Transcription
What are things you have noticed make someone more unlikely to change? I hate to say it that way, but yeah. I mean, I think that the tricky business is that we have some literature that talks about how to predict who is going to change and who is not going to change.
I think for a lot of patients, it's a matter of persistence and staying in treatment for a longer period of time. And it's true that with some patients, it may feel like some, a lot of treatment goals can be accomplished in a year or two. What I learned with the patients that I work with is that sometimes it may take three, four, five, or six years. And a lot of the times after three or four years or five years, people start getting into really, really important issues, and only then they feel that they can really fully confront them in a meaningful way. And that's when the like, a deeper work begins. So I think for a lot of patients, it's just a matter of time, or if they, if they survive in treatment, if they can stay in treatment, and it's a functional treatment that is change-oriented, it is possible to accomplish some of those changes.
Is it possible to accomplish the changes? I mean, it's not always easy to find someone who can treat this. Is it possible for someone to do on their own, get better without treatment? We know from literature that people get better with, if we follow people with any form of pathological narcissism over a period of time, there's a lot of literature that documents at least symptomatic improvement. We also know that treatment alone is may not be the only source of change in lives of people with narcissistic pathology. We know that life experiences could be important and could be transformative. That could be some type of disappointment, or sometimes promotions, or positive experiences that invite new perspectives. They don't always come from treatment, even though treatments could really facilitate those experiences and also facilitate people's understanding that those experiences are meaningful to them.
It becomes more complicated when we look at functional improvement. We usually, we see that people still struggle functionally. There are a lot of difficulties, interpersonal, and a lot of difficulties with vocational functioning. And there's a lot of difficulties in, in terms of emotional intimacy. And we know that some of them are symptomatic changes occur faster than more kind of characterological in terms of traits and deeper psychological dimensions. However, they do occur. We do know from literature that those changes are possible. However, with psychotherapy, the hope is that those changes can happen faster. We have an unpublished study that we're hoping to get in print, that documents that changes in people with pathological narcissism and specifically narcissistic personality disorder are possible. They can get better, not just symptomatically, but also functionally. And those changes occur in treatment. So while this is not a report that can validly say that treatment is effective, but we do know that a lot of those changes occurred in patients in treatment, and likely because of the treatment that they were in.
Got it. So essentially, right, you can sort of reduce symptoms, but to become functional, which is where I guess you might argue recovery lives, it's almost, I guess, the difference between running a mile and training to become a professional runner or something like that. You know, when you have to actually, I mean, you need some kind of formal discipline and training. Yeah, I think that today we know that the hope that the difficulties will go away over time, especially if we're talking about difficulties functioning, that's not very likely. What's more likely is that it will require very intensive and uh challenging treatment that will be difficult, but it could really pay off for people that will stick with it.
Do people ultimately have to be sort of suffering or afraid of the consequences of what will happen to them if they don't get better to get better? You know, I think there are multiple ways of creating motivation for change. Yeah. Um, we know that some people come to treatment because they experience some of the negative consequences of their behavioral patterns or emotional patterns. And sometimes that keeps them in treatment. Sometimes we have to work on creating more durable motivation, a durable commitment. And for a lot of people, it's also a matter of suffering. They know that they suffer. Uh, however, they also need to be able to engage in treatment and use it in a very meaningful way and confront a lot of the painful patterns that they have. However, there are a lot of surprises. Sometimes we don't think that people can engage in treatment in such a way, and then they do. And then they engage and they are willing to look at painful and shameful dynamics and tolerate very uncomfortable emotional states. And ultimately, they can try to make some changes in that. I don't think we're talking about that anything is possible, but changes are possible. At least some of the changes are possible.
And you also used when we spoke the metaphor of the vase, the broken vase, where it's not like you're cured, you know, you're not cured, but it's, can you say that metaphor? It was such a beautiful metaphor. It's a beautiful. So the metaphor is that if we have a vase and we break it, and then we try to glue it together, it could still be a vase, but we know that it was also broken. If I'm not mistaken, in Japan, they used to, they have a tradition of gluing it with gold, and so you could see this, the golden seams that signify the the breakage, but we know that it's a functional vase, but it's also documents the the history. And that could be true for some patients that they could be put together in that way. But that's not the only way in which people can be put together. People find new ways of expressing their needs, and they find more adaptive ways of expressing, um, any type of need for admiration or desire to, for example, to be famous and be admired by other people. It's not uncommon for them to find something adaptive.
Like what would be an example of something adaptive for that desire? People do need to feel appreciated and admired. People could volunteer for in a certain place, and they could feel admired for the work that they are doing there. So it's almost like they're scaling down, if you will, or they're scaling, or they're finding something that's meaningful for them. Right, it could be just something that they found meaningful, and they say, they say that, I guess I can do this.