How is NPD Treated?
In this video, narcissism specialist Dr. Mark Ettensohn provides an overview of the psychodynamic approach to treating pathological narcissism, touching on key theoretical contributions of Otto Kernberg and Heinz Kohut, and discussing the manualized therapy models of Transference-focused Psychotherapy (TFP) and Mentalization-based Treatment (MBT).
General treatment recommendations for clinicians working with narcissism are provided.
Dr. Ettensohn is also author of the book, Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life, available on Amazon here amzn.to/3nG9FgH.
To learn more about NPD from a compassionate perspective, visit Dr. Ettensohn's website at www.DrEttensohn.com.
References
Crisp, H., & Gabbard, G. O. (2020). Principles of psychodynamic treatment for patients with narcissistic personality disorder. Journal of Personality Disorders, 34 (Special Issue), 143-158.
Ettensohn, M. D. (2013). The relational roots of narcissism: Exploring relationships between attachment style, acceptance by parents and peers, and measures of grandiose and vulnerable narcissism. Dissertation Abstracts International: Section B: The Sciences and Engineering, 73(10-B(E)).
Kernberg, O. F., Yeomans, F. E., Clarkin, J. F., & Levy, K. N. (2008). Transference focused psychotherapy: Overview and update. International Journal of Psychoanalysis, 89, 601-620.
Pincus, A.L., & Lukowitsky, M.R. (2010). Pathological narcissism and narcissistic personality disorder. Annual Review of Clinical Psychology, 6, 421-446.
#npd #narcissism #mentalhealth #mentalhealthawareness #psychology #healing #psychologist #psychoanalysis #psychotherapy #guide
I will remove comments that are abusive to any individual (including myself) or population. This includes comments that are abusive toward pwNPD.
🤝🤝👐👐🤲🤲
I’m a vulnerable narcisisst and the only way I can truely (at least almost) atone towards the people i manipulated, wronged and hurt (mostly without me even knowing, due to pathological self-centredness) is to develop myself and help others. Generally shackling myself off from narcissism
Best of luck with your therapy and growth 😊
how do you know that? what made you aware? do you have avoidant attachment patterns?
This is really awesome! Most just address how to deal with narcissists, how to avoid them,get rid of them etc…I don’t think finding a competent therapist is possible for everyone. Would love to hear more suggestions on what we can do ourselves more to heal the pain than a DBT approach…
The problem is that healing from narcissistic issues is a relational process. It essentially requires a sort of re-parenting. The patient must be allowed to project onto the therapist and have those projections understood and empathically interpreted. The patient must be allowed to form self-object transferences with the therapist and have those tolerated by the therapist (something a romantic relationship wouldn't be able to withstand long-term) while simultaneously subject to gentle-but-firm boundaries that mitigate their destructive potential and help the patient accomplish the developmental tasks that are needed to create a more nuanced, integrated, stable, and realistic sense of self.
@@healnpd what do you think about Vaknin's Cold Therapy?
@@healnpd yeah, thank you! That’s very helpful. I genuinely have not heard any therapist talk about NPD in a way that that made me feel understood and heard rather than attacked, or it felt condescending, or like they were so focused on the behaviors, they barely gave attention to the cause. I hope your tone and your general understanding and approach is adopted by more people because when you already feel so attacked and on edge, walking into a therapist who adopts the same tone as the rest of the world toward NPD, feels like walking towards a guillotine🤦♀️
@@lcstyle2029 Sam Vakmin has zero education in psychology. (His degree is in something else) His cold therapy idea is to torture and abuse a person.
@@mac1291 I hope that you find the right therapist for you. You deserve the best chance at healing like everyone else does.
I have looked for someone that seen narcissistic with the compassion I've seen them with (inspite of their deeds) for yearsss. I could see the broken pieces that are there so clearly, I just don't have the training. I have so many ppl that I love fall into the category of a narcissis. I refuse to allow them to stay in misery and bring other there as well. Theyre dynamic ppl. World changers to the core. I believe this is why the enemy wants to leave them as societies cast aways. I look forward to their healing & total restoration. I can even see a new level of healing being bought to their victims through this. I will continue study. Thank you for being a voice of light. You just don't know how I've searched. I look forward to future mentoring from you in the near future. Thanks
I appreciate this new perspective on NPD and I think it's important to get out of the judgmental space we usually occupy when thinking about pwNPD/narcissistic traits. However, it is very frustrating to listen to a long video discussing how it's not necessarily the pwNPD's fault they are the way they are, how to recognize projections, how to be patient during therapy as they learn how to realize their self, etc., when I have endured very poor treatment by that person. At some point, my empathy runs out for these types of people. Same with BPD. I'm sorry you possibly had a dysfunctional childhood or parent and I hope you find peace some day, but I cant afford to create any more space for you than I already have. Props to all the mental health professionals out there that are willing to tackle NPD rehab.
I can’t avoid all people with difficult personalities. Your videos have been helpful for me to understand how to set boundaries with myself and other people. The results are that I navigate difficult people more successfully. And bonus I learn to navigate myself better too. Sometimes I’m the difficult person that I’m dealing with. Ha!
First of all I just want to sincerely thank you for making this channel and extending your knowledge and compassion towards such a stigmatized and misunderstood population. For the last few years I've noticed traits of subconscious grandiosity and overt vulnerability in myself, along with patterns of behaviour in relationships that got me thinking about NPD, or at least narcissistic defense mechanisms, as a possible explanation. Seeing everything about NPD online made me feel truly hopeless and scared to seek help, but finding this channel has really helped me a lot, and I feel a lot more assured in trying to heal/build a sense of self! I've just started going to therapy regularly, and I find it's been helping me a lot with becoming more self aware and capable of controlling my reactions to my own projected self-hate, but I'm worried that, since my therapist is mainly focused on CBT and ERP (I've got OCD as well), we won't be able to address the underlying borderline personality organization. Do you think it would be worth a shot to share this video/channel with her? Do you have any advice on broaching that subject with her in general? I feel bad going to her and saying "hey I think you're not helping me the right way, listen to this guy", but I also really like our sessions and I just want to make sure we're on the right track. Anywho, thanks for your videos and your time, it means a lot!
I think it is always a good idea to express your feelings and concerns with your therapist - especially when they are about the therapy.
You've likely already acted on these questions, and would like to hear how it went if you did. It sounds like you have a pretty good relationship and comfort zone w/ her. I heard one of these really good psychologists that take the empathetic approach w/ NPD say that the method of therapy is not even as important as the connection w/ your therapist. Not saying not to suggest another approach you have instincts that it might work better, just thinking if a good relationship exists, they will likely be amenable. If they are already well trained in dealing w/ NPD, they know not to be easily insulted. Doctors can better pretty excited about new methodologies and cutting edge practices they may not have tried. If she's tried this type of thing and didn't find it worked well, she'll let you know why. Could be a lack of training too, so lack of comfort zone, but that's all to be discussed.
Your channel is hands down the BEST one on narcissism. Period.
Thanks!😊
Listening and reflecting, as you would with a toddler, like the example you provided in another video. Kid crying: look at me, I'm hurt Caregiver: ouch, did you get hurt? Kid happy: look at me, I did something great Caregiver: wow! Very nice, good job Etc etc
I love you. Thank you.
You're welcome!
At least this one has silver lining among the spate of doom and gloom and toxicity out there by demonizing them. Yes, I agree these are some of the most hateful people on earth, but I refuse to believe they are so damaged beyond repair.
It’s hard to help someone who doesn’t know they need help or want help sometimes they just have to hit rock-bottom and hope they bounce
I can certainly appreciate your compassion for narcissists. They are indeed the most suffering people among us. However there are those of us who need to take measures not to get engulfed in their misery. Our position seems harsh at times but distancing can be our best defense. It may not always be possible to do that physically but it’s essential to learn how to distance emotionally.
A second before he said that clinicians should be tolerating feeling devalued and worthless I was thinking to myself that it’s impossible for somebody who is paid to listen to me which is the ultimate form of transactional relationships can make me change my idea that every relationship is transactional therefore i should always be perfect or play the rule the caregiver didn’t do in my childhood:)
In my experience the vulnerable narc perceives themself too much as a victim that they do not see they need therapy but everyone else does…
How does one get through these defenses? what if the narcissist blocks you because of your empathy and your sometimes flawed responses? I accepted his flaws, but he instead uses mine to villainize me. This is after I showed him complete acceptance and I cared about him for who he WAS, all of his toxicity that he admitted to me. I helped him see his goodness. yet all of that history just seems to be "forgot" now. I don't understand that.
Look up shaneen megji, she has a lot of stuff on narcissists that has helped me a lot
I watched this last night and I was just reflecting on how you talked about balancing between Ottoberg’s method and Khout’s method. The delicate balance between working to challenge the grandious and empathizing with the vulnerable state. All without pushing the grandious too far where they shut down, nor coddling the vulnerable. It reminds me so much of Marsha Linehan’s work where she thinks in dialectics. She talks a lot about constantly balancing between the two sides in efforts to prevent the borderline from collapsing in treatment. I find it very interesting that your style mirrors that aspect of Linehan’s. I can see why you’ve likely had much success with your clients.
Yes, there is a delicate line to walk that involves validating without gratifying or colluding.
@@healnpd as someone who isn’t a professional I can say this is so hard to do with our loved ones. But I try very hard. I just bought your book by the way. (Jacob recommended it). Its right up there with Wendy Behary’s and Elinor Greenberg’s books in terms of professionalism and compassion. I’m grateful that there’s people like you who don’t give up on this population. They deserve help and when they get that help it benefits everyone around them.
@@ange7422 🥺
This channel and these videos are underrated.
This is so good. I appreciate the acknowledgment that Kohut and Kernberg were both right. Also, the importance of integrating Kohutian, MBT, and TFP approaches. Much appreciated. This was so helpful to me!
Thank you Dr. Ettensohn for your compassion toward NPD. This is a video that has much to teach and should be listened to several times over and over.
You are very welcome
Thank you 🙏
Thanks a lot.
Thanks Jacob
Thank yiu
Music is so relaxing) its a pleasure to listen to you.
Thank you for making this video, it has helped me understand how I can help some people
Beautiful 🤩 intertwining of two perspectives! Not all narcissists are polarized or linear into one category. But rather needing “meet in the middle where I am” but as you said, not giving into their faulty thinking. Not sure if I said that correctly!
Thank you so much for the video and for developing this empathic approach to treating narcissism. Would you consider explaining the concept of self-object transferences in therapy more in detail and perhaps give some examples?
Thank you.
You're welcome!
Thanks so much for your content! I wonder if you could do a video on how to find an experienced therapist to help with treatment.
Thanks for sharing :) are there any particular styles of therapy you would recommend the most? Am currently looking for a therapist
The problem is that a narc puts all of his oder her heat, flames on you sooner or later when you're in love with them. I see your point. Your perspective is the therapist's trying to cure the narc. Dr. Ramani's vantage point is the one of the narc's spouses. She has got her reasons, too. You're just talking to different audiences. I myself decided to go no contact before I even knew it was narcissism. I was just so fed up to intuitively make a cut.
Thank you for your channel & videos. They offer a balanced and hopeful view of a person with NPD. The views of Kernberg & Kobut are explained in an accessible way. I wouldn’t however like a few videos explaining some of the toxic behaviours (& how they can be healed), such as triangulation, pathological lying & gaslighting, lack of empathy & triangulation. Thank you
It seems like those behaviors are symptoms of the core issues of NPD. I don't know that you should have an agenda to fix specific issues because then the person might feel like the therapist is treating them like a parent who expected good behavior when the emotional child was not doing well and not yet knowing how to relate and respond to their emotions in a connected way. It seems like repairing the inner emotional connection has to come first or at least have a big head start. Then again, if the client/patient brings up the issues as being problems in a relationship because their partner is saying so, then maybe that is an opportunity to talk about it. But seems like that shouldn't be the main focus because the behavior isn't going to be healed, the person needs to be healed in order to have enough inner stability to shift the outer behaviors. I'm not a psychologist, but I'm someone who has taken trauma courses and loves to learn about all things psychological and emotional. NARM trauma courses focus on not setting an agenda, because most people struggling have had an agenda put on them by caregivers and other adults their whole life and it can derail the healing process from what I recall. Highly recommend NARM!
Just wondering how often you get to treat narcissistic patients who VOLUNTARILY come to you? Another aspect of the question is whether these people realize that they have a problem? Is denial of any problem not part of the very description of narcissism?
All of my patients seek treatment voluntarily. Sometimes, someone will seek treatment at the urging of a partner, adult child, or spouse. The idea that pwNPD don’t realize they have a problem is only partly correct. When in a more grandiose/defended phase of the disorder, they are unlikely to recognize the problem or the need for help. However, most pwNPD experience periodic collapse into vulnerable phases of the disorder, when they are much more likely to seek help. The frequency and duration of such periods of collapse vary between individuals. Some live in a chronic state of collapse, others are so well-defended that collapse rarely occurs, if ever.
@@healnpd Thank you! I watched quite a few of your videos and found the one about how aware narcissists are of their (insulting) behaviour towards others particularly interesting. If they are not aware of hurting you they would never say sorry, would they? And thereby potentially kill any further conversation, very unfortunately. I would join the other comments saying that your presentations are very helpful, thank you!
🙏DBT skills help me a lot too
Makes sense. Glad to know you felt helped.
Thankyou for a really clinical explanation. Do you know a therapist with these capabilitys in Spain? Or Italy?
Isn't it interesting how everyone is supposed to understand narcissists, yet narcissists aren't expected to understand anyone else or themselves for that matter. What a deal for narcissists. If I'm around a narcissist I just walk away. It's too much of an emotional toll and it's not my job to understand them.
But the narrative needs to be changed from narc = villain, to most of them are just broken people, just like the rest of us, and in their mind, not out to get us, as what most of their friends/family want to believe. Defaulting to seeing one’s self as the victim, and the narc, as the perpetrator, is always easier and more validating than becoming educated and keeping the psychological playing field even.
I would be curious to learn how schema therapy fits into or between these two methods of treatment. Love this video.
Thanks for watching. I may include schema therapy concepts in a future video.
DR PL TELL THE POSSIBLE YREATMENT PARTNERS CAN DO AT HOME IF THEY CANT AFFORD THE COSYLY TREATMENT OUTSIDE.GOD WILL BLESS YOU FOR IT
can we get a more in depth explanation of (self)object relationships? i hear it a lot but find it hard to truly grasp the concept
Thank you so much for your compassionate approach. I have a suggestion for a future video. I would like to know what is the best way to support a loved one with npd when you aren’t their therapist and have to maintain firm boundaries. In my case, my ex with whom I share a very young child. I care about him and I want to support him in being the best father he can be, but I also have to maintain firm boundaries because the romantic relationship is over.
what do you think of GIT-PD (guideline informed treatment for personality disorders) for NPD? its very new, mostly used in the netherlands. is it possible a video about this is made?
I love this channel. just a thought - maybe it's better not to use music and change your voice to be less monotone? it's just that together with the music my mind is floating away 😂
This was one of my earliest videos and I hadn’t quite gotten the sound right. I don’t use background music anymore. Thanks for the suggestions, and thanks for watching! 🙂
Hello everyone! I'm looking for an expert narcissistic recovery counselor/therapist that knows these dynamics he mentions in his video, and can hold their own. I just want to go to the right one, does anyone know of any good ones that match the criteria he mentions in the video?
My wife has destroyed my life in so many ways but at times she can be the most caring and loving person and I haven’t given up on her yet other professionals have told me it’s a fake persona and your just kidding yourself you should just Leave it’s damaging your mental health which already has . But seeing this presentation Answered so many of my questions and has convinced me that I’m right she is worth it now i just got to fit it , but how when we hardly talk with out fighting .I actually know her better and she knows yourself and I know that her problem started from a young child of having parents pretty much ignored her and Favoured her younger sister So where do I start Apart from beating up her very arrogant father
I doubt a romantic partner or spouse is going to be able to help someone with NPD move toward better mental health. It's too close and intimate of a relationship. Seems like you would need space and serious education and training to maintain the discipline to stay unattached to the projections and manipulations of a narcissist, especially a vulnerable narc. I get it though. I went there too with my ex, trying to help him. In the end, he left me, or at least went out and had an affair and flashed it in front of me all over social media and at work. Cost me financially too. Now that I'm finally moving through the last of my pain and anger over that betrayal, only now can I think about his well-being. It's good you have empathy for her, but are you also having that much empathy for yourself? Or are you identified with being a rescuer like I was?
Read Atwood & Stolorow
I don't understand how therapy like this could work for help in real life, though. It sounds great, but once they leave the office, no one in the outside world will actually treat them that well or be that present & consistent. I mean, people just aren't that kind & loving to each other in general ime. So doesn't it just hurt more to build a secure attachment with someone you're paying to do it? If you start believing it's possible to have in real life, then that just sets you up to keep getting hurt again out in the world, doesn't it?
@frankievalentine6112 - It takes a long time for the changes to happen, in part because the “dose” of therapy is small compared to the rest of the person’s life. Children soak up a lot of empathic attunement, attention, care, and self object experience - particularly during the first four years of life. That period of care can be enough to allow the person to internalize those experiences. Sure, the world can be a shitty place, but people who have gotten what they needed when they were young tend not to *feel* shitty in an enduring way, despite the challenges they face out in the world. Therapy is meant to be a boundaried recreation of the kind of early experience that promotes such resiliencies. The relationship itself becomes the vehicle for change.
How does someone get evaluated for narcissistic personality disorder
You would need to see a licensed mental health provider.
Please reupload without music. My brain cannot concentrate on a talk with music playing at the same time. Thank you!
Did you delete my comment I replied to, as well as the persons comment I replied to?
@sierrashaheen677 - I don’t think so. I remove abusive comments, so if your comment wasn’t abusive (or I guess the comment that you were replying to wasn’t abusive), then I would have no reason to remove it. Abusive comments are ones that call people names or actively spread harmful or damaging misinformation. KZhead also has their own comment removal algorithm. Comments sometimes “disappear” when I haven’t even seen them.
I think the therapists can make a lot of money off these patients, if you can ever get a narcissists to go to a therapists and it must be remembered..THEY NEVER CHANGE.. learn that the hard way as i have and understand..
The narcissist will most likely have the therapist eating from the palm of their hand within the first couple of sessions.