A Narcissistic Family is identified in a new way for Mental Health Professionals in a book written by Mental Health Professionals. This is so important because when in the trenches with clients with Narcissistic Personality Disorder or several NPD traits, behind closed doors, we still grapple to truly get beyond the narcissistic defense mechanisms that leave these clients with wide gaping blind spots that are the extreme defenses against the very insight and self-awareness that cannot be reached without getting in touch with a great deal of pain.
The application of this understanding and integrating this approach to working with clients creates so much more successful treatment outcomes for clients whether diagnosed with NPD or BPD or co-morbidly both. Without having to address either or both personality disorders with clients beyond the common personality traits that are causing pain, distress, and relational difficulties. In other words, it is more helpful to approach these clients from a client-centered humanistic psychology approach. One that does not focus on the diagnostic labels.
A common pattern was studied and found through a wide variety of (as quoted below) personality traits previously identified with people raised in dysfunctional (non-alcoholic and non-abusive) families. These common patterns of traits were found to have originated within the Adult Children of Alcoholics (ACOA) model.
“Among adult children of dysfunctional (but nonalcoholic and nonabusive) families, we found a body of personality traits previously identified with the ACOA model. These included chronic depression, indecisiveness, and lack of self-confidence. Within this population we found common behavioral traits as well: a chronic need to please; an inability to identify feelings, wants, and needs; and a need for constant validation. This group of patients felt that the bad things that happened to them were well deserved, while the good things that happened were probably bly mistakes or accidents. They had difficulty being assertive, privately feeling a pervasive sense of rage that they feared might surface. They felt like paper tigers-often very angry, but easily beaten down. Their interpersonal relationships were characterizedized by distrust and suspicion (bordering on paranoia), interspersed with often disastrous episodes of total and injudicious trusting and self-disclosure. They were chronically dissatisfied, but were fearful of being perceived as whiners or complainers if they expressed their true feelings. Many could hold their anger in for extremely long periods of time, then become explosive over relatively insignificant matters. They had a sense of emptiness and dissatisfaction with their achievements; this was found even among individuals who externally may have been viewed as very successful.”
Stephanie Donaldson-Pressman; Robert M. Pressman. The Narcissistic Family: Diagnosis and Treatment (Kindle Locations 45-52). Kindle Edition.
“Regardless of the presence or absence of identifiable abuse, we found one pervasive trait present in all of these families: the needs of the parent system took precedence over the needs of the children.”
Stephanie Donaldson-Pressman; Robert M. Pressman. The Narcissistic Family: Diagnosis and Treatment (Kindle Locations 64-65). Kindle Edition.
Whenever the needs of a parent or both parents are prioritized consciously or subconsciously as taking precedence over the needs of a child or their children the dysfunction that comes to the fore rapidly and frequently interrupts a more functional family system. Children experience arrested emotional development. Children and their needs require being put first with the urgency that they arise for young and developing children in order to ensure functional healthy psychological development. Narcissistic (Borderline as well) parents revert to a stress reaction/anger/rage reaction of perceiving their needs as in competition with those of a child or children needing more in those crucial moments. Narcissistic traits (Borderline or both sets of traits) within a parent or parents deeply wound a developing child leaving them with the traits quoted above in adulthood.
It is important, in working with clients, to look more at the family dysfunction, the narcissistic family dynamic, especially in the absence of alcohol abuse or other forms of abuse directly to children. Children or a child in a Narcissistic Family will suffer the results of unmet needs in early childhood development that arrest emotional development and that do indicate emotional/psychological abuse. It is also much more effective, in treatment, to see the client that could diagnosed with Borderline Personality Disorder or Narcissistic Personality Disorder, or co-morbidly both, through the lens of the personality traits (which can be identified, worked on, and dealt with) outside of the diagnostic labels that carry so much stigma. Stigma that results in substantial numbers of Mental Health Professionals who won’t even take on these clients. Especially those they identify as or diagnose as having Narcissistic Personality Disorder.
Looking at the personality traits as symptoms of the Narcissistic Family rather than pathologizing the client or the family, is a more holistic and humanistic way of helping clients in ways that prove much more effective. It is also important to separate out the person (lost person and often unaware person) from the behaviour that they exhibit that is so harmful to those close to them. Behaviour and attitudes that can also be stressful for therapists.
While professionals continue to try to find ways to create more efficacy in the treatment of some with NPD, there are still a very high number of those diagnosed or undiagnosed with Narcissistic Personality Disorder that are not reachable at this point beyond just meeting criteria and then that’s not a high number of those with NPD either. People with NPD continue in so many ways to traumatize others and continue to do so. The number’s of those diagnosed with NPD is growing, the number who would/could be diagnosed with NPD is also growing. There are many factors known and unknown that we understand about this. Unlike BPD, (where treatment is still resisted by a high percentage of those with BPD, treatment can be highly effective for those who will seek it and stick with it. The same can’t be said for NPD. When BPD is co-morbid with NPD the treatment is even more complex, compounded, and often not successful.
If a person has 2-4 traits of NPD, some can be helped. However, it is still, in my experience, the very rate that can be helped. Therapists have to be very careful when dealing with any number of NPD traits under 5 and certainly those who are or need to be diagnosed with NPD with 5 or more traits, to not help the client to actually learn how to better abuse as they often feign wanting help just for this purpose. Often they will become abusive with the therapist and their are other red flags to watch out for in treating these clients to ensure that you are not supporting or trying to work on their issues with them in ways that they are manipulating professionals to learn to do more harm to others. I have experienced this myself in a number of clients over the years. Usually, if one keeps more focused on the presenting issues and is more careful to structure the therapy then let the client with Narcissistic traits – whether they meet the diagnostic criteria of 5 or more or not from “running the show” and “working their own agendas”.
The pathological model of labeling and diagnosing an individual with an Axis 2 Personality Disorder and being too focused on limiting beliefs as to degrees of success with certain diagnostic labels can significantly reduce the chances of effective therapeutic alliance. Mental Health Professionals need to be more flexible in their approach to core symptom patterns. This flexibility will greatly help them hear and validate the client as well as help to educate and support growing personal self-awareness and insight. Personal awareness and insight that clients may never get to defending against Axis II diagnosis or diagnoses.
The most effective focus for these clients is for Professionals to focus not so much on anything labelled “pathology” by a focus on the individual’s presenting relational difficulties but rather a focus on the dynamic experienced in how an adult-child was impacted by the enmeshed unchallenged toxic alliance between a Narcissistic parent (or both parents) wherein the parents protect either each other or one parent protects the other and both fail to respond to the child’s needs.
Therefore the family systems dysfunction is a more effective approach to helping clients from a Narcissistic Family and/or who have a parent with Borderline Personality Disorder or co-morbidly both BPD and NPD and the impact and on-going negative relational, emotional, psychological effects that children grow up with and the personality traits that are then naturally out of balance. They are more extremely experienced from our clients due to their needs having been unmet to neglected and the defensive strategies this creates in each adult child of a Narcissistic or BPD Family (or both) that result in rigid defense mechanisms that create in the lives of our clients. The toxic dysfunctional relational styles and overcompensating defenses that interfere with healthy relating. Relational styles and defenses that under the weight of what was experienced in a dysfunctional family system – The Narcissistic Family – The Borderline Personality Disordered Family – The often combination of both BPD and NPD in a parent or each parent having one or the other personality disorder or both.
When clients comes to us with these traits, defenses, and relational styles that are so challenging and difficult coming from the client’s inability to cope at all with the pain that they have suffered. Pain as a result of having a parent or parents that put their own needs ahead of our clients’ needs when they were in the stages of early childhood development – arrested somewhere in that process – we can have much more success working within a framework of the dysfunctional family system model. We can bring a new understanding to its impact.
Believing that you can struggle with Axis II presentation of personality traits that many clients just defend against is a recipe for poor client retention and for not being as effective as many Mental Health Professionals now know that we can actually be.
It is also an out of the box approach. It’s not a glass is half empty or half full approach. In my opinion, work, and practice, it is evidenced that it is most helpful to client growth, healing, and recovery to view the core aspect of this approach as the glass is refillable in a different and more healthy way perspective. That, in my experience, is allying with clients in ways that set them up for success and for re-learning the very interrupted attachment and relational interpretative deficits that are created when one comes from a Narcissistic Family system. When our clients were children whose needs were lost to those of a parent or parents end up with a narcissistic intrapsychic injury that is carried by them into adult life in ways that do not allow them to have the self/other relational understanding to have healthy successful relationships.
Rather than battle with a client over a label, I truly have witnessed and experienced time and time again that a holistic, out of the box, non-pathologizing non-stigmatizing approach is most effective. This approach creates space for a therapeutic alliance with the client as well as the building of attachment and relating that teaches and heals.
Identifying a Narcissistic or BPD Family System or mixed combination of the two in history taking with each client is my approach and it is highly effective with clients across a multitude of modalities of treatment. I have found Schema Therapy one of the most effective core modalities of treatment in both the presentation of BPD traits or NPD traits.
More people with NPD and/or BPD traits can be very effectively helped when the approach is a client-centered one and a holistic one.
© A.J. Mahari, December 17, 2015 – All rights reserved. Copyright of the authors book and quoted material noted above. This book is by Therapists for therapists and truly does articulate how I have worked with clients in these areas for years. Book: The Narcissistic Family: Diagnosis and Treatment by Stephanie Donaldson-Pressman; Robert M. Pressman