema So suddenly everything becomes clear. You had a need. You had a belief You had a reasoning process or a logical analytical process deductive process Inductive process you had some process of thinking cognitive process And when you put everything together you came up with a solution and this should be solution is a is a scheme or multiple solutions are shema So when these are reinterpreted when you become self aware of these background processes This self-awareness begins to generate healing dbt identifies fixation or Perseveration example rumination caused by early developmental deprivation and by protective in attentional constriction So as a child you've been deprived for example of maternal love in case you had a dead mother and You have learned gradually as a pay as a as a borderline personality disorder patient You had learned gradually to react to this deprivation by kind of mentally insisting By getting fixated by being unable to move on until the issue is resolved until your needs are met You know, we all know these insistent children who keep nagging and nagging until they get what they want because they feel deprived Similarly, you develop protective attentional constriction. You filter out a lot of data and information Because they're too painful. They're too hurtful. They threaten your inner Precarious balance because you're emotionally dysregulated. You're very vulnerable. You don't have an outer protective armor or shield or skin dbt examines the effects of negative reinforcement through emotional avoidance or in other ways and Also studies in adequate coping skills dbt claims that negative reinforcement emotional avoidance Inadequate coping skills. They are actually rewarded. There's something called partial reinforcement effect I will not go to it right now, but they are actually gratifying things while in healthy people emotional avoidance Inadequate coping skill is caused for for distress Healthy people don't like it borderlines actually do like it and not only borderlines. We're talking about plus the big but mostly borderline Now dbt dialectical behavioral therapy, which is used mostly for borderline involves individual therapy group skills training re-skilling you acquire new skills phone contact to shore you over you know in between sessions and Therapist consult consultation, which is not for you. It's for your therapist Exactly like in psychoanalysis your therapist consults other therapies actually a typical dbt Process involves as a minimum two therapies one supervises the other so to speak consults the other dbt focuses on using validation and problem-solving to counter severe behavioral control issues of quiet desperation problems of life of living and to reduce the borderline's perception self-perception as incomplete incapable of experiencing happiness and joy for example missing broken damage goods This is dbt dbt is an exceedingly successful therapy it has immediate effects On borderline patients well over 50% of borderline patients within the first year of dbt lose the diagnosis the Borderline can no longer be diagnosed in these people The next therapy I would like to discuss is cognitive behavior analysis system of psychotherapy or see bus it was developed by McCullough and Adopted by sparing it is not to be used with dbt. He's dangerous Exactly like cold therapy that we're going to discuss at the end. This is a therapy which is dangerous for borderline patients the clients of see bus Learn to analyze life situations and manage daily stressors stressful events They evaluate evaluate which thoughts which behaviors prevent them from accomplishing desired outcomes So it's a very very pragmatic kind of therapy more like I would say management consultancy It and there are two processes two stages one is called elicitation and the other is called remediation In the elicitation phase the therapist asks the patient questions about the situation the client's role and functioning within the situation and the desired outcome and Then the therapist demonstrates to the client that his behaviors even his cognitions were counterproductive Prevented him from accomplishing the desired outcome and this leads to a revision of these self-defeating behaviors and cognition cognition Of course, there's an underlying assumption that every client and every patient is not masochistic Is not self-defeating is not self destructive by nature is not self-traction That every person seeks his own best interests. That's not always true with cluster B personalities At any rate one thing the therapy does for sure is it replaces emotional reasoning with consequential logical analytical reason and that's a major achievement because many cluster B personalities engage in emotional reason The next therapy is mindfulness-based cognitive therapy MPCT. It was developed by Tisdale It fosters awareness Focus on thoughts feelings and experiences in the present with an attitude of acceptance and without analysis even Not only without judgment, but without analysis now MBCT had become in as I said earlier had become a module if you wish Some of its techniques became integrated into dialectical behavior therapy EMDR even Shema therapy and so next therapy is pattern focus psychotherapy. It was developed by by sperry himself Spary defined pattern as a predictable consistent self perpetuating style of thinking feeling acting coping and self-defense It can be as a pattern can be adaptive and Encourage you to be competent to be self-efficacious To leverage your agency to secure favorable outcomes from your environment But the pattern can be maladaptive. It could be inflexible ineffective inappropriate And if it is maladaptive it causes symptoms it impairs your functioning in a variety of settings including interpersonal relationships and It it reduces your satisfaction with yourself and with your life a State called dysphoria. It generates dysphoria Therapy the pattern focus therapy consists of replacing hurtful painful maladaptive patterns With helpful adaptive patterns and this is done by Interpreting situations and behaviors in a certain way so as to throw light Shed lights suddenly on how maladaptive the pattern is You see this there's a commonality between all this they all had all these therapies assume That early on in childhood We had become malformed and This malformation this wrong molding wrong sculpting of Who we are. I mean there is a tendency to regard The the newborn is a kind of raw material and the parents mold and sculpt this raw material Kind of plastic art of parenting And they produce an object are they produce an art artwork But if they don't know how to do it or if they have their own problems The dead mother andray greens dead mother then The object art is deformed malformed and Is likely to behave in ways Which will not be conducive to health happiness Good relation satisfactory relationships Attainment of goals, etc. They all make these assumptions This is the underlying assumption of modern psychotherapies in plural Which leads me to shema therapy shema therapy was developed by young Shema therapy changes these maladaptive patterns, which in shema therapy. They're called shemas They're 18 shemas These are enduring and self-defeating ways of regarding oneself and others And the 18 shemas are arranged in five domains Shemas are perpetuated through you through coping styles There is shema maintenance shema shema avoidance and shema compensation And you can you can work with these shemas you can reconstruct them Which is very difficult takes a lot of time and investment, but you can also modify them Which is a bit easier. You can interpret them insight Is supposed to generate internal dynamics of change Or you can kabu flash them Disguise them so that they are no longer able to operate Very similar by the way to how viruses behave with the immune system Just an apropos I'm going to read to you a list of all the shemas because it's a wonderful summary or summation of everything that's wrong with cluster B personality disorders So here are the shemas maladaptive shemas and shema domains Shema domain number one disconnection and rejection one abandonment instability the belief that significant others Will not or cannot provide reliable and stable support Number two mistrust abuse the belief that others will abuse humiliate cheat lie manipulate or take advantage of you Number three emotional deprivation the belief that one's desire for emotional support will not be made by others Number next one defectiveness shame The belief that one is defective bad unwanted or inferior in important aspects Social isolation alienation the belief that one is alienated different from others or not part of any group In period autonomy and performance is the next domain And within this domain we have the following shema Dependence in competence the belief that one is unable to competently meet everyday responsibilities without considerable help from others vulnerability to harm or illness The exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent it catastrophizing next shema Next shema enmeshment and developed self the belief that one must be emotionally close with others at the expense Of full individuation or normal social development Next shema failure the belief that one will inevitably fail or is fundamentally inadequate in achieving one's goals next domain impaired limits or boundaries Scheme number one entitlement grandiosity the belief that one is superior to others and not bound by the rules and norms that govern normal social interaction Number two insufficient self-control self-discipline the belief that one is incapable of self-control and frustration tolerance Next domain other directness at other people Subjugation the belief that one's desires needs and feelings must be suppressed In order to meet the needs of others and avoid retaliation or criticism Next self-sacrifice The belief that one must meet the needs of others at the expense of one's own gratification Next approval seeking recognition seeking the belief that one must constantly seek to belong and be accepted at the expense of developing a true sense of self And then we have the domain of over vigilance or hyper vigilance and inhibition Scheme number one negativity pessimism a pervasive lifelong focus on the negative aspects of life While minimizing the positive and optimistic aspects Next emotional inhibition the excessive inhibition of spontaneous action Feeling or communication usually in order to avoid disapproval by others feelings of shame or losing control of one's impulses Next unrelenting standards hyper criticalness The belief that striving to meet Unrealistically high standards of performance is essential in order to be accepted and to avoid criticism And finally punitiveness the belief that others should be harshly punished for making errors Schema therapy is a very powerful therapy and very intelligent if I may add Next Kernberg who else still active in his 80s amazing men The father of the field together a bit later with Theodore Miller Transference focused psychotherapy developed by Kernberg Kernberg said that infants form internal representations of self and internal representations of others of objects and The infant connects these internal representations of self and others via emotions or more precisely effect A personality disorder occurs When positive representations and negative representations fail to integrate later in life echoes of melanocline Such splitting Such splitting between all negative all positive Representations of self and of others such splitting effects of course relationships Including the therapeutic relationship including therapy So Kernberg Very similar to cold therapy I'm doing this in cold therapy as well Kernberg encourages transference to the therapist because he believed that when the patient Engages in transference when the patient projects his inner it's so to speak His internal objects onto the therapist the patient exposes These internal objects to scrutiny The patient delineates The faulty relationship template by engaging in a faulty relationship with the therapist via transference And if the therapist is empathic The therapist can correct This faulty template Via empathy and support and so Insight empathy and insight these are the two pillars So identity integration is accomplished as the patient experiences negative emotions But in a safe accepting environment Beautiful if you if you are an adherent of object relations as I am This is simply beautiful. It's the culmination of the field Okay, next one Mentalization based treatment MBT remember all these therapies Have been Have been Deemed have been deemed as efficient or efficacious therapies There is some something called division 12 of the american psychological association And they measure the efficiency of therapies So all these got top marks. It's like these companies that measure the efficacy of antivirus programs. You know, so this one passed They they fought well the malware of the mind mentalization based treatment and the MBT developed by bateman and from agi This therapy this treatment mode modality assumes that That you need to as a therapist you need to help the patient to experience secure attachment Because if the patient experienced secure attachment He can he can develop impulse control. They believed that Impulse control is the outcome of insecure attachment So they empathically and insightfully they provide insights reflect on and label correctly The patient's state of mind. They believe that by analyzing this state of mind and giving it a label This helps the patient to feel safe And secure as though the patient has a handle on his situation and this allows him to control his impulses They believe that Impulse control is possibly the biggest problem in relationships And so if the state of mind Is insightfully reflected on and correctly labeled Especially powerful emotions Uh, especially cognitive errors if they're pointed out It's 50 to healing and this leads to improved relational skills Finally Developmental therapy development therapy was developed by quite a few people But the main figures are bloke BLO CH R locher Cartwright and sparing Cartwright locher and sparing Developmental therapy regards problem problems in personal growth And needs satisfaction On a dimensional continuum From this order to adequate to optimal so when you analyze the patient's personal growth trajectory You know, we have this A phrase that we no longer use by the way arrested development It's taboo. Don't use it. It's like the n word so When you analyze personal growth when you analyze the satisfaction of the patient's basic and not so basic needs You know muscle or hierarchy When you analyze this you shouldn't analyze them discreetly But you should create a continuum a spectrum Dimension and this dimension goes from disordered to adequate to optimal And i'm going to read to you quoting from lence perry's book For mentioned i'm going to read to you how this looks with cluster B Select cluster B disorders mainly the dramatic ones histrionic Optimal so everyone is a spectrum every cluster B disorder is a spectrum Every healthy person has a spectrum And the spectrum is optimal adequate disorder. So histrionic optimal Having found the love they seek within themselves They are altruistic and giving without expecting reciprocity. That's the optimal adequate While fun loving and often impulsive they can delay gratification And be emotionally appropriate much of the time The disordered version which is histrionic personality disorder The disordered version is Uncomfortable in situations in which they are not the center of attention By the way, the histrionic personality disorder together with schizoid personality disorder and others had been removed From the alternative model of the dsm 5 and they will not exist in the dsm 6 Let's talk about narcissistic. What's the optimal adequate and disordered versions of narcissism? narcissistic optimal energetic self-assured without expecting special treatment or privileged or privileged adequate confident yet emotionally vulnerable They favor special treatment or privilege Disordered narcissistic personality disorder Manifests a grandiose sense of self-importance and demands special privilege Schizoid is cluster a it's it's not class to be schizoid optimal Deeply grounded in themselves. They are emotionally connected to the world. That's optimal Adequate reasonably comfortable being around others provided. They are limited demands for intimacy or emotional connectedness disordered version Neither desire nor enjoy close relationships. Now the reason I inserted schizoid into this Is because I Recommend that you watch three of my previous videos the series about schizoid narcissists Their good grounds to assume that schizoid personality disorder is a facet of narcissism is another name for a subtype of narcissists dependent codependent optimal May seek out the opinions and advice of others when making major decisions, but the decisions they make are ultimately their own optimal Adequate have the capacity to be responsible and make decisions But still seek out and rely on others for help and advice disordered codependent or dependent personality disorder Needs others to assume responsibility for most major areas of their lives Antisocial or psychopath psychopath is an extreme antisocial Optimal have the gift of gab and easily befriend others although they may not offer much depth to these relationships Adequate and respect by acting honorably and with compassion by using power constructively and by promoting worthwhile causes Remember in previous videos. I kept telling you that many many activists social justice activists and so on are actually psychopaths But they are adequate psychopaths disordered A real psychopath a robot hair Harvey Cleckley psychopath primary psychopath Exhibits aggressive impulsive self-serving self-serving and irresponsible behavior Okay, borderline the queen of the of the of the roost borderline optimal Sensitive introspective and impressionable individuals who are very comfortable with their feelings and inner impulses Adequate borderline they quickly and easily engage in relationships and are sometimes hurt and rejected in the process Disordered borderline displays frantic efforts to avoid real or imagined rejection and abandonment And finally I think yeah finally the paranoid Optimal highly observant and discerning. They can defend themselves without losing control or becoming aggressive Adequate thin skinned. They are rather sensitive to and hurt by criticism Which is very simple little narcissists one of the reasons I I keep saying that paranoia or paranoid Personality disorder is a subtype of narcissistic personality disorder paranoia is narcissism disordered Suspicious without sufficient basis that others are exploiting harming or deceiving them Okay, and now we come to the last one number 12 call therapy developed by Vaknin Call therapy is based on two premises one that narcissistic disorders are actually forms of complex post-traumatic conditions And two that narcissists are the outcomes of arrested development. You don't you don't say here Narcissists are actually the outcomes of arrested development and attachment dysfunctions Consequently cold therapy borrows techniques from child psychology Because narcissists are children Narcissists according to cold therapy are children in a post-traumatic state So cold therapy borrows techniques from child psychology and from treatment modalities used To in order to deal with ptsd and cptsd Cold therapy consists of the retraumatization of the narcissistic client in a hostile Non-holding environment which resembles the ambience of the original trauma recreates the original trauma The adult patient successfully successfully tackles this second round of hurt And so resorts early childhood conflicts and achieves closure Rendering his now maladaptive narcissistic defenses Unnecessary redundant and obsolete This also improves his relational capacity Because the narcissists goes through the the trauma second time, but this time resorts the conflict the early childhood conflict So he doesn't need to do this with his spouse or his next girlfriend or his intimate partner or lover Cold therapy makes use of proprietary techniques Such as erasure Suppressing the client's speech and free expression and gaining clinical information and insights from his reactions To being stifled this way Other techniques include grandiosity reframing guided imagery negative iteration other scoring happiness map Mirroring escalation role play a similar to confabulation hyper vigilant referencing and reparenting The very limited sample of Clients who had undergone cold therapy to its end level one two and three The results have been Very positive It proves it's proving to be an efficacious trade effective treatment For narcissistic personality disorder and major depressive episode, which seems to sustain an early belief That narcissism is a form of depression Cold therapy is also philosophical really metaphysical framework. I suggest that the client should regard his or her life as a movie The main goal in life the core task and the engine of meaning is to direct this movie to direct this film So as to render it an accomplished hit a work of art and a masterpiece of narrative At every inflection point and faced with any critical decision The client should truthfully answer the question Would I have paid money to watch this movie? This yarn that i'm weaving the flick that is my life If the answer is no a transformative change, of course is called for Directing the film should be the client's overriding priority. Every other thing should be subservient and secondary to this Role to this chore. Everyone in the client's life should feature in this movie And yet the client should navigate this light motif and channel his or her creativity without a script As an exercising Improvising the twists and turns of the plot should come as a surprise first and foremost to the client himself Okay, now let's To some criticism of some of these treatment modalities start with mindfulness I said that mindfulness has been had been incorporated to various therapies modern treatment modalities Terror psychotherapies emphasize the present over the past and the future mindfulness There is a clinical diagnosis for the kind of people who are focused on the moment Care little about the past and others in the past and cannot foresee or take into reckoning the consequences of their actions in the future These kind of people are called psychopaths mindfulness In my view and that's only my view Fosters entitlement, grandiosity, disempathy, recklessness I am dead set against it It's also too closely allied With new age, fake gurus, corn auties You know, I don't like it. I seriously dislike it Next cognitive behavioral behavioral therapies CBT The CBT is this group of therapies this family of therapies postulated insight Even if merely verbal insight intellectual analytical insight It's sufficient to induce an emotional outcome verbal cues analysis of mantras Of negative automatic thoughts that we keep repeating for example. I'm ugly I'm afraid no one would like to be with me. I'm bound to fail If you analyze these sentences the itemizing of our inner dialogue or monologue our inner narrative And our repeated behavior patterns learn behaviors and learn helplessness Where when they're coupled with positive and rarely negative reinforcements So if you put all this together the inventory list of your thoughts your behaviors your your beliefs about yourself And The therapist then uses negative and positive reinforcements if you put all this together This induces according to CBT cumulative emotional emotional Tantamount to healing Here's the problem Cognitive reframing is not a technique in any treatment modality. It refers to a mental process of shifting thinking The inner conversion of positive thoughts regarding oneself one's life and others Into negative cognitions or vice versa Cognitive reframing can be induced in therapy or by shifting circumstances of one's life as well as by no information reframing is a shift from one narrative Of one's life and of others place and roles in one's life to another narrative with a bigger Explanatory power And organizing principle which imbues one's personal history with meaning and direction Creates goal orientation goal direction So the technique used in various psychotherapies Is known as cognitive restructuring of cognitive distortions Cognitive distortions is is automatic negative thoughts or ends Yeah But they are distortions. They are not real. They are counterfactual They conflict head on with reality, but when these negative automatic cognitions thoughts conflict with reality the patient gives up on reality He's invested emotionally in the validity and truth Of these negative automatic thoughts. So he is fighting tooth and nail to preserve them Cognitive restructuring is the main technique used in CBT Some elements of cognitive restructuring like guided imagery are incorporated in core therapy as well Psychodynamic theories reject. So this is CBT Psychodynamic theories reject the notion that cognition can influence emotion. That's where there's a major conflict Between the metaphysical if you wish pillar Of philosophical pillar of CBT and psychodynamic theories. Psychodynamic theories says Your thinking cannot influence your emotions Healing requires access Access to and the study of much deeper strata By both patient and therapist is not enough just to think you need to dig deep Psychodynamic therapies starting the psychoanalysis They are form of archaeology Let's let's say that CBT is tourism And psychodynamic therapies are archaeology The very exposure of these deep layers to the therapeutic process Is considered sufficient to induce a dynamic of healing The therapist's role is either to interpret the material revealed to the patient for example in psychoanalysis By allowing the patient to transfer past experience and superimpose it on the therapist Another option is to provide a safe emotional and holding environment Conducive to the patient changing himself So either the therapist is active has an active role Or he just provides the environment within which He activates the patient and then it's the patient who is doing the work The sad fact is that No known therapy is effective with narcissism itself There are quite a few therapies treatment modalities Which are reasonably successful as far as coping with some of the effects of narcissism Some of the abrasive and antisocial and self-defeating behaviors So many therapies are very effective at modifying the behaviors of the narcissists But none of them Not even called therapy heals or cures narcissism The nonsensical nonsensical A concept of recovered narcissism or recovered narcissists. It's a scam I'm sorry Anyone who uses this phrase is a con artist pretending to be a professional No textbook supports this Let's talk a bit about dynamic psychotherapy psychodynamic therapy and psychoanalytic psychotherapy the old school All of them are not psychoanalysis just to be clear All of them are it's their forms of intensive psychotherapy based on psychoanalytic theory theory Without the very important element of free association This is not to say that free association is not used in these therapies only that it is not a pillar of the technique You can go through a course of therapy in these therapies and not freely associate Dynamic therapies are usually applied to patients not considered suitable for psychoanalysis For example those suffering from personality disorders with one exception the avoid avoidant personalities Typically different modes of interpretation are employed and other techniques borrowed from other treatment modalities. It's very eclectic actually But the material interpreted is not necessarily the result of free association Or dreams like in psychoanalysis The psychotherapist is a lot more active than the psychoanalyst the psychoanalyst provides a black screen On which the patient projects everything via transference via defense mechanisms and so the Psychotherapist in dynamic psychotherapy Psychodynamic therapy and psychoanalytic psychotherapy is very active is an active interpreter. It's a collaboration Psychodynamic therapies are also open-ended At the commencement of a therapy the therapist unlist makes an agreement a packed Alliance therapeutic alliance with the analyst with a patient or the client The pact says that the patient undertakes to explore his problems for as long as may be needed Which is of course very good for the therapist bank account This is supposed to make the therapeutic environment much more relaxed Because the patient knows that the analyst is at his or her disposal No matter how many minutes would meetings will be required In order to broach painful subject matter. In other words, there's a blank check The therapist is telling the the patient No, no matter how long this is going to be Even if it's years I'm going to be here for you at your disposal for as long as you want me So we call this open-ended psychotherapy And sometimes these therapies are divided to expressive versus supportive, but it's a bit of a misleading In my view it's a bit of a misleading division Still expressive means uncovering Making conscious the patient's conflicts and studying his or her defenses and resistances The analyst interprets the conflict in view of the new knowledge gained And guides the therapy towards a resolution of the conflict The conflict in other words is interpreted away Through insight and through the change in the patient motivated by his or her insights So insights come from both the therapist and the patient The supportive therapies as opposed to the exposure The expressive therapies. I'm sorry the supportive therapies seek to strengthen the ego Their premise is that strong ego can cope better and later on alone with external situational Or internal instinctual related to drives pressures Remember the narcissist does not have an ego. That's a narcissist problem ironically Supportive therapies seek to increase the patient's ability to repress conflicts rather than bring them to the surface of consciousness When the patients painful conflicts are suppressed or repressed The attendant dysphoria The symptoms the conflict had generated Vanish and are ameliorated or reduced. So does the anxiety This is somewhat reminiscent of behaviorism. The main aim is to change behavior and to relieve symptoms. Never mind what? And it usually makes no use The the this kind of behavior therapies make no use of insight or interpretation although there are some exceptions Let's talk a bit about group therapies class to be class to be patients in group therapies Start with narcissists. Narcissists are notoriously unsuitable for collaborative efforts of any kind. They're not team players And they're not built for group therapy They immediately size up other people as potential sources of narcissistic supply. They use called empathy The or they decide that someone is a potential competitor. It's a power play immediately They idealize the suppliers and devalue the competitors. This obviously is not very conducive to the dynamic in the group Moreover, the dynamic of the group is bound to reflect the interactions of its members Narcissists are individualistic Borderlines are anxious psychopaths are ruthless and callous and so cluster B personality disorder people regard coalitions with disdain or contempt or as opportunities or you know It's not good They need to resort to teamwork to adhere to group rules To succumb to a moderator and an agenda and to honor and respect the other members as equals Is perceived by cluster B patients as either humiliating and degrading Or as contemptible weakness or as something to be exploited and leveraged And so a group containing one or more cluster B patients is likely to deteriorate very fast degenerate and fluctuate between short very small size coalitions based on superiority interest content and Outbreaks especially narcissistic outbreaks acting out the compensation of rage coercion anxiety The most difficult patients by far in therapy are psychopaths and narcissists In therapy, the general idea is to create the conditions for the true self To resume its growth Provide safety predictability justice love acceptance a mirroring Reparenting a holding environment Therapy is supposed to provide these conditions of nurturance in guidance through transference transference cognitive relabeling or other methods And the narcissists must learn that his past experiences are not laws of nature That not all adults are abusive That relationships can be nurturing and supportive that love is fun Most therapists try to co-opt the narcissist's inflated ego his false self his defenses They compliment the narcissist challenging him to prove his omnipotence by overcoming his own disorder They appeal to the narcissist's quest for perfection brilliance and eternal love And to the narcissist's paranoid tendencies in an attempt to get rid of counterproductive Self-defeating and dysfunctional behavior patterns And by stroking the narcissist's grandiosity These therapies hope to modify Or to counter cognitive deficits thinking errors The narcissist's victim starts Bed dynamics The these therapies make a contract with the narcissist the contract with the narcissist In order to alter his conduct And some therapies even go to the extent of medicalizing the disorder Attributing it to a genetic hereditary or biochemical origin And so absolving the narcissist from his responsibility and freeing freeing his mental resources to concentrate to focus on the therapy Confronting the narcissist head-on and engaging in power politics A more clever than you my will will prevail and so on Is decidedly unhelpful and could lead to rage attacks And a deepening of the narcissist's persecutory delusions bred by his humiliation in the therapeutic setting Same goes for borderline same for Same for the psychopaths Successors have been reported by applying 12 step techniques As modified for patient suffering from antisocial personality disorder And also with some treatment modalities even nlp Neuro linguistic programming, which many say is a scam Sing to somehow work Shema therapy that I've mentioned eye movement Desensitization EMDR and so on But whatever the type of talk therapy the narcissist devalues the therapist The narcissist's internal dialogue is I know best I know everything this therapist is less intelligent than I am I can't afford the top level therapist who is the only one qualified to treat me As my equal of course, I'm actually a therapist myself. Why am I why am I here? What am I doing here? And so there's a litany of self delusion grandiose self delusion and fantastic grandiosity these are defenses of course resistances because Em That's in the therapy. There's a kind of role play I mentioned at the beginning of this video long long time ago when we were all much younger That the narcissist approaches therapy as he approaches a shared fantasy and he allocates roles Now the problem with therapy is at the very inception of the therapy. There are roles to allocate superior authority Therapists type inferior supplicant narcissist type. No, no Narcissists don't like this and so they react We defense and resistance and they say a narcissist says to himself He my therapist should be my colleague We are equal in certain respect. It is he who should accept my professional authority and learn from me Why won't he be my friend after all I can use the lingo and the psycho babble Even better than he does. I know terminology and I know his own feel better than him At any rate, it's us me and him against a hostile and ignorant world shared psychosis for the other And then there is this internal dialogue Just who does the therapist think he is asking me all these questions What are his professional credentials? I wonder which university did he graduate if at all? I am a success and he is a nobody therapist in a dingy office and he is trying to negate my uniqueness I'm making 10 times more money than he does He's an authority figure in his own office and I hate this and I hate him and I will show him I will humiliate him and prove him ignorant. I will have his license revoke transference Actually, this therapist is pitiful. It's a zero. It's a failure and I will smear him Everywhere I go after all this is over. Such reactions are even much more common among borderlines and psychopaths And this is only in the first three sessions of the therapy this abusive internal exchange Becomes more vituperative and pejorative as therapy progresses Agnes Oppenheim wrote the following in the international dictionary of psychoanalysis Mirror mirror transference is the Remobilization of the grandiose self Its expression is I am perfect and I need you in order to confirm to me that I'm perfect When it is very archaic Mirror transference can easily result in feelings of boredom Tension and impatience in the analyst whose otherness is not recognized in the analyst in the therapist Counter-transference is a sign of this The notion which first appeared in Heidt's cohort's work in the psychoanalytic treatment of narcissistic personality disorders in 1968 This notion of mirror transference Was further elaborated in cohorts analysis of the self in 1971 Mirror transference can take three forms depending on the degree of regression in the nature of the point of fixation Fusion transference is the most archaic form and it refers To a primary identity relationship in which the other the therapist is completely a part of the self an extension It shows itself when the analyst is taken to be omnipotent and tyrannical and is experienced as an extension of the self In twin-ship or other or alter ego transference The other the therapist is experienced as being like the self Lastly in mirror transference properly speaking The analyst is experienced the therapist is experienced as a function in at the service of the patient's needs If the patient feels recognized he experiences a sense of well-being Linked to the restoration of his narcissism Mirror transference can be primary the reaction to a broken idealizing transference or secondary to one of these In the restoration of the self a book published in 1977 Heidt's cohort distinguished it from alter ego transference Some authors have refused to consider this transference as being a result of the evolution of narcissism They've seen it merely as a defense Narcissists generally are averse to being medicated actually Most patients with personality disorders are averse to medication Resorting to medicines is an implied admission that something is wrong Narcissists are control freaks and they hate to be under the influence of mind altering drugs prescribed to them by inferior others Additionally many of them believe that medication is a great equalize It will make them lose their uniqueness creativity superiority and so on. It's a form of social control Unless they can convincingly present the act of taking their medicines as heroism they don't want to take medicine Sometimes with for example pioneering vaccines The the narcissist can tell himself what what he's doing is heroic It's a daring enterprise of self exploration Which is intended to benefit humanity. It's part of a breakthrough clinical trial and so on and so forth, but these are exceptions Narcissists and personality disorders people often claim That the medicine affects them differently than it does other people Or that they have discovered a new exciting way of using the medicine Or that they are part of someone's usually themselves Learning curve part of a new approach to dosage part of a new cocktail which holds great promise narcissists Borderlines histrionics. They must dramatize their lives in order to feel worthy and special Outneil out unique either be special or don't be at all Narcissists are drama queens exactly like borderlines and histrionics and some types of psychopaths very much like in the physical one Change is brought about only through incredible powers of torsion and breakage Only when the narcissist elasticity Gives way only when he is wounded by his own Intransitutes only then is their hope. It takes nothing less than hitting rock bottom real hard Takes a real crisis multifaceted in all dimensions of narcissists life simultaneously and we border failure are not enough