Narcissists are as easily recognizable as they are prevalent. We've all had to contend with their boorish and abrasive attitudes, their hypercompetitive nature and undisciplined response to the slightest, and often misinterpreted or completely imagined, stimulus.
A familiar narcissist is the office bully — hypersensitive to any hint of critique or correction, yet prone to spilling hurtful and possibly vindictive insults to any that cross their path.
At home or in the office, a certain measure of distance can often be placed between the narcissist and the offended parties, but in the therapist's office, no such boundary is permissible.
Wendy Behary, L.C.S.W., director of the Cognitive Therapy Center of New Jersey, specializes in cognitive and schema therapy and has worked with individuals and couples dealing with narcissism. In a lecture entitled "Empathic Confrontation: Schema Therapy With Narcissists and Difficult Patients" — given at Weill Cornell Medical College's Department of Public Health on April 7 — Behary discussed the root causes of narcissism, the manifestations of the symptoms, and the difficulties therapists face in working with narcissistic patients.
"Why is it that narcissists are so difficult to deal with?" Behary said. "Why is it that they push our buttons perhaps more than any other patients we work with?"
Like many psychological conditions, narcissism is often the result of an unhealthy relationship with one's parents. Several maladaptive schemas, or early childhood traits, often contribute to the development of narcissism later in life. Mistrust, abuse, emotional deprivation, social isolation, entitlement, subjugation and unrelenting standards or hypercriticalness all represent maladaptive schemas commonly associated with narcissism.
When one of these schemas is activated, a narcissist will enter into certain modes that are characterized by recognizable behaviors such as acting disrespectfully or arrogantly.
"Narcissists don't want to feel rejected so in an effort to not feel that smallness, they become overbearing, obnoxious, and boorish and don't stop talking about themselves," Behary said.
The goal of the therapy is to not only have the patient recognize that such behavior is a sort of mask, but to also chip away at that protective layer. Eventually, Behary said, narcissists must learn to nurture and understand the "lonely child" aspect of themselves so that they could in turn understand and nurture others.
To do this, Behary employs empathic confrontation, a method of providing understanding while still holding the patient accountable.
Regardless of the therapeutic method, there are several dangers when treating narcissists, including the triggering of the therapist's own schemas.
"We all have early maladaptive schemas," Behary said. "Nobody has perfect beginnings."
But treating narcissists, Behary stressed, while difficult, can be very engaging and important work.
"You're really on your toes when you're working with them," she said.