(From Quora) Is narcissism a real problem and how can therapy help

Narcissism is a broad category that runs from healthy narcissism, pride in one’s work, for example, the abnormal such as paranoia. Paranoia may seem a rather odd manifestation of deranged narcissism but think of it like this: how much narcissism does it take for someone to believe the FBI is following you, yes you and you alone. That is narcissism run amok.

A person who finds it nearly impossible to empathize with others, someone who needs constant admiration, such as our president, someone who becomes enraged or aloof if disappointed in someone, someone who, the narcissist believes, should always pay attention to him/her.

People who suffer from pathological narcissism that have not crossed the frontier into frank madness are often diagnosed with the DSM designation, Narcissistic Character/Personality Disorder. I included “Character” only in so far as this particular disorder was, and still is among many practitioners, thought of as a character disorder. One analytic writer in the last century referred to such patients as having character armor that protected them from a host of thoughts and feelings.

People with this disorder often seek help because things just don’t “feel right,” or a sense of pervasive emptiness or meaninglessness has crept into their lives leaving them vaguely unhappy. They also come for Tx after the breakup of yet another love relationship; or they may be dissatisfied in the progress of their careers.

I have treated many people with varying degrees of disturbance to their narcissistic equilibrium. When they come for therapy with me, and after a period of evaluation including my evaluation of their ability to engage in and profit from therapy, we discuss the diagnosis, prognosis and an estimate (a very loose estimate) of the length and difficulty of their treatment. Once they agree, we begin to look together at what troubles them.

This work is taxing for the therapist as the patient can adopt a haughty, dismissive pose towards me and the treatment itself. Or they may defensively idealize me for often lengthy periods. Some need to do this, and all need to resolve that transference so as to be able to have a firmer vis-a-vie with reality.

This particular transference can be quite tricky and seductive for the therapist. I find being idealized the most difficult transference because being told am the most incisive, intuitive, sensitive therapist the patient has ever seen can induce all manner of disturbances in the therapist; that is, me. I can feel my own grandiosity fed by such idealizing and not want to engage the patient in looking at what is really happening between us.

But fate always steps forward in the guise of me making a terrible mistake: saying something that indicates to the patient that I, god forbid, didn’t understand them, or said something that indicated that I wasn’t the most brilliant person the patient has ever known. This can, and does cause severe disruptions in the therapeutic alliance as the patient rapidly de-idealizes me and begins to degrade me; call into question my intelligence; call into poor light my training; suddenly realize, and they should have known better, that I intentionally duped them.

I find the de-idealizing quite uncomfortable but far easier than being idealized. It takes very patient work on my part to help the patient and me uncover just what my “horrible” mistake was and empathize with the patient’s very deep disappointment and primitive rage at my failure. A failure that usually mirrors the traumatic failures of the patient’s earliest care givers.

These kinds of “enactments” occur rather regularly in the therapy with these exquisitely sensitive and deeply damaged people, who, behind their haughty disdain for me, yearn for genuine, empathic contact. Often the way they treat me is a replication of how they were treated.

At other times the patient may need me to “mirror” them for lengthy periods of time. They need me to accurately see and feel them and convey accurate understanding to them in a manner that slowly repairs the faulty mirroring they received as very young children.

Once again, I will miss something, usually related to my countertransference to their need for me to mirror them, and my mistake will feel horribly wounding and disappointing. Again, we have to patiently, and often painfully reconstruct what happened with me taking responsibility for what I did that was perceived as so wounding.

It is these moments that allow for the healing and growth of not only the patient, but even me, in my advanced age. Both of us share an exquisitely human moment that is ultimately growth producing and precious us both.

I have greatly condensed and simplified what therapy is like for both the therapist and the patient. My apology if my rather prolix “brevity” in this explanation leaves some scratching their heads. If you have questions or comments about what I’ve published here, please feel free to contact me here at Quora. I will try to respond with far fewer paragraphs.

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Why is making friends so exhausting when you have borderline personality disorder?

Because, primarily, the person suffering from this disorder is so very sensitive to any signs of rejection. This ravening fear often borders on paranoia and all to often breeches that frontier. In my experience in treatment with those who suffer in this way, the thought or fantasy of rejection is often exquisitely preternatural.

As an experiment in empathy try putting yourself in such shoes and imagine what it must be like, out of your crushing loneliness, to so desperately want a friend, a friend to accept you, sulfurous flaws and all. Yet know that a harrowing flaw your in your personality, a flaw that you consciously or unconsciously know only too well, will command you to behave in a manner that will lead to your dismissal by the very person you so desperately want to accept you.

Yes, rejected once again, and, god forbid, alone again. Alone with a self-hatred and yawning emptiness that, like a cosmic black hole, swallows all in its path. Imagine a self-loathing so barbarously implacable that you cannot see beyond your own hellish abandonment.

Yes. It is the repeated experience of emotional and/or physical abandonment that grinds away in the background of such a stricken person.

It is because of these awful tragedies that I can not brook the prejudicial, and yes, thinly disguised hateful attacks I so often read here on those burdened with the agonizing realities of the mental illnesses of borderline and/or narcissistic personality disorders.

Please, dear readers, silence if not empathy.

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How do I know if my problems are real or downplayed by me

How do I know if I subconsciously downplay my problems or if they are real?
Mark Maginn
Mark Maginn, Psychotherapist, poet, memoirist, blogger, (2012-present)
Answered just now
Fascinating question. Not sure, but how about talking over a couple of your problems with a trusted friend and see what feedback you get. If still confused, check in with a licensed psychotherapist and ask for feedback or if present, a diagnosis.

I’m only guessing here, but I suspect that you might not share your problems with others. If you did, you might not be confused about this. If making friends is a possible problem than checking in with your friendly neighborhood psychotherapist might be warranted.

In any event, good luck figuring this out. But really, if your “problems” are not significantly interfering in a major area of your life, such as love relationships, friendships or work, then I wouldn’t be too concerned. If, however, you’re getting feedback from others that you’re missing something, then, again, a trial therapy with a psychotherapist might be in order.

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What will you do if you are sad? (Quora)

Hold still and feel the sadness; get to know it; don’t push it away; befriend it. This will not only lessen the feeling but will allow the person the time and space to resolve it. By this I mean that the sadness and from where it springs can be safely integrated into the psyche & personality of the person experiencing this most basic of human emotions.

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What will you do if you are sad? (Quora)

Hold still and feel the sadness; get to know it; don’t push it away; befriend it. This will not only lessen the feeling but will allow the person the time and space to resolve it. By this I mean that the sadness and from where it springs can be safely integrated into the psyche & personality of the person experiencing this most basic of human emotions.

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Exactly what does my therapist mean when she says to “be mindful”? Quora)

This comes from Mindfulness Meditation a practice that research has shown to be quite effective in the treatment of mental disorders. You might want to ask your therapist about this as I’m quite sure it will be helpful to you.

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Why did loneliness lead me to psychosis? (Quora)

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Why did loneliness lead me to psychosis?
I was studying abroad. I wasn’t able to make friends, and worse than that, I made some people angry at me (I think, because they would snigger at everything I did). As a few weeks passed I started to think that people on facebook were doing things related to me, like if they would come online it would be because I did something online. Like everything I was doing was somehow having an effect on people’s activities on facebook. I was having fights with (the people I thought disliked me) songs on Spotify. For example someone would play ‘My god, he knows me’ and I would think of it as an insult and play ‘Retarded retard’.

(Oh, god, this is so embarassing, but please do give me an answer if you have one).

Near the new years eve, I spent a lot of time hungry as I was too depressed/lazy to cook, and at midnight I was convinced my computer was hacked. There were some compromising videos (heh) on there, and I was certain that the people who disliked me were putting those videos up, editing them, all over the world. The noise, loud music, and everyone going ‘Happy new years’ only strengthened my belief. It was the worst thing I ever faced (held a knife on my neck, until my flatmate’s boyfriend cam out of nowhere).

A week later I went into class. And in the second class, I suddenly realised people were hearing my thoughts. I stopped going to class because of that, and took an interruption 1 week before the exams as I hadn’t studied anything. I thought I was being tested on for some technology that enables people to hear thoughts. But I realised it wasn’t true 2 months later, when a teacher failed to recognise who I was, and the psychosis period ended.

I am fine now, on 2mg risperidone for safety. But I am scared a lot because I am going abroad again for studies, and wondering if it will come back.

My response: That’s quite a story, harrowing and uplifting all at once.
As I only know what you’ve posted here about your experience I would say your disturbance might have been a combination of being in a foreign country, anxious, alone and with the stress of academic pursuits. I imagine that this may have been the first real move away from your family which is always a vulnerable time for a young person and it isn’t unusual for the young person to experience what you did.
I think it was a combination of stressors, not the least of which is being alone in a foreign country by yourself. I’m so happy to have read that this psychotic episode has passed and can certainly empathize with your struggle as well as your trepidation regarding re-experiencing that episode again.
Good luck. I hope you are working with a therapist to really understand in depth what led to such a frightening experience, one I expect that will increase your empathy for others who find themselves in a the throes of their own psychotic episode

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How do you take mentally ill relatives to the psychiatrist? (Quora)

These situations are so confusing, tragic and possibly lethal. Yes, the mother and daughter should waste no time in leaving to be somewhere that they can be safe from him. As he is a threat to them, he can be involuntarily committed. In this instance wherein the danger is clear and present, the police should be contacted to that they may safely transport him to the nearest emergency room where he can begin to receive the help he and his family so urgently need. Good luck to them in both the near and long term.

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How can I choose a good therapist or psychiatrist? How can I know they are good at what they do or good for me? (Quora)

1st off, there are not many psychiatrists who actual engage in psychotherapy as they are pushed ever more into doing medication management. Clinical social workers provide the most therapy services in the US and many psychologists specialize in psychotherapy. Almost everyone you think about working with will be well trained and have the proper licenses, though you wan to check that. The real question is, are you comfortable with therapist you meet with. That can start be assessed in the initial phone call and the following initial appointment. Remember, a perfectly good therapist may be someone with whom you personally don’t connect with. It’s neither blamed on your or the therapist, it’s just a matter of fit. That should be your key point in deciding on whom to work with. Good luck.

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Why and when do we use family focused therapy or interpersonal and social rhythm therapy for bipolar disorder over CBT? (Quora)

I endorse family therapy for this. The patient with the diagnosis of bipolar disorder may also be in individual therapy. I suggest family therapy to work on issues, patterns and triangles that may contribute to the identified patient’s—here, the one with the diagnosis—symptoms. Family therapy can help the entire family confronting a member with a serious mental disorder. The impact of this disorder will reverberate throughout the family and that will create feedback for the identified patient(IP). As that patient begins to free her or himself from the role of the family’s IP s/he may well find the bipolar symptoms backing off.

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