Find Your Happiness

Who has it?  What is it?  How do we get it? Happiness is subjective for everyone, but happiness must be defined by every person in order to be tangible.  How does one achieve a goal without measurable tasks?  It seems impossible to seek happiness but not know what must be done daily to have it.

So what is happiness?  I ask clients to pretend as though they have a magic wand which they will use to make their life happy overnight.  Then I ask, 'what has changed?'  I often hear crickets to this question because it is difficult to envision what needs to change in our lives in order to achieve happiness if we do not examine the elements that make up our own personal happiness.  Many psychotherapists, psychologists, and others in helping professionals claim to be happiness experts, but in reality, everyone who comes to therapy is the master and expert of his or her own happiness.  It takes applied self-exploration to know what comprises happiness for you. 

What does happiness mean to you?  Is it feeling fulfilled by your job and family?  Is it obtaining a goal, like a college degree or promotion?  Or is it living in the moment and taking in the beauty of your surroundings? Is happiness comprised of other emotions, such as relaxation, excitement, energy, concentration, sadness, despair, or contentment? These are great questions to ask, but the deeper question left unanswered is, what measurable/attainable tasks must I accomplish each day in order to achieve my goal of happiness?

other considerations

Instead of thinking that happiness is something that happens to you, a passive state, try to conceptualize happiness as something that you cultivate and nurture daily.  If your goal is to feel happiness and fulfillment for most of your day every day, the tasks of meeting this goal must be concrete and based on knowledge of yourself to inform your choices (e.g. eating ten cupcakes might make someone feel happy in the moment but may cause lethargy, anxiety, or depression in the coming hours or days. The net outcome is not happiness.) 

Maintaining a mostly happy life involves hard work and dedication to your cause at times. For example, I know that 30 minutes to an hour of exercise every day makes me happier, calmer, and feel better. I still struggle to do this because it does not bring immediate satisfaction to me personally. It is hard work to put in the time to maintain happiness through exercise but I KNOW that if I broke down the net outcome hour by hour the net outcome would be happiness. It would look something like this:

exercisedoodle.jpg

Being happy and fulfilled can be exhausting, taxing, and overwhelming, especially if you struggle with depression, anxiety, or other life stressors. If this is the case, start small! Create a goal of feeling happy (or whatever positive feeling it is that you wish to feel) for 5 minutes, 15 minutes, or an hour every day. Don't focus on big, overwhelming goals, but rather look for small things that bring you happiness like drawing or painting, listening to music, dancing in your house, smiling, playing with an animal, or anything else that brings on feelings of happiness without detracting from your overall well-being.

What does a state of happiness look like to you?  And what do you have to do daily to feel happy?

How to Find the Right Therapist

"How do I find the right therapist?" I am often asked this question and would like to preface my opinions by saying that they are just that – opinions. Therapists are as diverse as their clientele and I presume that all would have something to add to this discussion, or perhaps an entirely opposite perspective. If you are looking for a healing, caring, supportive, and emotionally challenging experience, this is my take.

The Basics

1. All therapists are different, but I would say that the primary characteristic of importance in your therapist is that he or she tries to make you feel comfortable and wants to be present with you.

2. Having said that, everyone will be nervous at the beginning of therapy, your therapist included if he or she is human, so give yourself a few weeks to settle in. If you feel inclined, talk to your therapist about feeling nervous and he or she should response empathically.

3. Therapy can be funny and light-hearted at times, but you should not feel the need to impress or entertain your therapist.

4. Therapy can be humorous, intellectual, and emotional, but remember that intellectualism and humor can be used to defend against difficult emotions. Therapists are in the business of emotions, so you may be challenged to access your own at times.

5. You should feel safe in therapy at all times and your therapist should be able to create that safety with you.

Soap box:

Many of the clients I see have discussed "settling" with their previous therapist(s).  He or she would listen most of the time, or was good enough is not an ideal therapeutic situation.  You have the right to the right fit for you.  If it isn't ideal, talk to your therapist about what is missing.  If he or she responds in a way that upsets you, say that you're upset.  If it gets to the point where you want to end the relationship because of this disconnect, talk about it.  A relationship with a therapist should enhance your ability to have relationships in the real world.  As a model of relationship, a therapist should encourage honesty, even when it is difficult, and should always have your interest first on the list of importance.

Step 1. Assess your needs.

What do you need and what do you want? You can have both needs and wants met in therapy with the right person. Read the following questions for guidance on your needs and wishes for therapy.

Are you going through a life transition like college, marriage, divorce, parenthood, or late adulthood?

Are you a member of an oppressed group? Is it important to you that your therapist is a part of this group or has special training around your difference?

Will it be difficult for you to speak to a stranger for the first time?

Have you had therapy experiences in the past that did NOT work? What was missing?

Are you depressed, anxious, sad, or do you have a dominating emotion that comes to mind?

Have you consulted a medical professional and if so, what does he or she recommend?

Do you just want to talk and have someone listen?

Do you want to explore your past or focus on the present? Or both?

Do you want to be challenged or supported unconditionally?

Do you want to talk about goals and be accountable to your therapist in attaining them?

Do you seek structure or freedom in therapy?

Are you more comfortable with a particular gender, and why? Would it be helpful to you to have a therapist representing the gender of comfort or perhaps to have a new experience with the gender you do not prefer?

Are you comfortable with a particular age group, and why? How would your experience be enhanced or compromised with different age groups?

What are you able to pay for therapy?

Step 2. Find a recommended therapist

Word of mouth is the most helpful way of finding a clinician but more and more, therapists are advertising and promoting themselves online. There are some websites that verify the credentials of the therapists who are advertising (psychologytoday.com, goodtherapy.org) so make sure that the therapists you read about have credentials.

Money is usually an uncomfortable topic for most people, but prospective therapists should be clear about charges when asked. Some therapists work on a “sliding scale” basis, meaning that they have different rates depending on financial need. If you are in need of financial assistance, think about what you are able to pay and ask the therapist if the rate would be acceptable.

Credentials:

LPC-i and LPC – These therapists are master’s level professional counselors who are seeking or have obtained a clinical licensure. You can expect to pay more to see an LPC than an LPC-Intern.

LMSW and LCSW – These therapists are master’s level social workers who are seeking or have obtained a clinical licensure. You can expect to pay more to see an LCSW than an LMSW.

Psy.D. or PhD. - Psychologists are doctorate level clinicians who perform therapy and also focus on psychological assessment or testing. Psy.D. is a newer degree plan focusing on clinical psychotherapy as well as research and testing. You can expect to pay more for a doctorate level clinician than an LPC or an LCSW.

M.D. or D.O. - Psychiatrists are medical doctors who are primarily focused on psychobiological assessment and medication management for patients. Some psychiatrists are trained in psychotherapeutic techniques but most have little training in psychotherapy. You can expect to pay the most for a psychiatrist since he or she has a medical license and can prescribe medication.

Unfortunately, when assessing therapists one can rarely tell which will be a fit on paper. You may be able to read a bio on the therapist that may help you get a feel for his or her personality and theoretical leanings, but having a conversation is the best way to assess goodness of fit.

Use the questions from Step 1 to guide you in expressing your needs and ask about their training, specialties, and areas of practice. Despite the traditional hierarchy, you may find your needs anywhere in this ranking of therapists.

Step 3: Get to know the therapist

In order to assess fit, one has to “talk the talk” in some ways to understand how a therapist operates. Read up on types of therapies and you may find that one resonates with you.

Psych Central's article on Psychotherapy - check out the types of therapy on the left index

Ask questions and expect to get your needs met!  This principle is basic to living a life with healthy self-esteem and self-care.

As always, take care.

Depression's Best Friend Anxiety

Depression and anxiety go hand in hand. At times they are confusing bedfellows, but it is nearly impossible to have one without the other. For example, a woman says, "I feel depressed and can't get out of bed. Then my husband comes home and I just want to bite his head off. I'm such an awful person." This person isn't awful, she's suffering from a complex combination of anxiety and depression. Her anxiety may be manifesting as lashing out (or acting out behaviors) and one of depression's lesser known side effects is irritability, which can lead to such thoughts and behaviors.

SPOTTING DEPRESSION

The obvious definition of depression is "a depressed mood for most of the day and a diminished interest or pleasure in activities" in the words of the Diagnostic and Statistical Manual-IV-TR (DSM). Another tricky depression antic is that it can be symptomatic in the form of low self-esteem or low self-image. You may hear someone saying things like "there's no excuse for the way I've messed up my life," or "it's my fault that I didn't go to work because I'm lazy." The DSM also points out "excessive and inappropriate guilt" as a symptom. This might manifest in an "I can't get over it" attitude or an "I'm totally unworthy of anything fun or good" campaign.

Other signs may be excessive crying, severe change in appetite, sleeping all the time or not sleeping at all, feelings of worthlessness, indecisiveness, lack of concentration, recurring thoughts or images of death, and at it's worst, ideas of suicide.

SPOTTING ANXIETY

Anxiety can take on many forms like panic attacks, fears about being in public or socializing, and reactions to traumatic events, but in terms of depression, general anxiety can also be the perfect compliment to its counterpart, depression. Anxiety often produces excess chemicals in the brain that leave us feeling on edge, in hyper drive, overwhelmed, fatigued, unable to concentrate, irritable, tense, and not sleeping like we should.

TREATMENT

It is important to understand the interaction of depression and anxiety on the mind and body to understand how to treat it. When a person is in a state of arousal (anxiety), the body and the brain work hard to calm the system, but over time those biological functions become overworked and no longer soothe our anxiety. We have to learn how to "override the system" in order to control our anxiety - namely, taking long deep breaths (in the nose, from the belly, and out the mouth), and changing our thought patterns when we become anxious or depressed.

Next time you think, "I'm such an idiot," and you can feel yourself turning red, feeling keyed up, or your heart beating quickly, stop and take 5 deep breaths while telling yourself something realistic about the problem. "I'm only human, and humans make mistakes." "This won't matter in one week's time." "I'm very smart, I just rushed and made a mistake that I can fix." Or, try to externalize the anxiety: "Anxiety is attempting to intrude on my mind and body right now, but it will not overtake me. I know how to breathe through this."

If you are feeling depressed, my best advice to you is to be kind to yourself and seek help. If you can lie in bed for an extra hour, and you feel like you need to, then do it. If you want to comfort yourself in some way to not feel so badly and it won't hurt you in the long run, I encourage it. We are taught to be so hard on ourselves and it is very important to fight the urge to push yourself to your limit all the time. Loved ones are the best antidote to depression, even though it may seem scary or impossible to share what you are going through. If you sincerely and repeatedly reach out to loved ones and still feel alone, seek help online, find a local support group, or get in touch with an organization who helps people in your situation. It is important that you feel understood and connected when experiencing depression and anxiety.

If your depression is to the point of suicidal thoughts or urges or thoughts of harming anyone, you should immediately seek help from a professional! Better yet, seek help from a professional before your symptoms are life-interfering. You do not have to wait until you are incapacitated to ask for help. 

What is Co-Narcissism?

Mommie Dearest

If you're having an, "oh great, one more thing to worry about" response to the unfamiliar word "Co-Narcissism," you're not alone. I am not a proponent of inventing and loosely wielding new psychological problems, diagnoses, and concerns for people seeking help and understanding through their interpersonal conflicts, low self-esteem, and a myriad of other problems that we experience in relationship with others. At times, I believe that labeling, classifying, and over-extending our language around mental well-being can create an overwhelming sense of helplessness. However, after reading "Co-Narcissism: How We Accommodate to Narcissist Parents," by Alan Rappoport, Ph.D. I felt eager to share this article because it has the potential to provide clarity, compassion, and peace of mind for those struggling to understand his or her complex relationships with parents, partners, children, and other significant others.

Whether you are a therapy participant, a therapist, or simply curious about relationships, I can say with near certainty that this topic will resonate with you. I hope this new term can be added to our vernacular of interpersonal dynamics and provide insight to those who are looking for healthy ways of connecting by examining existing, learned patterns of relating to the world. As you read, remember that there is no one interpretation through which you can see yourself or your loved ones. I will also add, in an effort to quell the mounting anxiety of those who fear that being termed "Co-Narcissistic" is a negative attribute, it is not. It is one of many lenses through which you may find answers to your questions as you reflect on your upbringing, behavior, depression, anxiety, and relationship patterns. In the words of Alan Rappoport, Ph.D.:

"This article introduces the term “co- narcissism” to refer to the way that people accommodate to narcissistic parents. I use the term narcissism here to refer to people with very low self-esteem who attempt to control others’ views of them for defensive purposes. They are interpersonally rigid, easily offended, self -absorbed, blaming, and find it difficult to empathize with others. Co- narcissistic people, as a result of their attempts to get along with their narcissistic parents, work hard to please others, defer to other’s opinions, worry about how others think and feel about them, are often depressed or anxious, find it hard to know their own views and experience, and take the blame for interpersonal problems. They fear being considered selfish if they act assertively.

If any of this sounds familiar, strap in for a fascinating read.

Reprinted with gratitude and the permission of Alan Rappoport, Ph.D. A PDF version of this article can be found among his publications on his website. If you would prefer to hear a reading of this article, Paul Gilmartin of The Mental Illness Happy Hour podcast (http://mentalpod.com/) shares it with his listeners here.

Co-Narcissism: How We Accommodate to Narcissistic Parents Alan Rappoport, Ph.D.

Abstract

This article introduces the term “co- narcissism” to refer to the way that people accommodate to narcissistic parents. I use the term narcissism here to refer to people with very low self-esteem who attempt to control others’ views of them for defensive purposes. They are interpersonally rigid, easily offended, self -absorbed, blaming, and find it difficult to empathize with others. Co- narcissistic people, as a result of their attempts to get along with their narcissistic parents, work hard to please others, defer to other’s opinions, worry about how others think and feel about them, are often depressed or anxious, find it hard to know their own views and experience, and take the blame for interpersonal problems. They fear being considered selfish if they act assertively. A high proportion of psychotherapy patients are co-narcissistic. The article discusses the co-narcissistic syndrome and its treatment, and gives case examples of patients who suffer from this problem.

Narcissism

Narcissism, a psychological state rooted in extremely low self-esteem, is a common syndrome among the parents of psychotherapy patients. Narcissistic people are very fearful of not being well regarded by others, and they therefore attempt to control others’ behavior and viewpoints in order to protect their self-esteem. The underlying dynamic of narcissism is a deep, usually  unconscious,  sense  of  oneself  as dangerously inadequate and vulnerable to blame and rejection. The common use of the term refers to some of the ways people defend themselves against this narcissistic dynamic: a concern with one’s own physical and social image,  a  preoccupation  with one’s own thoughts and feelings, and a sense of grandiosity. There are, however, many other behaviors that can stem from narcissistic concerns, such as immersion in one’s own affairs to the exclusion of others, an inability to empathize with other’s experience, interpersonal rigidity,  an insistence that one’s opinions and values are “right,” and a tendency to be easily offended and take things personally.

A high  proportion  of  people  in psychotherapy have adapted to life with narcissistic people and, as a result, have not been able to develop healthy means of self- expression and self-directedness. I have coined the term “co-narcissism” for this adaptation, which has the same relation to narcissism as “co-alcoholic” has to alcoholism and “co-dependent” has to dependency. Co-alcoholics unconsciously collaborate with alcoholics, making excuses for them and not confronting them about their problem in an assertive way. The same is true of the co-dependent person, who makes excuses for the other’s dependency and fills in for him or her as necessary. The wife of an abusive husband who takes the blame for her partner’s behavior is another example  of  taking  responsibility  for someone else’s problems. Both narcissism and co-narcissism are adaptations  that children have made to cope with narcissistic parenting figures. To the best of my knowledge, every narcissistic and co- narcissistic person that I have encountered has had narcissistic parents, and the parents of their parents are reported to have been even more highly narcissistic.

To the extent that parents are  narcissistic, they are  controlling,  blaming, self-absorbed, intolerant of others’ views, unaware of their children’s needs and of the effects of their behavior on  their  children, and require that the children see them as the parents wish to be seen. They may also demand certain behavior from their children because  they see the children as extensions of themselves, and need the children to represent them in the world in ways that meet the parents’ emotional  needs.  (For  example,  a narcissistic father who was a lawyer demanded that his son, who had always been treated as the “favorite” in the family, enter the legal profession as well. When the son chose another career, the father rejected and disparaged him.) These traits will lead the parent to be very intrusive  in  some  ways, and entirely neglectful in others. The children are punished if they do not respond adequately to the parents’ needs. This punishment may take a variety of forms, including physical abuse, angry outbursts, blame, attempts  to  instill  guilt,  emotional withdrawal, and criticism. Whatever form it takes, the purpose of the punishment is to enforce compliance with the parents’ narcissistic needs.

Co-Narcissism

Children of narcissists tend to feel overly responsible for other people. They tend to assume that others’ needs are similar to those of their parents, and feel compelled to meet those needs by responding in the required manner. They tend to be unaware of their own feelings, needs, and experience, and fade into the background in relationships.

Co-narcissistic people are typically insecure because they have not been valued for themselves, and have been valued by their parents only to the extent that they  meet their parents’ needs. They develop their self-concepts based on their parents’ treatment of them and therefore often have highly inaccurate ideas about who they are. For example, they may fear that they are inherently insensitive, selfish, defective, fearful, unloving, overly demanding, hard to satisfy, inhibited, and/or worthless.

People who behave co-narcissistically share a number of the following traits: they tend to have low self-esteem, work hard to please others, defer to others’ opinions, focus on others’ world views and are unaware of their own orientations, are often depressed or anxious, find it hard to know how they think and feel about a subject, doubt the validity of their own views and opinions (especially when these conflict with others’ views), and take the blame for interpersonal problems.

Often, the same person displays both narcissistic and co-narcissistic behaviors, depending on circumstances. A person who was raised by a narcissistic or a co- narcissistic parent tends to assume that, in any interpersonal interaction, one person is narcissistic and the other co-narcissistic, and often can play either part. Commonly, one parent was primarily narcissistic and the other parent primarily co-narcissistic, and so both orientations have been modeled for the child. Both conditions are rooted in low self- esteem. Both are ways of defending oneself from fears resulting from internalized criticisms and of coping with people who evoke these criticisms. Those who are primarily co-narcissistic may behave narcissistically when their self-esteem is threatened, or when their partners take the co-narcissistic role; people who primarily behave narcissistically may act co- narcissistically when they fear being held responsible and punished for another’s experience.

Narcissistic people blame others for their own problems. They tend not to seek psychotherapy because they fear that the therapist will see them as deficient and therefore are highly defensive in relation to therapists.  They do  not  feel  free  or safe enough to examine their own behavior, and typically avoid the psychotherapy situation. Co-narcissists, however, are ready to accept blame and responsibility for  problems,  and are much more likely than narcissists to seek help because they often consider themselves to be the ones who need fixing.

The image I often keep in mind, and share with my patients regarding narcissism,  is that the narcissist needs to be in  the spotlight, and the co-narcissist serves as the audience. The narcissist is on stage, performing, and needing attention, appreciation, support, praise,  reassurance, and encouragement, and the co-narcissist’s role is to provide these things. Co-narcissists are approved of and rewarded when they perform well in their role, but, otherwise, they are corrected and punished.

One of the critical aspects of the interpersonal situation when one person is either narcissistic or co-narcissistic is that it is not, in an important sense, a relationship. I define a relationship as an interpersonal interaction in which each person is able to consider and act on his or her own needs, experience, and point of view, as well  as being able to consider and respond to the experience of the other person. Both people are important to each person.  In  a narcissistic encounter, there is, psychologically, only  one  person  present. The co-narcissist disappears for both people, and only the narcissistic person’s experience is important. Children raised by narcissistic parents come to believe that all other people are narcissistic to some extent. As a result, they orient themselves around the  other person in their relationships, lose a clear sense of themselves, and cannot express themselves easily nor participate fully in their lives.

All these adaptations are relatively unconscious, so most co-narcissistic people are not aware of the reasons for their behavior. They may think of themselves as inhibited and  anxious  by  nature,  lacking what it takes to be assertive in life. Their tendency to be unexpressive of their own thoughts and feelings and to support and encourage others’ needs creates something of an imbalance in their relationships, and other people may take more of the interpersonal space for themselves as  a result, thereby giving the impression that they are, in fact, narcissists, as the co- narcissist fears they are.

Co-narcissistic people often fear they will be thought of as selfish if they act more assertively. Usually, they learned to  think this way because one or both parents characterized them as selfish if they did not accommodate to the parent’s needs. I take patients’ concerns that they are selfish as an indication of narcissism in the parents, because the motivation of selfishness predominates in the minds of narcissistic people. It is a major component of their defensive style, and it is therefore a motivation they readily attribute to (or project onto) others.

There are three common types of responses by children to the interpersonal problems presented to them by their parents: identification, compliance, and rebellion (see Gootnick, 1997, for a more thorough discussion of these  phenomena). Identification is the imitation of one or both parents, which may be required by parents in order for  them  to  maintain  a  sense  of connection with the child. In regard to narcissistic parents, the child  must  exhibit the same qualities, values, feelings, and behavior which the parent employs  to defend his or her self-esteem. For example, a parent who is a bully may not only bully his child, but may require that the child become a bully as well. A parent whose self- esteem depends on his or her academic achievement may require that the child also be academically oriented, and value (or devalue) the child in relation to his or her accomplishments in this area. Identification is a response to the parent seeing the child as a representative of himself or herself, and is the price of connectedness with the parent. It results in the child becoming narcissistic herself.

Compliance refers to the co-narcissistic adaptation described earlier, wherein  the child becomes  the  approving  audience sought by the parent. The child is complying with the parent’s needs by being the counterpart the parent seeks. All three forms of  adaptation   (identification,   compliance, and rebellion) can be seen as compliance in a larger sense, since, in every case, the child complies in some way with the needs of the parent, and is defined by the parent. What defines compliance in this sense is that the child becomes the counterpart the parent needs from moment to moment to help the parent manage threats to his or her self- esteem.

Rebellion refers to the state of fighting to not accept the dictates of the parent by behaving in opposition to  them. An example  of this behavior is that of an intelligent child  who does poorly in school in response to his parent’s need that he be a high achiever. The critical issue here is that the child is unconsciously attempting to not  submit  to the parent’s definition of him despite his inner compulsion  to  comply  with  the parent’s needs. He therefore acts in a self- defeating manner in order to try to maintain a sense of independence. (If the pressure for compliance had not been internalized, the child would be free to be successful despite the parent’s tendency to co-opt his achievements.)

Psychotherapy

Co-narcissistic people automatically and unconsciously assume that everyone is narcissistic. They have the same fear about the therapist, but are able to enter treatment because they also believe that the therapist may be different. The most significant aspect of co-narcissistic patients’ work in therapy consists of determining to  what degree the therapist is narcissistic. We might even say that the therapy consists of helping the   patient   develop   confidence   that   the therapist is not narcissistic . It is powerfully healing for the patient to experience a relationship that is not based on narcissism. Co-narcissistic people are therefore greatly helped by the therapist’s embodiment of Carl Rogers’ principles of accurate empathy, interpersonal warmth and positive regard, and personal genuineness. These behaviors by the therapist provide a  direct contradiction to the experiences that have caused their problems. Patients will seek to determine how safe they are not to accommodate their behavior to  the therapist’s imagined needs, but to be able to experience and express themselves freely. The patient will carefully observe the therapist’s behavior and make  judgments about how much the therapist is able to consider the needs of the patient and how open he or she is to the patient’s experience. The patient will also want to see that the therapist is not co-narcissistic,  so  that  the patient can use the therapist as a model who shows by example that she or he believes it is safe to be assertive and not to orient oneself around another’s needs. The patient will therefore observe the therapist for signs of how assertive he or she is, and also pay attention to examples the therapist may provide from his or her own life to assess how free of co-narcissism the therapist may be.

In addition to the beneficial effect of the relationship between therapist and patient, a major part of the therapy process involves understanding how  events  and  experiences in patients’ early lives  resulted  in  their current fears, inhibitions, and orientation towards others. I find it very helpful in my work as a therapist to explain narcissism and co-narcissism to my patients. Having an intellectual understanding of the  nature  of the problem goes a great distance towards helping them make sense of their lives and why their relationships take on the characteristics that they do. It also gives us a framework within which we can discuss the issues of concern to them, and helps them understand what to work on to free themselves from these problems. A description of my own theoretical approach can be found in the books, TransformativeRelationships (Silberschatz, 2005) and HowPsychotherapyWorks(Weiss, 1993).

 Narcissistic people seek therapy much less frequently than those who are primarily co- narcissistic, and are more difficult to help. Their deep-seated conviction of their own worthlessness, and their strong defenses against the therapist discovering this “truth” about them, makes it difficult for  them  to feel safe with the therapist and to  benefit from the therapeutic relationship. The therapist also has to cope with the patient’s poor ability to empathize with the therapist. This lack of empathy is manifest in a variety of inconsiderate behaviors,  and  can challenge the therapist’s ability to maintain a good sense of self-esteem. Narcissistic people, compared to co-narcissistic people, are therefore less personally  satisfying  for the therapist to work with when they do seek treatment. They are also less professionally rewarding to work with because of their difficulty in engaging in the therapeutic process. Treating  them  empathically, helping them to feel safer to empathize with others, not losing self-esteem in the face of inconsiderate behavior by the patient, and expressing one’s own experience as appropriate are all important elements in working with narcissistic people.  (Once, when I told a narcissistic patient of mine that her criticisms of me were hurting my feelings, she was astonished. She said that she had no idea that her behavior had any effect on anyone. She became much kinder towards me  following  that  interaction.)  As with the co-narcissistic person, helping the person to gain an  understanding  of  the origins of their problems  (usually identification with a narcissistic parent) can also be very useful.

Case Examples

Mario is the son of two narcissistic parents. His parents divorced when he was ten, and, thereafter, he spent half the week in each parent’s     home.     The     difficulties     this arrangement caused for him went unrecognized by either parent. Mario’s father was so isolated and self-centered that, during the times they were together, Mario was often completely ignored by his father and learned to endure long hours of loneliness without  complaint.  Mario’s mother was more able to engage with her son, as long as he was careful to attend to her emotional needs and not to make demands on her. Both parents moved frequently, making it hard for Mario to form friendships and develop a sense of connectedness, interpersonal security, and good self esteem outside of his immediate family. What proved of immense value to Mario in preventing more severe psychological damage than he might otherwise have suffered was that he spent summers with members of his extended family in Spain. These people were much healthier psychologically, and the relationships he had with them were supportive and rewarding.

Some of the effects of Mario’s upbringing were: a diminished awareness of his own feelings, needs, and point of view; a tendency to feel isolated and a difficulty connecting emotionally with others; a tendency to accept blame, control by others, and mistreatment without complaint  and often without awareness that it was happening; and a loss of a sense of direction and purpose in life. He could also be moody and irritable.

As a teenager, Mario formed a relationship with Jill, whose parents  were psychologically healthier, but whose mother was somewhat narcissistic. Her familiarity with narcissism and co-narcissism helped her relate to Mario, and Mario benefited by spending time with Jill’s family who were warm and accepting towards him. Mario and Jill eventually married and had two children. Mario did not finish college despite his high intelligence, but was successful in his career in business. He came to therapy at the insistence of his wife, who was troubled by his  difficulty  in  forming  good  relationships with the children and his tendency to be interpersonally disconnected and insensitive. She was also troubled by the degree of influence his parents had  over him. Mario had some appreciation for the validity of Jill’s concerns, and was distressed by the problems that occurred in his relationship with Jill.

Mario made good use of  therapy.  He initially discussed his wife’s  concerns,  and the problems these created for him. Her concerns primarily centered around his tendency to isolate himself, to go about his affairs without considering his effect on others, and not to maintain or value a close emotional connection with his children. She was also concerned about his tendency to idealize his parents, particularly his mother, and to make excuses for her behavior and not to recognize her self-centeredness with regard to himself or his  family  members. But Mario soon was able to understand how the experiences he had with his parents made it difficult for him to relate to others in a way that was satisfying to himself or to the other person. He appreciated the therapist’s interest in him, his ability to think about things from Mario’s point of view, and the value there was in understanding how his past experiences affected his current view of himself and others. In addition to spending time analyzing Mario’s  past and current relationships, many of the sessions consisted of Mario’s describing his daily activities and his plans for the future. It was very beneficial to him to have someone who was interested in listening to him and  who enjoyed learning about him and sharing his life. Other than in his relationship with Jill, this was a new experience for him, and it greatly helped him to have a better sense of self-esteem. The key for Mario, and for most people who suffer from the narcissistic/co- narcissistic dilemma, was to experience a relationship in which neither person has to sacrifice himself for the other, and each can appreciate what the other has to offer. While the therapy relationship is focused on the patient, it is important that the therapist engage in it as a real relationship, so that the patient can benefit from the experience of a healthy relationship in  which  both participants can express themselves and find value and satisfaction in their experience with each other.

As the therapy progressed, Mario reported enjoying his children more, feeling less co-opted by his mother and seeing her more clearly, isolating himself  less,  and experiencing a greater enjoyment of his life and the people in it.

________

Jane is the daughter of a narcissistic father and a co-narcissistic mother. Jane’s father was domineering with the  family  and  with his employees in the highly successful business he built, although, interestingly, he was quite co-narcissistic in relation  to  his own father. Jane’s father was highly critical of her, her sister, and her mother. Jane’s mother had been severely rejected and criticized as a child and, as a result, she developed a strong sense of worthlessness, a loss of inner-directedness, and a tendency to accommodate to the expectations of others. Jane’s mother twice tried to divorce her husband, but her low self-esteem prevented her from doing so; nevertheless, she did decide to go to graduate school while raising her children, earned a Ph.D. in art, and taught at the college level. However, the criticism and denigration she received from her husband reinforced her low sense of self-esteem and prevented her from recognizing her talents or respecting herself. Jane, despite her high intelligence and independent spirit, did not do well either in school or socially. She seemed to lack the motivation to succeed, although while in college she started a home design business and consulted in graphic design. None of her efforts brought recognition or approval from her father, who was relentlessly disparaging. As a result of the constant undermining by her father, and the co-narcissistic model presented by her mother, Jane came to believe that she was unable to succeed in a career and could not form satisfying, stable relationships. Her relationships were marked by self-sacrifice, and she had no direction in her life.

 Jane made good use of her therapy. Initially, she described the ways in which her family was dysfunctional, and she gained confidence in the accuracy of her views by the therapist’s agreement with her assessment. She also tested whether the therapist needed to criticize her by characterizing herself as inadequate in a variety of ways, but the therapist showed, by expressing a more positive and realistic view of her, that he had no wish to put her down. He explained these inadequacies as a compliance with  her  father’s characterizations of her and  her identification with her mother. The therapist also pointed out her many talents, her creativity, initiative, and intelligence. Jane was able to make use of this support  by doing better at school, becoming less enmeshed with her family, and starting a new graphic design business. Jane was late for a number of sessions, thereby again testing the therapist’s wish to be critical or disparaging of her, as her father would have done. Instead of being critical, the therapist interpreted these latenesses as an inhibition against acting in her own interests by getting the full benefit of her therapy, and therefore a compliance with her father’s view of her. Jane took heart from the therapist’s reactions by continuing to develop healthier personal relationships, being less subservient to her father, and becoming more assertive and successful in the pursuit of her education.

Conclusion

All of us are narcissistic, and co-narcissistic, to varying degrees. When our self-esteem varies in relation to how  others  think and feel about us, we are experiencing a narcissistic   vulnerability.   When   we   feel helpful  in  overcoming  narcissistic anxieties to realize that the other person’s behavior is a result of their own views and experience, is not a reflection on oneself, and one’s self- esteem does not have to be affected by their behavior. For co-narcissistic people, who experience strong feelings of guilt  and blame, recognizing that they are not responsible for another’s experience is a great relief. It is important for people with either narcissistic or co-narcissistic problems to come to believe that they have intrinsic value, independent of their accomplishments or what others may think of them.

The reader is referred to Elan Golomb’s book, Trappedin  the Mirror (1992) for a variety of examples of narcissistic/co- narcissistic  parent-child  relationships. Another discussion of narcissism can be found in Children of the Self-Absorbed (Brown, 2001).

References

Brown, Nina W. (2001). ChildrenoftheSelf-Absorbed. Oakland, Ca: New Harbinger

Golomb, Elan PhD (1992). Trappedin the Mirror. New York: Morrow

Gootnick, Irwin MD (1997). Why You Behave in Ways You Hate: And What You Can Do About It. Roseville, Ca.: Penmarin Books.

Silberschatz, George, PhD, Ed. (2005). TransformativeRelationships. New York: Taylor & Francis.

Weiss, Joseph, MD. (1993). HowPsychotherapyWorks:ProcessandTechnique. New York: Guilford

Alan Rappoport, Ph.D., has practiced psychotherapy in San Francisco and Menlo Park, Ca. for twenty-five years.

Find Yourself Friday!

The Journey

One day you finally knew what you had to do, and began, though the voices around you kept shouting their bad advice— though the whole house began to tremble and you felt the old tug at your ankles. "Mend my life!" each voice cried. But you didn't stop. You knew what you had to do, though the wind pried with its stiff fingers at the very foundations, though their melancholy was terrible. It was already late enough, and a wild night, and the road full of fallen branches and stones. But little by little, as you left their voices behind, the stars began to burn through the sheets of clouds, and there was a new voice which you slowly recognized as your own, that kept you company as you strode deeper and deeper into the world, determined to do the only thing you could do— determined to save the only life you could save.

-Mary Oliver

Maya Angelou on Life Lessons

In searching for inspiration this morning, I stumbled upon a quote by Maya Angelou, one of my personal heroes.  In an effort to "throw something back," I've shared it today.  This is my reminder that nothing is permanent, to live with an open heart and an open mind, to hug someone every day, and to treat others and myself with kindness and compassion.

“I've learned that no matter what happens, or how bad it seems today, life does go on, and it will be better tomorrow. I've learned that you can tell a lot about a person by the way he/she handles these three things: a rainy day, lost luggage, and tangled Christmas tree lights. I've learned that regardless of your relationship with your parents, you'll miss them when they're gone from your life. I've learned that making a "living" is not the same thing as making a "life." I've learned that life sometimes gives you a second chance. I've learned that you shouldn't go through life with a catcher's mitt on both hands; you need to be able to throw something back. I've learned that whenever I decide something with an open heart, I usually make the right decision. I've learned that even when I have pains, I don't have to be one. I've learned that every day you should reach out and touch someone. People love a warm hug, or just a friendly pat on the back. I've learned that I still have a lot to learn. I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

-Maya Angelou

What's the Use in Being Sad?

One of the most common questions asked in therapy is, "why should I be sad when I can be happy?"  There are variations to this question like, "why would I want to focus on my difficult past when I can move forward and not be in pain?"  Or, "I don't want to suffer anymore.  I came to relieve my pain, not feel it all over again."

I empathize deeply with the idea that revisiting painful memories, events, and feelings can be overwhelming and seems an undue punishment on the path to healing.  However, I also know that the healing process rarely takes place without returning to the old (or fresh) wounds in order to tend to them.  As a therapist, I try to create an emotionally safe environment in which people can explore their feelings and leave knowing that they are cared for and perhaps even feeling better. This Pollyanna version of therapy occurs occasionally, but the reality is that emotions are messy, complex, and can be very overwhelming.  Sometimes digging up hard feelings can make things worse before they get better.  The process of unearthing pain and fear is courageous and facing an unknown process like therapy, while life-enhancing, is hard work.

One of my favorite authors/researchers/story tellers, Brené Brown, discusses the importance of dealing with "the things that get in the way of joy, meaning, and connection" in her 2010 book  The Gifts of Imperfection, which I highly recommend to everyone reading this post. Brené Brown is a fellow social worker (LMSW, PhD) who studies people and their experiences with shame, vulnerability, courage, and worthiness. Her thorough, evidence-based approach to the study of shame and other human emotions allows me to unequivocally recommend her work as an unbiased clinician.  My status as a total Brené-Brown-ophile lends me to speak from a vulnerable, human place of  admiration and to share that her work has changed my life, my work, and my connections with the people I love. If Brené Brown were Elvis, I would be the screaming, crying teenager watching her TED Talks. The following quotation caught my attention while reading The Gifts of Imperfection:

"If we want to live and love with our whole hearts, and if we want to engage with the world from a place of worthiness, we have to talk about the things that get in the way - especially shame, fear, and vulnerability."

We have to talk about, process, feel, and share the things that get in the way of worthiness, connection, and happiness in order to define, look for, and live a life or worthiness, connection, and happiness.  Brené (yes, we're on a first name basis) would call this way of living "wholehearted" and others may call it conscious, purposeful, connected, or self-aware.  Whatever you call it, the sentiment is the same: in order to experience joy and have meaningful relationships we must sort through the pain, hurt, and fear.

You are not alone if this sounds like a daunting, horrifying, or completely foreign concept. I too was among the horrified before finding the safety, patience, and motivation to endure this process. A good therapist was instrumental in this process for me - the safety of a warm, non-judgmental person who was dedicated to my care was extremely powerful through some of my most difficult growth. In fact, it is what drew me into the field of psychotherapy and guides me in my practice of empathy, compassion, and gentle exploration with my own clients.  Pretty powerful stuff.

After reading that paragraph you may be thinking, "ahem. I don't want to BE a therapist.  Why, again, would any NORMAL person want to go through pain, terror, and negative feelings?"  I get it. What makes it worth it? And furthermore, why do we need someone else to witness, support, and be there for us through the vulnerable, life-altering process of healing?  This is my best shot at answering that question:

People are not emotionally wounded alone, they are wounded by and among other people.  The most powerful way to heal wounds is by vulnerably, bravely sharing the pain with another person(s) and receiving a corrective, kind response like empathy, compassion, protection, and care.You may find something more powerful than pain after experiencing it, knowing it, and moving through it.  Over time, you may find that pain is no longer terrifying, but tolerable after working your emotional muscles. You may find that you are your own courageous, badass, superhero.  You might, at last, love yourself not despite imperfection, but because of imperfection.  You might find that you are good enough, just the way you are.

Take care of yourselves and others.

Visit Brené Brown's blog to learn more about vulnerability, courage, and wholehearted living:  www.ordinarycourage.com

Brown, B. (2010). The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are. Center City, Minnesota: Hazelden.