Passive-Aggressive (Negativisitic) Patient Therapy Notes

Uploaded 3/9/2011, approx. 3 minute read

My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.

The negativistic, passive-aggressive personality disorder is not a formal diagnosis in the psychiatric community. It appears in Appendix B of the Diagnostic and Statistical Manual 4, an appendix titled Criteria Sets and Access provided for further study.

Despite this fact, passive-aggressive or negativistic personality disorder is widely diagnosed by many health practitioners and also treated.

So here is the simulation of a first therapy session with Mike, a male 52 years old diagnosed with negativistic or passive-aggressive personality disorder by his therapist.

Mike is attending therapy at the request of his wife. She complains that he is emotionally absent and aloof.

Mike shrugs, we used to have a great marriage, but good things don't last. You can't sustain the same levels of passion and interest throughout the relationship. Isn't his family worth the effort as a therapist?

Another shrug. He doesn't pay to be a good husband or a good father. Look what my loving wife did to me.

In any case, at my age, the future is behind me. Carpe diem is my motto.

The therapist tries to probe. Does Mike consider his wife's demands to be unreasonable? And Mike flairs. With all due respect, that's between me and my spouse.

Then why is he wasting his time in the therapist? I didn't ask to be here, protest Mike. Did he prepare a list of things he would like to see improved in his family life?

He forgot. Can he compile it for the next meeting? Only if nothing more urgent pops up.

It would be difficult to continue to work together if he doesn't keep his promises, says the therapist.

Mike understands, and he will see what he can do about it.

But he says it without great conviction.

The problem is, Mike says, that he regards psychotherapy as a form of conartistry.

Psychotherapists, he says, are snake oil salesmen. Later-day witch doctors.

Only far less efficient.

He hates to feel cheated or deceived. Does he often feel cheated or deceived as a therapist?

Mike laughs dismissively. He is too clever for run-of-the-mill crooks. He is often underestimated by them. He always has the upper hand.

Do other people besides crooks underestimate him?

He admits to being unappreciated and underpaid at work. It bothers him.

He believes that he deserves more than that.

Obsequious intellectual midgets rise to the top in every organization, Mike observes, with virulent envy and rage.

How does he cope with this discrepancy between the way he perceives himself and the way others evidently evaluate him?

Mike says he ignores the fools. How can one ignore one's co-workers and one's superiors?

Mike simply doesn't talk to them. He says, in other words, does he sulk?

Mike refuses to answer. His rage, barely suppressed, rises to the surface.

Finally, after some additional pressure, Mike admits that he does sulk but not always.

He sometimes tries to enlighten and educate people he deems worthy of his efforts. He often gets him into arguments.

And he has acquired the reputation as a cantankerous curmudgeon, but he doesn't care.

Is he impatient or is he an irritable, irascible person? What do you think, Mike counters?

During this session, did I ever lose my cool? Frequently, says the therapist, Mike half rises from his chair, then thinks better of it and settles down.

Do your things, he says solemnly and contemptuously. Let's get it over with.

This has been the simulated first therapy session with Mike, a passive-aggressive male, 52 years old.

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