 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is the therapy show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to part two of The Narcissistic Clients and this part two bit is going to be about how we work with somebody that is narcissistic or has narcissistic tendencies in the therapy room. I'm Jackie Jones and I'm going to introduce you to the wonderful Bob Cook. Hello. Hello. With all these words of wisdom about how we would work with a person with narcissistic tendencies or personality traits in the therapy room or the disorder even. Yeah, either way and we talked last podcast about the features of a narcissist and how we can spot a narcissist, the profile of a narcissist. So let's work a little bit now or talk a little bit now on how you would work with them from that framework. So in some ways this bit I'm going to talk about is the same as any disorder or person we work with. You have to find a way to create a environment where they feel attuned and they feel understood. Now, or somebody who has to be special, have a sense of entitlement and all the things I've talked about the last podcast, then maybe this is a bit more challenging. However, we need to be find a way to do this and the best way I know to do this way is to use your own sense of empathy and your own sense of attuning to the child. So you need to create an environment where using empathy you can get to their child. So in other words, we could use empathic transactions from the TA world or it could for many other psychotherapy world we want to pick use sense of empathy to get to that. Now last podcast I told I was talking about an example of Eleanor Greenberg when she was actually explaining this process of a client of hers who had a rant and rave in the session because he just had a hamburger and the waitress had given mustard instead of tomato sauce and he had ranted and raved at her and wanted to get her sacked and when he came to the therapeutic room with Eleanor Greenberg he ranted and raved at her and demanded that she go down next door and make sure that the waitress was sacked. So how do you treat that? So the best way to treat this is to de-centre from the waitress and use empathic attunement or empathic transactions to actually inquire about how the narcissistic client felt in terms of did they feel shamed or humiliated or slighted or discounted and in that way the client will feel understood and safe and then you'll be able to work with what with the real injuries which of course existed 20 or 30 years ago whatever it is not worth what the waitress said or did or did not do. So the first step is use empathy or empathic transactions to get alongside the clients so they feel understood and soothed and most important safe. Yeah so you were talking in the last one about us needing to be perfect and us you know the client might idealise the therapist. That's really interesting because you also spoke about them needing to be top dog, them needing to be you know the status and all that sort of stuff. So do we kind of get that status from them through empathy because it's kind of like we're on their side where we understand completely how you would have felt so that's how we make that connection right. Right because no one in their life has really understood them before yeah so you'll have to be very super very special if you can actually be one of the few people in the world who could understand how hurt, shamed, devalued, discounted you actually feel. Yeah so and we're not talking big life events here, what that lady was describing was a burger with mustard and not tomato sauce but that can cut them to the core. Yeah absolutely another example with somebody who's narcissistic who I took on and quite high on the continuum I would say about the third or fourth sessions on maybe five actually I thought I was doing quite well so I think it was perhaps five and they've been talking about their world and everything else and XXXX and I made a very big mistake. I started to identify and I thought I'd used my own sense of self to come alongside the child in the sense of mutuality. I walked the same path however with a narcissist that is a big mistake or can be a big mistake so when I said something like it's 20 odd years ago I stand on my exact transactions but I said something like you know I can understand that because you know I felt the same way in XXX in the service of mutuality. Yeah I remember this what I'm going to say Jackie as as it was yesterday and I'm sure it's 25 years ago so the person suddenly stood up and bellowed at me for a good and it's a long time in the therapy session this 10 minutes about therapy isn't about my feelings it's about his. Wow. And I was very surprised that he didn't walk straight outside the door and leave. I don't remember it's such a long time how I got him back but I must have got him back by either apologising or some empathic transactions which talked about how he felt when I talked about my feelings instead of asking him about his feelings. Yeah yeah he's a mistake because if you think about relational needs and you think about the unmet relational need for mutuality you might aim for that but with a narcissist it's a dangerous road that so I learned somebody who's narcissistic trains I don't share my sense of self because you're actually well not at the beginning I think you can do it later on in therapy but certainly not at the beginning stage of therapy when they don't know you at all they will only feel safe and secure if they feel that you're inquiring about their frame of reference and not yours. Yeah yeah and they are special and unique so if you're using that mutuality to try and make a connection then they're not that special if you've experienced something similar to them. Yeah and probably shamed. Yeah yeah I always suspect that shame was the biggest feeling they had and there's a lot written about shame when you talk about narcissistic injury there's many books you would find many articles in the literature about shame being the deepest injury for the narcissistic client where they felt shamed belittled humiliated by the slightest remark you might make. So if we talk about where this develops you know how it starts the hurt child it's quite normal for well we do all go through a phase of you know the world does centre around windows when we're young. Yeah one at the age of one we have an enormous potist I again I remember my daughter coming in at the age of one to my bedroom and said daddy I'm here in the most omnipotent way possible so at the age of one we you know it's very normal to have that level of omnipotence and it's not until they reach the age of between one and a half or perhaps a bit later to three and a half where they go into a whole repotement stage around separating and individuating which is another story altogether but in those early stages of life nine months a year that sense of omnipotence is I think a general stage of child development. Yeah yeah and in order to to have that you know separating out an individuation of repotement and everything am I right in thinking that we need to this is going to sound awful I don't even know how to say hurt our child's ego to a certain extent so that they move out of that boundaries yeah they don't get everything that they want I'm not saying that we hurt them but we will ultimately hurt their feelings because they won't get everything they want when they want it and we will put structure and boundaries in place and limits around instant gratification yeah yeah which is going to hurt the child because all kids want what they want when they want it well it's a strong word hurt but I'll go with that but my my grandson looks very hurt if he doesn't get it when he wants it I would say healthy hurtness yeah oh yes yeah I'm not talking physical hurt but his feelings get hurt if you know when he says to me nanny do this now and I say I can't I'm busy he looks hurt yeah but the worst thing is if you didn't do that but that's that's kind of what I mean so it is healthy hurt it is letting them know that unfortunately they are not the centre of everybody's universe yeah and I think I think that comes later in the developmental spectrum about one and a half to two this is why they call that area the terrible twos yeah because what happens is the child goes into a huge and I'm not going to say some narcissistic fit but you I was thinking my client who stood up and bellowed at me about the fact that I had an actually asked questions enough about how he felt and I was daring to talk about how he felt and I was thinking of Jessica the age of two who um had a had a real sort of bellowing ranting raving session at a two-year-old because she was in Tesco's and wanted to go this way instead of that way yeah yeah so it's a it's a normal part of of development for children to be narcissistic particularly like you said terrible twos and troublesome threes yeah yeah yeah and you know healthily we need to set those structures and those boundaries and those and they will feel safer then yes yeah yeah because that's good child if they get what they want when they want it kind of puts them in charge of the situation somehow which that's right the problem though is um if the child may have to do this starts testing their own sense of self definition and testing their own abilities and start individuating in those early developmental milestones and the parent does not validate that and doesn't allow them to get the sugar first or whatever it is they don't go and get the sugar for them or whatever every example we put then what happens is they may feel shamed her humiliated misunderstood yeah because they're not allowed to test their own power themselves yeah which it's important that the kids do stamp the foot down but it's about you know them understanding that the parent is doing what they're doing in order to keep them safe and you know that they there are structure and boundaries in place within the family unit I think for a child to feel in control at a young age is so scary for them somebody has to meet them at that level absolutely so I couldn't agree more the problem as I said before is if the parent doesn't allow them to test their own power yeah now that and at the same time have the structure and safety for them to be able to do that yeah yeah so that you when I have spoke to people all right you know when they they want to know about the narcissist and I say that you know that's when it's it starts to be formed and what you were saying about being empathic and them not having you know a robot sense of self and that empty core it puts a different slant on it you know people give narcissists a really bad press and I'm not saying you know that it's nice to be on the receiving end of a narcissist but when you look at how they present and the reasons why it is okay to be empathic towards them yeah it's more than okay to be empathic and in fact the whole self psychology movement led by co-ords in the early 1960s and the treatment of narcissism talked about the empathic attunement being the way forward and without that attunement of narcissism will happen yeah having said that I don't know whether it's appropriate for you know us to talk about in this session about protecting the other person in a relationship with a narcissist you need to protect yourself in that relationship as well I think that's a completely different podcast yeah that's taking us outside the clinical room yeah even look at how comes somebody would have a relation with somebody's narcissistic that level and in terms of protection and look at what's these um sort of scripts that collide that makes somebody go out with a narcissist you know we could look at a schizoid or subservient personality we could do many things but it's really outside the remit of this podcast it's an interesting podcast to have by the way to look at you know what types of scripts collide I think I'm just aware of the listener that you know if there is somebody that's listening to this particular podcast because it is around narcissistic personalities just to bear in mind the other person that potentially could be in a relationship with them when I'm talking about being empathic towards them and those sorts of things that I don't want to discount anybody else no so I'll say some of those people number one you're not their therapist yeah number two you can't meet the needs of somebody at 25 or 30 whatever it is when actually the injury is 20 years ago in other words whatever you do will make any difference in that sense yeah what you need to do is set the boundaries and be protective of your own self now that might mean not being in relationship with somebody or if you feel that you can have the type of relationship of a high level empathy and creating that type of environment but you know you're not the therapist no you know this is to humans hopefully meeting from two adult positions if that's not possible then you need to start thinking about whether you need to be in a relationship whether the relationship is unhealthy and what makes up a healthy relationship and I tell you what doesn't make up an unhealthy relationship is where you have the continuation of a parent child's script instead of the ability to have two adult to adult conversations yeah yeah I just thought it was worth mentioning that it's a very important one you know taking on board who potentially could be listening to this yeah no you shouldn't be in a relationship with somebody who is a full blown narcissist and is creating a situation which is abusive for you you need to find a way somehow to set the boundaries and create a protective environment for yourself but I think also for the people listening to this you know there is a continuum of narcissistic traits to narcissistic disorders yeah and they're two different things somebody with narcissistic traits probably might have enough adult or accessibility to them for enough adult for them to go to therapy or deal with the things they need to deal with so they're in a better relationship somebody a narcissistic personality disorder will never have that no so the clients that you have worked within the therapy room how how did it end right okay let's deal with narcissistic personality disorder because I have dealt with people with high continuum they are usually in therapy if they stay and we work with the child and get to the child and the or the full self for five to six to seven eight years every week so it's long-term psychotherapy yeah that's that's that side high function narcissists yeah narcissistic traits where they have people have issues of maintaining an adult relationship for example or they aren't able to account for the other or they have impaired empathy at a sort of mining level if I want to use that language then it's also they don't have to be in therapy necessarily five to ten years or something might be only therapy for a year or might be even six months but you can still work in a way where you can get to the child because the therapy is with the child eager state not in the here and now yeah but because they have more accessibility to their adult they're more able to be in a therapeutic relationship with you where they can look at their relationship where they have some access to empathy but you see the number one position Jackie at this level is that they haven't got empathy because they haven't got empathy for themselves yeah so if you can get to a place where they can start seeing themselves as needing help get to a place where they see themselves in a compassionate way where you start to teach them what is a self-caring position in a relationship they will they will then have empathy for the other yeah now that is what that goal is reachable at this level of one could say a neurotic narcissism if you like rather than this personality disorder level which is far more challenging but at the level of the neurotic narcissist if you want then it is more achievable but they will need to come to therapy to do it yeah and sometimes that being in a relationship and realizing that things aren't going that well can be the catalyst for them to go to therapy yeah yeah so on this list of things to do that I know this may be a technical term for people listening but through the what I call idealizing transfers which has come from the empathy and the environment of an empathic tuned therapy where they can start to idealize you and see you as somebody who's on their side understands them for the first time they're able to start talking about their narcissistic for self if you want to put it that way as that idealizing transfer starts to evolve they start to feel protected by the therapist they will then start maybe to allow you to see their depression despair their inadequacy and what's beneath the grandiose defense but they have to be able to see you at least as special as them or even more so yeah yeah which kind of links in I suppose to what you've said earlier um about coming alongside them and trying to do that mutual thing you know that to allow for them to allow us to be on the same level status wise as them yeah yeah they need to idealize you to do that yeah yeah and that takes time it takes time for that transfer to evolve yeah what what sort of games go on in the therapy room with them well G professor might be one where they are more wonderful than you or or it will be I'm okay and they attempt to uh devalue the therapist put the therapist down and attack the therapist now if the therapist can withstand that and through empathy and empathic transactions to get what's underneath that then they're on to a winner yeah and then hopefully you move to what I would call the recognition stage which you start to some people might call this through educative therapy but you start to help them recognize that their narcissistic behavior actually doesn't help them in relationships yeah now you're only going to get there if they're going to if through the idolizing transplants they're going to allow you to you know touch their false sense of self and all the things I've just talked about and then you can start you know teaching them if you want to look at it this way I like it in a way because you can start um helping them recognize that their narcissistic behavior pushes people away rather than helps them have any sense of intimacy I think I think in that stage also they need to start to find compassion and compassion for themselves yeah because then they can give it to other people yeah I again I don't know why but as you were saying that it's kind of like separating out the behavior from them you know that how they hold people at bay doesn't necessarily define who they are as a person you know if they understand that it's a protection it's you know yeah you're right and it's at this stage where they may decide to leave therapy I think most they're very highly likely therapy if they don't if they haven't got the motivation to go further yeah because the next stage of course is helping them making changes in their relationship and in life but if they don't want to recognize it in the first place or they've got a motivation yeah I think really Jackie until they start really having self care for themselves and compassion for themselves and empathy for themselves they'll find it difficult to have empathy for other people yeah so that has to be a lot of work on finding their compassion for themselves finding kindness for themselves teaching them what that is helping them look at self care because once they do that they are then more able to be able to do to other people and if they can do it to other people then you're going to have more success in that's called the recognition stage if you like and then you'd be able to judge how much motivation they have to going on to be able to make the changes they need to make yeah in therapy now this is long term therapy yeah yeah but because when you're talking about self care and you know compassion for themselves and everything there's something around in order to do that you need to be vulnerable and realize that you're not super human that you're not you know impenetrable if we're going to be compassionate and empathic towards ourselves that shows a certain amount of vulnerability which goes against the narcissistic stuff so I can see why that's kind of backwards and forwards in yeah yeah that's why that's this is where they may leave therapy yeah yeah and I often would you remember I said earlier perhaps I hope it was in this podcast but it might have been the other one where the challenge is that they have to see humans as normal and normal and mortal yeah I'm making mistakes doesn't mean that the world's going to end yeah and it may take a very very long time in this particular stage for them to come to the acceptance that it's okay to make mistakes and in fact a degree of normality is normal and that's you know they don't have to be special they don't have to xxx but the problem is yeah you're right again is that you're touching on their grandiosity defense or they you know I call God defense or Elena Greenberg did anyway that grandiose omnipotent defense so it's like hopefully you have done enough therapy by then to enable them to perhaps have enough motivation or be able to see some of the changes they need to make and one of them is exactly what you're talking about is see them you know sharing their vulnerability as a strength and not a weakness yeah would you use humor in a therapy room with the narcissist wonderful you would definitely the passive aggressive which podcast we're talking about passive aggressive you assume we're a lot probably not so much okay and the reason for that is they may think you're laughing at them and then feel shame do you remember I said it's really one of their features of analysis is that they will take the slightest criticism or the slightest word yeah yeah maybe humiliation and shame and all those sort of things and humor is one of those areas where I think somebody who's got a very very very sensitive psychic skin may not see humor is humor so I don't tend to use humor much with somebody now as as they work through this and all the things that we're talking about have more accessible to adult and that's a different story but I think it's something to to be aware of is that they they're any perceived you know criticism or slight and they could see humor that way I think yeah interesting so it's something to consider clinically as you work through it and they're more able to have access to the here and now rather than their regressed child in your stay then you're more able to test that out in fact the more I'm thinking is probably a good test of how far you've come in therapy that they can take your humor without feeling completely annihilated and shamed and humiliated would be a good criteria of how far you've come yeah but usually but often they're very very serious characters yeah I think that that's what I was thinking because I I do use humor quite a lot in the therapy room more more than I'm quite open about my I don't know is it fail to is that the right word did you know what I mean that I make mistakes to get to that stage of the narcissist is a long time now again if you think of the continuum and the you know narcissist traits rather than the personal disorder you probably get there quicker yeah where you will need to go is to what Greenberg calls especially the full glow master system calls the called after the recognition stage called the lost paradise stage in other words for them to for them to get on in relationships not push people away and not tap them and not all the things we've just talked about exploit them and I've talked about after my compassion for themselves and all those sorts of things but they also need to get also what will happen is they start to change their narcissistic defenses or coping mechanisms they're more likely of course to go to a place where they get in touch with what they've lost because you see if you've got a grandiose omnipotent defense system where everything is you're so special and all the things we're talking about world is so wonderful because you're so wonderful and you're so perfect next xx and you can control it and da da da that might seem from that position almost like a paradise yeah but of course once you start giving those narcissistic defense and go through the recognition stage that I talked about then you have to start getting in touch with the lost paradise yeah so a sense of grieving and loss around that yeah yeah and also getting in touch with the painful memories of their unhappy family life you know so of course you know once you get touching on what wasn't and how they were misunderstood and actually how they were shamed maybe um that's hard stuff for them to get hold of yeah yeah so we could do more episodes on this Bob we could do a whole month on narcissistic people yeah because to get to that stage you don't often get there by the way because then they have to move on towards we call the self activation stage which is actually integrating a lot of the new coping mechanisms and ways of being so for example the very simple level and again I've lost track of this was in the last podcast of this podcast if they take somebody out that they actually can listen to them for half the conversation and ask them about you know how are you getting on what's it been like what do you do what's your favorite food have you had other relationships and all those sorts of things if they can actually do that which is what I call the self-activations phase and and changing their narcissistic coping mechanisms then they're on the way to cure yeah you saw it on I talked about Love Island I asked you always on the other podcast but I like watching these reality TV programs away because I like the psychological aspect of all now one of these alpha males who I'm sure has been narcissistic traits just talked about himself all the time and very rarely talks about how the other person is and one of the women started to complain about the fact that this person never talks about anything about themselves and never asked them about how they're getting or how they're feeling and that is the complaint of somebody who's around a narcissist that they're not seen yeah not ever talked about because the other person's always talking about themselves which in a relationship is not very good no the narcissist is to get to that place and understand that and recognize that and change their patterns so they can actually do the a very different normal what we've seen by so many people's normal you know communicating is actually a massive leap yeah yeah so Bob we need to end I can actually say Jackie I could go on talking but I hope the two podcasts this one and the one before have been useful and helpful yeah and it's worth maybe mentioning that if anybody does want us to talk more on this topic that they can get in touch and message us and we're quite happy to talk about lots of things yeah because I can I realize there's this place for comments and questions on the on the videos I mean on the YouTube videos of the podcasts yeah I said I must make sure I answer but we happily talk about that or people want another podcast about the reaction to this one yes 100 another one we could do because we're here to answer people's questions absolutely as well as talk about the stuff that we like talking about so what we're going to do next time Bob we're going to do the history yeah that's where people get confused with narcissistic traits and histrionic traits and actually even those are similarities there's great differences yeah right okay okay until the next time Bob I'll give you a quick sign I want one minute just to say show you the difference in the treatment so for example with a histrionic client the best way the best way to come alongside somebody who's histrionic and will present with feelings is to ask them feeling queries yes if you did that with somebody who's narcissistic they would feel shamed humiliated and devalued and probably never come back see you next week see you next week bye yeah bye bye you've been listening to the therapy show behind closed doors podcast we hope you enjoyed the show don't forget to subscribe and leave us a review we'll be back next week with another episode