Labelling People – Thinking About Narcissistic Personality Disorder

Recently, the New York Times reported that the mental health diagnostic “bible,” the DSM is going to drop Narcissistic Personality Disorder in its 5th Edition.   Laura Smith, Ph.D. provides a good explanation for why this was done, here.  While an interesting development in its own right, the move brings to mind an overriding concern about the easy use of labels like “narcissistic.”  Many, many, times have I heard people in recent years label someone as “narcissistic.”   It’s not that “people who believe the world only exists if seen through their own eyes” don’t exist – and it’s not that these folks don’t cause a lot of distress to those close to them. (I remember hearing in my training that the only way you see a person with NPD in therapy is if their spouse or family basically says, “Get help on this or we’re outta here!”)  San Diego mediator Bill Eddy identifies people struggling with NPD as one of a handful of “high conflict personalities” who challenge helping professionals mightily.  But here’s the problem – it’s easy to label, isolate and dismiss another person, losing sight of the fact that this rigid shell of a personality they present to the world covers enormous, old pain.   Eddy has suggested that the 4 major “high conflict personalities” at their core, are protecting themselves from the pain of early, constant violations to their developing, tender personalities.  The “borderline” personality is driven by the Fear of (emotional) Abandonment, suffered so early.  The “antisocial” personality is driven by the Fear of Being Dominated.  The “histrionic” personality is driven by the Fear of Being Ignored.   The “narcissistic personality” is driven by the Fear of Inferiority.  In fact, these people with hugely (over)inflated views of themselves have buried within their hearts a glass shard of failure to measure up – of not being good enough.  When we almost cavalierly label others as “narcissists” (or any other thing) we rob them of their humanity and pain.  Of course,  in their striving to protect themselves from the ancient, overwhelming wounds that are long-buried within,  they may often overwhelm and deeply injure their intimates.  But as with all injuries which we suffer at the hands of others, our own healing comes in part through our own halting efforts to understand and even hold compassion for the other. It’s not necessary to label the other so that we don’t take on responsibility for our own injuries.  It was never our fault anyway.  To humanize ourselves without dehumanizing the person who wounded us is an ongoing challenge and, I think, righteous goal.

Couples Therapy – What to Look For

John Gottman has observed that, on average, couples come in for counseling after they have been experiencing serious problems in their relationship for 6 years.  That means that when you sit in that client’s chair for the first time, you probably will be feeling angry, hurt and hopeless.  You will probably feel blamed by your partner.  You may be trying desperately to save your relationship – or you may be almost out the door and have agreed to give this one more shot.  You might have had a horrible fight recently that leaves both partners exhausted and wounded.  So now I’m going to share a prejudice of mine: People who seek the help of a therapist for couples work should see someone who is specifically trained to work with couples.  A therapist who is really good at working with individuals, may not be so helpful with couples.  Teaching communication skills can be very useful, for sure, but every couple brings with them a rich and complex dynamic.  It is this dynamic (or system….or cycle) that a therapist needs to understand and touch.  When we are stressed in our relationship we already feel alone and isolated.  Working with couples from an individual perspective only strengthens this sense of isolation, I think.  There are a number of wonderful ways to think about, and work with, couples in distress.  Many like Susan Johnson’s Emotionally Focused Couples Therapy.  Others develop an expertise in John Gottman’s approach.  Still others use Brent Atkinson’s Emotionally Intelligent Couples Therapy approach, or Dan Wile’s Collaborative Couples Therapy.  I prefer Johnson’s work, spiced by the work of these other exceptional and gifted people.  There are certainly more kinds of couples therapy out there.  My suggestion is that whoever you work with, make sure they have specific training and focus in an approach to couples therapy.