Transcription
The first thing I do when I'm seeing someone with narcissistic pathology is to try to make them aware of the costs and consequences of their, let's call it, grandiosity or hiding the self, which is a form of vulnerable narcissism, because people often are not aware of that. They'll come in telling you something that they don't understand about themselves.
I can give you a couple of examples. Like, a very high-functioning architect, you know, sort of at the top of his field, partner in his organization, um, was approached by the press to talk about a contract with the city. And they had been told not to talk to the press about this. So he was approached by somebody from the press who asked him to speak off the record, and he did. And he gave him information and then came in and said, "I just can't understand why I did that. I mean, it could just be a disaster for me if, you know, he should reveal his source or whatever."
And so, you know, I said, "Well, let's talk about it. Let's think about why you might have done that." And, you know, as we talked about it, one of the things he said was, "I guess it appealed to my vanity. It made me feel important." He's talked about actually how people in the Trump administration had been approached and spoken off the record to people in the press. So, it made him feel like that. It made him feel like he was important, etc., etc.
So I said, "Well, let's talk about what vanity is." And, you know, vanity is, you know, wanting to present oneself as being very important, very erudite, that makes you feel better about yourself. And then gradually, by explicating that and his offering more, I actually introduced the term grandiosity. Said, "Well, maybe what you're saying is it really fed your grandiosity." And that's the first time that word had come into the treatment, and he very readily said, "Yes, you're right." You know, "I often find myself wanting to present myself as extremely important, self-important, which, by the way, is one of the distinguishing features of grandiosity, unique, um, special." And then we talked about what was the cost potentially of having done that.
I'll give you another example. A female patient, very, very attractive and uh, no trouble attracting men, always had two or three men in love with her at the same time. Yet she couldn't, as she put it, close the deal with any of them. They were all wealthy, prominent men. They would uh, give her money, take her on lavish vacations. Sometimes there were two at a time. And there was one who she had decided would be the person that she should marry. He wasn't quite as exciting as some of the others, but she felt that he really loved her, would care for her, and, you know, she would be able to have children with him and so on.
Um, and she was at a party and a very prominent man started flirting with her, and she got swept into the way sometimes happens at parties, spending all the time at the party with him, thereby ignoring the man she had come with who she was actually deciding to commit to, and wound up going home with this other man. And then, of course, the person that she had thought she might commit to ended the relationship with her.
And so we talked about how because she got swept up into this infatuation, she sacrificed an opportunity for a really good long-term committed relationship with someone who truly loved her and had stood by her through a lot of really difficult things, situations. It was again wanting this kind of superficial admiration that took precedence over everything, and for that she sacrificed something that could potentially have been a much more enduring committed relationship.
So those are examples that getting people to reflect on. And she came and said the same thing. "I don't know why I did that. I have no idea." But unraveling that and and analyzing it and understanding it led to understanding some things about herself that she had not been able to really look at head-on. Um, and through that, then you begin to identify what we call in TFP the dominant object relation, that is the dominant representation of oneself in interaction with others that gets activated for this person.
So in the first situation, it would be a man who, you know, whose dominant representation of self was of a very unique, important person. So important that only he could talk to this reporter and who was slavishly, you know, courting him and flattering him. And that's the typical diad of the grandio self and the inferior other that we try to define in transference-focused psychotherapy. We try to define is what's the dominant object relation organizing that person's experience. It's not the only one.
And in the second case, it was a woman who her presentation of narcissistic pathology was not totally grandiose. It was more a combination of grandiosity and vulnerability. Um, she was very insecure. She felt very inadequate in many situations. Was sometimes overcome with feelings of shame. She was in a professional training program. She hadn't been able to finish her degree. So there were many self-defeating, self-abnegating qualities. And in that situation, there was this all-important, grandiose person who was paying attention to somebody with depleted narcissism. And she absolutely got swept into his orbit because by being in his orbit, she got the reflected grandiosity. So that's an example of a more vulnerable narcissistic presentation.
But in both cases, you see there was something driving that person, an object relational scenario that they didn't understand. So we go from talking about the costs and consequences of grandiosity to trying to define what is the dominant representation of self in relation to others that keeps coming up over and over again. And so that's that's the beginnings of treatment. Somewhere along there, that process, people become aware that they actually need therapy, that there's much more distress there than they were consciously or overtly aware of, that they are actually in pain.