My speech is a bit slurred, not because I've been drinking. Let me rephrase this, not because I've been drinking more than usual.
I have been to the dentist and I came back with a breakthrough conclusion.
If there's a group of people worse than narcissists, these are dentists in action.
I've been tortured and tormented throughout the whole process.
There was this beatific, angelic smile on my dentist's face, under the mask, I'm sure.
Okay, Shoshanim, today we're going to discuss how to cure the narcissist in your life.
Some of you, for some oblivious, self-destructive and masochistic reasons, insist to stay with your narcissist.
Well, at least let me educate you and edify you as what are the treatment options.
Good luck dragging your narcissist into therapy. That in itself is a process which easily competes with any dental treatment.
My name is Sam Vaknin and I'm the inevitable author of the one and only masterpiece, Malignant Self-Love: Narcissism, Revisited, which you can buy on Amazon if you don't have what to do with your money.
And I'm also a professor of psychology in Southern Federal University in Rostov-on-Don, Russian Federation. And I'm also a professor of finance and a professor of psychology in the outreach program of the SIAS consortium of universities, CIAPS Centre for International Advanced Professional Studies.
Thank you for listening and see you in the next video. No, I'm just pulling your leg. Stay, where are you going? Why are you going? Hello? I was kidding. Oh my God. People take everything so literally. It's mind shattering for those of you who still have minds.
Today, as I said, we're going to discuss treatment modalities.
Now, psychologists never can say anything normally. They can never use normal words. They don't say, for example, therapies or psychotherapies. They say treatment modalities because it sounds very scientific and excludes laymen from the fraternity of psychologists.
So treatment modalities is another word, another phrase for psychotherapies. And we're going to review the whole field.
Once you had convinced your narcissist that he needs therapy, are there any realistic options out there? Isn't he and you, aren't you wasting your time?
Not really, actually. The situation is a bit better than self-styled experts online would have you believe.
I can't resist taking a dig at these so-called experts with and without advanced academic degrees.
All right, let's proceed.
This is an interview that I gave to News Intervention. And the unfortunate interviewer is Scott Douglas Jacobson. Not because he's not a good interviewer is actually a superb interviewer, but because he had to spend a lot of time with me. Poor chap. My heart goes out to him if I had a heart.
Scott Douglas Jacobson, question number one.
Narcissism seems lifelong, immutable. You have commented eloquently, thank you, Scott, about narcissistic personality disorder and lifetime devour it by it in an Instagram post. Yet your intervention, cold therapy, is effective with narcissism and depression. What was the original insight into the first developments of cold therapy?
To which I answer that, exactly like borderline personality disorder, narcissistic personality disorder is a post-traumatic condition, a form of complex trauma. That was the insight that gave rise to cold therapy. So cold therapy is based on two premises.
Number one, that narcissistic disorders are actually forms of CPTSD. And number two, that narcissists are the outcomes of arrested development or stunted development and attachment dysfunctions.
Consequently, cold therapy borrows techniques from child psychology and from treatment modalities, therapies, which are used to deal with PTSD post-traumatic stress disorder.
Having survived this answer, Jacobson proceeds in call therapy and narcissistic disorders of the self, which is an academic paper I published in 2018. You list four misconceptions about pathological narcissism. Why have those been the misconceptions in particular?
Vaknin, that's me. Pathological narcissism is not merely a regression to an earlier childhood developmental phase, although such infantilization is a core psychodynamic of the disorder.
But there's so much more to it. There's so much more to narcissism than this. Narcissism is also not only a psychological defense, although narcissistic defenses and cognitive distortions, they play a key role in the pathology.
Narcissism is not simply an organizing principle or a schema, though, like every addiction to narcissistic supply in this case, narcissism helps the addict to make sense of the world, is hermeneutic, interpretative, and provides goal orientation and direction to his life. Narcissism comes replete with rituals, order, and structure.
And in this sense, narcissism is an exoskeleton, similar to a drug addiction.
Finally, narcissism is not strictly a personality disorder. The personality is intact. It's actually highly adaptive.
Narcissism is a post-traumatic condition amenable to trauma therapies.
Like in every other form of complex trauma, emotions get dysregulated or repressed, and conditions get distorted.
Jacobson, how are narcissistic disorders complex post-traumatic conditions and forms of arrested development and attachment dysfunctions? In which way? How are both pampering and punishing a child or an adolescent forms of abuse in the creation of a narcissist?
Vaknin, answering. Pathological narcissism is a reaction to prolonged abuse and trauma in early childhood or early adolescence. The source of the abuse or trauma is immaterial. The perpetrators could be parents, teachers, and other adults, or peers, even.
Pampering, smothering, spoiling, pedestaling, and engulfing the child are also forms of abuse. Instrumentalizing the child, parentifying the child. All these are forms of abuse because they don't allow the child to separate from the parent and to confront reality as an agent of personal growth and development.
Narcissistic and psychopathic parents play a role in this, usually.
The early childhood traumas of the narcissist prevent him or her from completing the process of separation, individuation.
The narcissist is not permitted, the narcissistic child is not permitted to develop boundaries. He's not permitted to become an individual. He freezes in time as a puer aeternus, a Peter Pan, an eternal adolescent.
The narcissistic child or the child that is about to become a narcissist reacts by avoiding the offending and hurtful parent, an insecure attachment style that becomes entrenched throughout his lifespan.
The child who is about to become a narcissist creates the false self and outsources many ego boundary functions to the false self, rendering the child dependent on the appraising gaze of others to buttress his grandiose inflated self-image.
Gradually, the narcissist develops an addiction to confirmatory input, a kind of confirmation bias, if you wish. He needs narcissistic supply because he cannot regulate and stabilize his internal environment without it.
What's left of Jacobson asks, what portions of the nervous system in early childhood and early adolescence seem most impacted by the long-term abuse and trauma to create narcissism if it is known?
No, it is not known, says the Vaknin. There are many studies about the neuroplastic effects of childhood abuse and trauma on the brain, but none of these studies is specific to NPD narcissistic personality disorder. There are studies about brain abnormalities in borderline and antisocial personality disorders, psychopathy, but not about narcissism or few about narcissism.
Jacobson, how are narcissistic disorders interpersonal disorders rather than disorders of the self?
Vaknin, the concept of individual which regrettably permeates modern psychology is counterfactual, defies the facts. We are formed fully via relationships with others. To conceive of the self as an outcome of narcissistic introversion, as Jung suggested, is disastrously mistaken.
Disorders of the personality are therefore problems in interrelatedness as the object theorists in the object theory school in the United Kingdom in the sixties had postulated.
Narcissism is no exception. It's a problem in relating to other people. It's a social disorder.
The Diagnostic and Statistical Manual Edition 5 had adopted actually this position in its alternative model of narcissistic personality disorder. I refer you to page 767. And I had been advocating this posture or this stance since 1997.
Jacobson, what are the goals of cold therapy?
Ornery Vaknin says the main two therapeutic goals of cold therapy are to render the false self redundant and to drive it to atrophy, use it or lose it kind of thing. And the second goal is to eliminate the need for narcissistic supply and the dysphoria that accompany deficiencies in narcissistic supply.
In short, to get rid of the grandiosity dimension in narcissistic personality disorder.
Other goals are to process trauma via skilled reliving, to own, to teach the patient or the client to own the trauma and to survive re-traumatization within the therapy.
To foster more adaptive functioning that is not dependent on outsourced regulation, cognitive distortions like grandiosity and artificial constructs like the false self.
To replace negative coping with positive coping strategies, negative coping strategies such as avoidance, withdrawal, defiance, or fantasy.
To integrate distressing materials, thoughts, feelings, memories, to lead to the internal resolution of dissonances resulting in an equilibrium and homeostasis, also known as health, to be healthy.
And finally, to help the client to evolve or to develop life skills such as resilience, empathy, and ego regulation.
Jacobson, why are well established therapies effective in the treatment of narcissistic disorders?
Well, the main reason they're not effective is that they treat the narcissist as an adult and the narcissist is a child.
And the other reason they're not effective is that narcissism is a post-traumatic condition and they don't pay enough attention to the traumatic aspect.
But instead of saying this actually in the interview, what I did is I provided a review of how each therapy, each treatment modality, fares, how it succeeds to tackle narcissism.
Let's start with behavior therapy.
It replaces problem behaviors with constructive behaviors via conditioning and reinforcement.
Cognitive therapy changes negative automatic thoughts, ANTs, automatic negative thoughts, and schemas that lead to attributional and other biases. It also changes errors in order to alter problematic behaviors and dysfunctional feelings and behaviors.
CBT, cognitive behavior therapy. It's a third wave of behavior therapy.
The primacy of therapeutic relationship, learning principles, analyzing triggers and environmental cues, exploring schemas and emotions, utilizing modeling, homework, and imagery, they all part and parcel of CBT.
A form of CBT is known as dialectical behavior therapy, DBT, developed by Linehan in 1993 to treat borderline personality disorder, but used with other personality disorders and also with disorders of mood, anxiety, eating, and substance abuse.
DBT deploys mainly with female patients and inpatient or residential settings, but that is changing fast.
DBT emphasizes emotional and affect regulation rather than conditions, unlike CBT, classic CBT. DBT is concerned with how were schemas formed via dialectic conflicts. It seeks to connect affect and need to cognitive inference processes and belief systems so as to be reinterpreted with greater self-awareness.
DBT identifies fixations or preservation causes caused by early developmental deprivation and protective attentional constriction. DBT examines affects of negative reinforcement through emotional avoidance or inadequate coping skills rewarded through the partial reinforcement effect.
And finally, DBT involves individual therapy, but also group skills training, phone contact, and therapist consultation. It is all pervasive. It covers the whole panoply of the client's interactions. It focuses on using validation and problem solving to counter severe behavioral dyscontrol, issues of quiet desperation, problems of living, and reducing incompleteness.
DBT is one of my most favorite therapies.
Cognitive behavior analysis system of psychotherapy, CBASP, developed by McCullen and adopted by Sperry, Len Sperry. It is not used with borderline personality disorder.
Clients in CBASP, clients learn to analyze life situations and manage daily stressors. They evaluate which thoughts and behaviors prevent desired outcomes.
Elicitation and remediation are used. Questions about the situation, the client's role and functioning in it, and the desired outcome.
And these lead to the revision of counterproductive behaviors and cognitions.
This therapy replaces emotional reasoning with consequential reasoning.
Then there is mindfulness-based cognitive therapy, MBCT. It was developed by Tisdale.
It fosters aware focus on thoughts, feelings, and experiences in the present with an attitude of acceptance and without analysis or judgment.
This is something known as pattern-focused therapy, again developed by Len Sperry, who was a very productive psychologist.
A pattern is predictable, consistent, self-perpetuating style of thinking, feeling, acting, coping, and self-defense. A pattern can be adaptive, competent, or maladaptive. Maladaptive, inflexible, ineffective, inappropriate, causes symptoms and impairs functioning and life satisfaction.
The therapy consists of replacing hurtful, maladaptive patterns, situational interpretations and behaviors with helpful adaptive patterns.
A very famous therapy is schema therapy, developed by Young, a very powerful therapy, and one of my favorites.
The therapy changes maladaptive schemas, 18 enduring and self-defeating ways of regarding oneself and others arranged in five domains.
Schemas are perpetuated through coping styles, schema maintenance, schema avoidance, and schema compensation.
Schemas can be reconstructed, modified, interpreted, or camouflaged.
I will quote from Len Sperry's handbook of diagnosis and treatment of Diagnostic and Statistical Manual edition 5 personality disorders, assessment, case conceptualization, and treatment. Third edition, 2016, published by Rutledge.
So Sperry arranged all the schemas and is table 1.2, maladaptive schemas and schema domains.
Disconnection and rejection domain. Shema number one in this domain, abandonment and instability, the belief that significant others will not or cannot provide reliable and stable support.
Mistrust abuse, the belief that others will abuse, humiliate, cheat, lie, manipulate, or take advantage of the client.
Schema number three, emotional deprivation, the belief that one's desire for emotional support and intimacy will not be met by other people.
Defectiveness shame, the belief that one is defective, bad, unworthy, unwanted, or inferior in important respects.
Social isolation and alienation is the last scheme in this domain. The belief that one is alienated, different from others, or not part of any group.
The next domain is impaired autonomy and performance.
And scheme number one, dependence incompetence.
The belief that one is unable to competently meet everyday responsibilities without considerable help from other people.
Vulnerability to harm or illness, the exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent it.
Enmeshment, undeveloped self, the belief that one must be emotionally close with others at the expense of full individuation or normal social development.
And finally, failure, the last scheme in this domain, the belief that one will inevitably fail or is fundamentally inadequate in achieving life's goals.
The next domain is impaired limits or impaired boundaries.
The first scheme in this domain is entitlement grandiosity, the belief that one is superior to other people and not bound by the rules and norms that govern normal social interaction.
The next scheme is insufficient self-control, self-discipline, the belief that one is incapable of self-control or in frustration tolerance.
The next domain is other directness, subjugation, the belief that one's desires, needs and feelings must be suppressed in order to meet the needs of other people and avoid retaliation or criticism.
Self-sacrifice, the belief that one must meet the needs of others at the expense of one's own gratification.
Approval seeking, recognition seeking, people pleasing in a way, the belief that one must constantly seek to belong and to be accepted at the expense of developing a true sense of self.
The next domain is over-vigilance and inhibition.
The first scheme is negativity pessimism, pervasive lifelong focus on the negative aspects of life while minimizing the positive and optimistic aspects.
Emotional inhibition, the excessive inhibition of spontaneous action, feeling or communication, usually to avoid disapproval by others, feelings of shame or losing control of one's impulses.
Unrelenting standards and hyper criticalness, the belief that striving to meet unrealistically and high standards of performance is essential to be accepted or to avoid criticism.
Punitiveness, the belief that others should be harshly punished for making errors.
So these are the schemas in the various domains.
The next therapy is transference-focused psychotherapy, was developed by the one and only Otto Kernberg.
Infants form internal representations of self-others, self-objects connected via affect.
A personality disorder occurs when positive and negative representations fail to integrate later in life and such splitting affects all relationships including the therapeutic relationship.
Transference to the therapist exposes the faulty relationship template also known as internal working mode and allows for the empathic correction of this template.
Identity integration is accomplished as the patient experiences negative emotions in a safe environment.
The next therapy is mentalization-based treatment MBT developed by Bateman and Fonagy.
Experience secure attachment in the therapy. That's the idea, to experience secure attachment and to enhance impulse control by empathically and insightfully reflecting on and correctly labeling one's state of mind, especially one's powerful emotions, overpowering emotions and cognitive errors and this leads to improved relational skills.
Developmental therapy was developed mainly by Blocher, Citright, and Sperry. It regards problems in personal growth and need satisfaction on a dimensional continuum from disorder to adequate to optimal.
I would add one more therapy which I regret that I did not include here and that's transactional analysis. It is emerging as a powerful therapy of personality disorder and maybe I will dedicate with a whole new video that's not a promise, that's a threat.
And of course there's called therapy developed by one Vaknin, a professor of psychology and a youtuber.
Jacobson, what are the first steps in formal identification and opening treatments of a narcissist when he attends cold therapy?
Vaknin sighs and responds. The client presents with a diagnosis of narcissistic personality disorder by a clinician.
Cold therapy consists of the re-traumatization of the narcissistic client in a hostile non-holding environment which resembles the ambience of the original trauma.
The adult patient successfully tackles this second round of hurt and so resolves early childhood conflicts and achieves self-efficacious closure rendering his now maladaptive narcissistic defenses redundant, unnecessary, obsolete so they die away.
Cold therapy makes use of proprietary techniques such as erasure, suppressing the client's speech and free expression, and gaining clinical information and insights from his reactions to being so silenced and stifled.
Other techniques include grandiosity reframing, guided imagery, negative iteration, other scoring, the happiness map, mirroring, escalation, roleplay, assimilative confabulation, hypervigilant referencing and re-parenting.
Cold therapy is proving to be, gradually, an effective treatment for major depressive episodes as well.
Jacobson, following from the previous question, as the series of therapy sessions conclude and as the patient lives out life after cold therapy, what are the preliminary outcomes from your early research?
The Vaknin. We have been following up on 63 clients over the past 10 years.
The results are promising but a caveat. The sample is way too small and self selecting to provide any statistically significant validation to the treatment modality.
Major depression and anhedonia have vanished without a trace. There's no remission ever.
The need for narcissistic supply had disappeared entirely and so we believe that the false self is deactivated, disabled or dismantled and the clients have altered their lifestyles radically, had reestablished contact with estranged family and friends and had become much more gregarious.
At a loss for words, Jacobson says, thank you for the opportunity and for your time, Professor Vaknin.
And the ineluctable Professor Vaknin responds shockingly. Thank you again, Scott, for your interest in my work.
The article also contains references.
Go to news intervention or Google news intervention Vaknin. And you will find me all over there. And as I said, there are references.
Okay. I hope some of you have survived this overview.
And if you have a narcissist, go no contact.
If you are seriously self-defeating and self-destructive, continue to live with a narcissist and try to get him to therapy.
Some behaviors can be modified. Behavior modification had been pretty successful, especially abrasive and antisocial contact.
But there's no touching the core of the narcissist. The narcissist is empty.
So there's no way to act upon this core. No way to mutate it, to modify it, to transform it.
There's nobody there. Simply nobody there. It's a hall of mirrors. You're in love with yourself.
Even cold therapy can do little except to eliminate the grandiosity, the false self, and the need for narcissistic supply.
So the narcissist becomes less grating and you probably would become less aversive.
But that's, I think, the maximum that can be accomplished.
Go away. Once you find out, pack your things. Move on.