Narcissists in Treatment: The Importance of Making Waves
Renowned author, relationship expert and lecturer in the field of addiction Rokelle Lerner feels that regardless of Narcissism Personality’s removal from the DSM5 , there is a clear need for clinical expertise in dealing with the pervasive narcissism that exists in alcoholics and drug addicts.
Recovery means finding a way of living that works:
Physically, emotionally and spiritually. In 1958, Bill Wilson, in the newsletter The Grapevine wrote, “the first job in recovery is sobriety, the second is emotional recovery.” As we know, many can get sober, but are still left with behaviours that don’t disappear with treatment or sobriety.We have all encountered addicts who have been through treatment and still exhibit self indulgent, narcissistic behaviours. Their relationships are painful and the people around them suffer constant anxiety, terror and pain well beyond their loved one’s sobriety.
In 2014, the American Psychiatric Association determined that the diagnosis of narcissistic personality disorder be removed from the Diagnostic and Statistical Manual 5th Edition. Regardless of this decision, clinicians need skills in dealing with the pervasive narcissism that exists in alcoholics, drugs addicts and those with process addictions.
A narcissist must protect feelings of grandiosity and omnipotence through chronic devaluation of others. Their acute radar for the limitations of others is particularly reserved for those that offer help and support. This investment in grandiosity spares the narcissist the terror unconsciously associated with dependency. And, it is this pervasive fear of dependency enshrouded by grandiosity that is central to the narcissistic personality structure. Developmentally, the narcissistic wound often occurs around the rapprochement sub-phase of childhood. So essentially it’s important to remember that when dealing with this personality, you are working with the emotional equivalent of a toddler. And the rules of a toddler are as follows: “If I want it, it’s mine, If I can take it away from you it’s mine, It must never appear to be yours in any way” According to Alan Schore , brain imaging studies show that attachment disruptions at the rapprochement phase of development affect the right brain areas involved in empathy and compassion. In addition, this type of trauma and the intense shame that ensues reflects a sudden shift from the sympathetic to the parasympathetic autonomic nervous system activity. In short, there are neurobiological and developmental reasons why these men and women have difficulty with empathy as well as self-regulation.
THE NARCISSISTIC ADDICT
The best way to describe a narcissistic addict is through metaphor: Lewis Carroll’s fable for children, Alice’s Adventures in Wonderland, tells of a young woman who swallows a magic pill and drops down a rabbit hole into a strange and wondrous land. If we link that tale to the myth of Narcissus, who is captivated by his own beauty, we have a description of the narcissistic addict: a man or woman who is both narcissistically disordered and lost in a version of wonderland. For some men and women, addiction is characterized by an insatiable desire to recover an infantile state of gratification, which can only be realized in “wonderland.” The narcissist’s false self is so grandiose and ego so cruel and shaming that the disparity between the false self and his or her internal, shameful reality will eventually knock them off their pedestal. Whether a failed relationship or a critical comment at work, sooner or later a narcissist will experience a “grandiosity gap” between their fantastically inflated and unlimited self-image and their actual limited and shameful reality. It makes perfect sense why a narcissist would turn to alcohol, drugs for comfort. Since the core emotion of a narcissist is shame, they are at high risk for addiction to substances ranging from sex to drugs to alcohol. The more internal shame a person feels, the more likely he will be attracted to anything that promises relief from pain and emptiness. Narcissism isn’t really about individuals who feel superior. The truth is that a narcissist has little sense of self. They’re desperate for praise because it’s the closest they’ll ever get to unconditional love. For instance, we’re all aware of the term “King Baby.” Although the image conjured up by this phrase is someone who’s arrogant, snobbish, demanding, and aloof, the truth is these are the very men (and women) who feel painfully inferior. In fact, the more a person displays this “kingly” or “queenly” behavior, the more second-rate they feel. These addicts/alcoholics are hiding tremendous shame with their pride.
THE KING AND QUEEN
An addict has difficulty coping with the normal frustrations of life. The “king,” however, because of his delusion of omnipotence is constantly creating unnecessary roadblocks by storming ahead despite the cost. A Twelve Step Program might appeal to the narcissist if he can appear as the ‘guru’. If the admiration and attention runs out in one group, he can always find another across town. Sadly, the narcissist has little staying power for sobriety and expects quick results. Since recovery is one day at a time, and the surrender to the notion of powerlessness is tantamount to recovery, the prognosis is questionable, but not hopeless. There’s always the chance that he’ll pick up a sponsor who has some good recovery from addiction as well as narcissistic traits. I would be remiss if I didn’t point out that king has a female counterpart. The victims of narcissistic women are frequently the ones over which she has the most power—her family. Criticizing, verbally abusing, and sometimes physically assaulting, she can’t allow them to be too successful or too happy. The queen is in deadly competition with her daughters. When they get to be teenagers and mum is experiencing the evidence of ageing, an ugly, hateful battle can develop between the queen and her children.
For those whose lives have been impacted by a narcissist, it’s important to remember the behaviours I’ve discussed here are related directly to childhood trauma. They are survival mechanisms that were formed in sadistic environments among other narcissists who learned the same survival skills in their childhoods. These defence mechanisms are passed down through the generations and systematically choke the life out of children. Narcissistic parents beget narcissistic children. Narcissists are set up for addictive behavior as their true self goes into hiding at an early age in order to please a parent figure and to survive. Emerging in its place is a false self that writes checks of bravado and grandiosity from an empty bank account. It’s important to remember that the narcissistic addict isn’t in treatment because he or she thinks they have a problem. He or she is seeking help because they are expecting you to restore their grandiosity as well as “participate” in their symptoms. Counter-transference issues abound. As Joanna Ashmun says: “Narcissists elicit profound and primitive wrath and hostility from sane and stable people”. Whenever possible it is important to avoid ongoing one-to-one therapy with a narcissistic addict and use a group therapy format as well as service and Twelve Step programs. In order for sobriety and recovery to occur, the treatment counsellor must develop a relationship with the shameful true self, much to the chagrin of the narcissistic patient. Vulnerability is so frightening to the narcissist that the therapist is consciously or unconsciously threatened to avoid making waves in the “pool.” Any ripples will fracture the reflection and the narcissistic addict’s sense of self. These interventions may be attacked, or ignored. Yet this is precisely the type of therapeutic relationship that is required to begin the path of healing.