Tuesday, December 28, 2010

Therapist Types: The Narcissist

This type is not uncommon and may come in male or female, hippy or square varieties.

The classic Narcissist type was a male Freudian analyst.  They would sit behind their “patients” while making them divulge shaming thoughts and feelings they may have experienced as children.  They would then “educate” their patients about what was really going on in their head.  The analyst had the knowledge and insight.  The patient was ignorant and unconscious of their own mental emotional processes.  The “insights” generally boiled down to repressed sexual feelings for Mom or Dad.  And if you didn’t buy it, obviously you’re an unsophisticated dufus.

Nowadays, Nacissitic therapists come in all shapes and sizes and theoretical orientations.  They may be traumatologists or chi-id synergistic specialists or psychodynamically informed eclectic practitioners or anything in between.  The common thread is, the therapist is the source of knowledge and insight.  There is often a distinctly paternalistic quality to the person or the relationship.  The therapist has special inside knowledge about what makes the client tick (regardless of theoretical frame—special inside knowledge may derive from beliefs about childhood trauma or beliefs about chemical imbalance, or any of the other myriad theories and wacky beliefs floating around out there).  Alternatively, the therapist may offer a special relationship and understanding of the client that no one else could offer.  The client could never solve his or her own problems without the therapist.  And, finally, the therapist seems to derive emotional sustenance from dependent relationships and will nurture dependence, sometimes indefinitely, but will not tolerate a critical client or colleague.  Some therapists of this type will actually meet the DSM-IV criteria for Narcissistic Personality Disorder.

The Narcissist Symptoms List:
  • Excessive number of capital letters listed after name
  • Posture:  sits back in chair with legs crossed, looks down nose.
  • Speech:  arrogant and polysyllabic with gratuitous use of opaque technical jargin.
  • Actively or inactively endorses criticism of other therapists, may even take part.
  • Deeply committed to his or her own opinions even in the face of contrary evidence.  This may be most apparent in the process of diagnosing and post diagnosis education.
  • Fails to stop or dismiss flattery.
  • Appears to thrive on the positive transference, adoration and emotional dependence of clients.
  • Promotes the idea the he has a special relationship/rapport with client or that no one truly understands the client at the same level that he does (yes, that’s an old pimp trick).
  • Low esteem or tolerance for colleagues.  May refuse to consult or collaborate.
  • Becomes irritable or even hostile in the face of criticism.  May even terminate services to clients who fail to reinforce the therapist’s ego.
  • Clients and colleagues are obsequious and sing the therapists’ praises.


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  2. Great series! This seems like the type of therapist that is excellent at making their client into a puzzle - figuring out what is wrong with them, elucidating issues and insight they might not have been able to realize about themselves, and then not doing a whole lot to help them through it. Realizing the source of problems is not therapeutic on its own and does not make things better. I really like this analogy of classic psychoanalysis: take all the old junk out of your basement that you haven't touched or thought about in years and spread it all over your front hallway, and then just let it sit there.

  3. The asymmetrical power-imbalanced structure of therapy is exactly what makes the profession a haven for wounded narcissists, and a harmful emotionally damaging experience for clients. It is much healthier, safer, and cheaper to seek out alternatives that are grounded in mutual, reciprocal, equal give-and-take relationships. http://trytherapyfree.wordpress.com/

    1. Its definitely an ideal arena for inadequate people to act out their immature power fantasies and unresolved personal issues.

    2. Most of the narcissistic physicians are employed in supervisory roles and patients are unlikely to have contact with them, although it is feasible. This personality structure whether a trait or disorder gravitates to upper echelons and administrative positions, less so in patient care positions.

  4. I truly wish more people were talking about this. So little seems to be widely known about these types of therapists and the end result is that victims of it don't get the support they need. In addition, professional licensing boards don't recognize this type of abuse when it gets reported. I am finding that the red flags for recognizing this type of abuse may be primarily helpful if the therapist isn't predatory in how he victimizes clients. In my situation, the abusive therapist seemed quite compentent for a rather long period of time before the abuse began (or at least when I recognized red flags). By that point, I dismissed the red flags because there had been what I believed to be a solid track record of interactions. Over a 6 month time period, I had dismissed dozens of red flags that had I seen them at the start of the relationship, I would have run out of his office immediately, never to return. It took me almost a year after I refused to see this therapist any longer before I found answers to what happened. I had to learn new words to do so (words like gas lighting, trauma bonding, Narcissistic Abuse). But the overwhelming feeling of finally realizing I wasn't to blame for what happened was one of the first big steps to me beginning to heal. I happened to stumble upon the TELL website (therapyabuse.org) one day when I was searching tirelessly for answers to what happened to me. It shouldn't have taken me that long. I truly wish more people were talking about this kind of abuse.

  5. She is the cult guru, the perfect mother, the closest to Good. she is the most dangerous of all animals, it is difficult for me to see her as human. TELL help me as well. I met her, and she try to change me, for more than 2 years so I can be like her. She did not manage to do that. I have friends, I have a partner, I can speak English, I have letters after my name. I confronted pure evil, and because I am alive, I can say I won. PTSD, is a scar so I will never forget the battle.

  6. This shows the danger of trusting people to know you better than yourself. Analysts tend to unearth problems or issues without offering therapy to deal with the pain. Many feed off the idealisation and dependence fostered in the client as they regress into a painful state of helplessness as core wounds are triggered without offering coping skills or means to manage the intenses feelings. In a perverse way sadistic pleasure appears derived from fostering neediness and anguish as the therapist looks on mildly amused as if watching a squirming bug under a bell jar after having intentionally triggered the client.Sexual and emotional abuse is rampant in the industry and denied or silenced by colleagues. The last psychiatrist told me I must learn to be silent in response to prior therapeutic and domestic abuse. As sessions are held in private the analyst can "doctor" records or deny outrageous comments or abusive behaviour. Secrecy and lies permeate this industry with many dysfunctional adults causing more harm than good to paying clients. The power inbalance prevents the development of real intimacy or equality.

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