Transcription
Now, it's not as bad to be borderline, I think. Apparently, or something, or it's bad, but NPD is worse. So, you know, at least borderline people have empathy, but, you know, NPDers don't. What's your experience and assessment of the whole confluence between borderline and NPD?
Yeah. First of all, let me say I agree with your impression of what's going on in the field. Like, when a therapist gets a borderline patient, they usually feel more comfortable than if they get a narcissistic patient. But that's because our knowledge has advanced. We understand better how to effectively treat a borderline patient. So, they're not as much of a threat to our capacity to help.
I think the field has been slower to advance in treating narcissistic personality disorder. So, that negative reaction you described is because a lot of therapists say, "I don't know what to do with this. I mean, I feel disarmed by this problem." That's why we're trying to develop more effective techniques. So, the problem isn't with the pathology, it's with the lack of expertise in dealing with it.
But having said that, I would go back to what I mentioned in terms of attachment style. One's sort of gut-level way of responding to connecting to another person. And there's a defined set of typical attachment styles. One is called preoccupied, where as soon as you meet another person, "What do they think of me? I hope I didn't do anything wrong." And, you know, "Gee, I hope they like me." And, you know, "Did I say the right thing to, you know, like the other person?" Matters a lot, too much, because you can't feel safe and secure. That is most typical of your classic borderline patient. The opposite of a secure attachment style, which is, "They seem fine. I think I was okay with them. Everything's going to be good."
With narcissistic personality, the most typical attachment style is dismissive. "You don't mean anything. You don't matter." So, it goes back to this nontransference of the narcissist. If the patient isn't reacting to you emotionally, isn't having responses and reactions, you don't have a lot to deal with. So, you feel disarmed. That's what we're having to face.
Both have a split structure. But the narcissist's defenses are more solidly entrenched. So, the narcissist's projection of what is considered bad is there in a very solid way. What you have with more classic borderline patients is a split between being all good or all bad. But the patient, one day will say, "You're horrible. Horrible." The next day, they'll say, "I hate myself. There's nothing good about me." So, who's good and who's bad switches all the time. That gives the therapist a lot more to work with. How can we understand that two days ago I was horrible, today you're you don't deserve to live? How can we understand the things that seem so contradictory? If in session after session the patient is, "You're not worth anything. Everything you say is stupid," and that goes on for weeks and months, you know, you don't have that wedge to enter into the system with. Interesting.
And so that's why narcissism is considered also a more primitive, right? It's like you missed the development earlier on or something. I'm not sure one is more primitive than the other. It's risky territory because a lot of it is conjecture based on clinical experience. And I certainly don't want to engage in what we in the field call parent bashing because that's not fair. And we know a lot of these disorders have a big genetic component, not in terms of the disorder itself, but in terms of traits and tendencies and aspects of the disorder.
But often, the person with a full-blown narcissistic structure has never felt loved and appreciated for who they are, for just being. They've never been cherished as a child just because you're there as my kid. Anything they got in terms of love or approval was for performance, not for just being there. It's a huge difference. And if you can't imagine being loved for just who you are, it's hard to feel really good about yourself. There's just always this pressure to earn it. It's exhausting and it leaves you never fully satisfied anyway because you've got this lingering sense, "If I weren't performing, I'd just be nothing and not appreciated." Whereas the borderline patient, for all of the sometimes difficult, intense, and chaotic family relationships, maybe it wasn't exactly that same dynamic.