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notes from November OFJ lecture by Jacqueline J West, PhD
The Shadows and Gifts of American Narcissism
Friday 11/12/10 organized via www.ofj.org
also some notes on Narcissism taken from a variety of sources

Dr West lives and practices in Santa Fe, NM
her site: matrix and meaning .com
http://www.matrixandmeaning.com/

from website: Jacqueline J. West, PhD. is President and Training Director of the C.G. Jung Institute of Santa Fe, a senior training analyst in the InterRegional Society of Jungian Analysts and Jung Institute in Santa Fe. She is in private practice in Santa Fe, New Mexico.

alpha narcissism = good, heroic, psychopathic, aggressive
grandiosity, dominance, exhibitionism, omnipotence
mature: consciously forceful and vulnerable
pathology: rigid narcissistic defenses
google searches, even scholar, yield nothing approximating what she was talking about

showed several paintings:
art of Anselm Kiefer, German, born 1945
empathy, humor, relationship, creative, cosmic

collective conscious and unconscious govern psyche-->individualism is aborted

social pressures-->human compliance with immoral instructions
collusive projection of aggression-->symptom: passivity

splitting good from bad-->projection

book: The Sociopath Next Door
http://www.amazon.com/Sociopath-Next-Door-Martha-Stout/dp/076791581X

How do we differentiate creative inner process from madness???????



NARCISSISTIC PERSONALITY DISORDER 301.81
in the DSM-III-R:
*3) pervasive pattern of grandiosity is essential feature
(fantasy or behavior)
*5) preoccupied with fantasies of unlimited success, power, brilliance, beauty, ideal love
*9) preoccupied with feelings of envy for the successful, unsatisfiable ambition
lack of action, or action that is driven, pleasureless
*1) can't take criticism, may respond with rage, shame, humiliation, or mask feelings
8) lack of empathy common, beginning by early adulthood, can't recognize how others feel
self importance often alternates with feelings of unworthiness, failure, fraudulence, lovelessness
3) exaggerate accomplishments, talents, expect to be "special"
*4) think their problems are unique, and can only be understood by other "special" people
self esteem fragile, overconcern with the esteem of others
*7) needs constant attention, admiration
7) fishing for compliments, mb charming
interpersonal relationships invariably disturbed
*6) sense of entitlement, unreasonable expectation of favorable treatment, cuts in line
*2) takes advantage of others: interpersonal exploitativeness for self aggrandizement
2) friendships only if profitable
2) in romance partner is treated as object used to bolster person's self esteem

mb more than one dx
depression v common
mb painfully self-conscious, preoccupied with grooming, remaining youthful
personal deficits, defeats, irresponsibility mb justified by rationalizing or lying
feelings mb faked to impress others
impaired interpersonal relations is inevitable
occupational fx may also be compromised or mb enhanced by thirst for success
complications: dysthymia and psychotic disorders (ie brief reactive psychosis)
complic: major depression in middle age
prevalence: increasing
risk factors: no info
dx: * marks major criteria

COMBINED DIFFERENTIAL (all sources)
narc rxn: situation specific
psychopath (no comprehension of others empathetic or compassionate states)
depressive (more guilty and melancholic, as vs emptiness in narc)
OCD (narc shows quest for perfection, mistxd if focus on control/guilt, better for narc to focus on anger and fantasied aggression)
hysteric/histrionic personality (exhibitionism is same, hyst shows more emotional exaggeration and less emptiness, more anxiety less shame, narc shows less involvement/dependence on others)
antisocial (more impulsive, less exploitative)

NOTES FROM YALOM
in group, Narcissist pts need to learn to share and to give
narc as criterion for inclusion in group p235
three types of problem patients: schizoid, narcissistic, borderline p389
these three often discussed together as "characterologically difficult", "axis two", "pre-Oedipal"
share many traits
pathology of all three based on serious probs in first few years of life
lack internal parental representations of a soothing, comforting kind
have preponderance of abandoning, withholding, and dissapointing parental introjects

prominent: rage, vulnerability to abandonment and narcissistic injury, tendency to employ the defense mechanism of projective identification: project a disavowed part of one's internal life into another and then link it with the other, often in the attempt to control that person

these pts often referred to groups by therapist when
1) transference has grown too intense for dyadic therapy
2) the pt has become so defensively isolated that group interaction is required to engage the pt
3) therapy has proceeded well but a plateau has been reached and interactive experience is necessary to produce further gains

many non-dxd individuals with narc traits with characteristic interpersonal problems
cause problems in group therapy

IN GROUP THERAPY
may have a stormy but productive course in therapy
p393-396
individual therapy being focussed on the self is gratifying, core problem emerges slowly
narc pt may judge group based on how much they get the spotlight
guard specialness, dislike having similarities with others pointed out
object to being included with others in mass group interpretations
group members who recognize the pattern and thwart the pts bids for attention are great therapy
but narc won't like it

in group therapy what's important is the nature of current forces, conscious and unconscious, that influence the way the narc pt relates to others
narc pt is highly vulnerable in group therapy
pt needs group to challenge their false statements with reality checks
needs to know that group members take them seriously and respect their ability to take responsibility for actions and change behavior
if group begins to ignore, patronize or mascot a narc, therapy fails
if group doesn't provide reality testing, patient assumes noxious deviant role

narcs expect group to reach out to them, do things for them
even when they do nothing
expect to be able to express scorn but receive none
expect to be praised just for being there
Yalom sees this last esp in beautiful women
narc can't write real letters or communicate fully, tend to be parsimonious about feelings

some therapists distinguish between two types: undergratified and overgratified
overgratifed = egocentric
undergratified = deprived and enraged, even explosive, anger often misunderstood by group

natural narcissism = healthy love of onesself
(example given by West: child who loves to dance and wants everyone to watch)
excessive narcissism = loving onesself to the exclusion of others, losing sight of the fact that others are sentient beings, egos, each constructing and experiencing a unique world
vain, selfish, conceited

dx: at least five of these
1) grandiose sense of self importance
2) requiring excess admiration
3) interpersonally exploitative
4) believe that s/he is special and can be understood only by other special high status people
5) preoccupied with fantasies of unlimited success, power, love, brilliance
6) a sense of entitlement
7) lack of empathy
8) often envious of others
9) arrogant, haughty behaviors or attitudes

Kernberg adds: shallow emotional life, derive little enjoymnt from life other than tributes recieved from others, tend to depreciate those from whom they expect few narcissistic supplies.

vast numbers of pts are highly vulnerable, neither neurotic nor psychotic but somewhere btween
considerable debate re psychodynamics and developmental origins not discussed in his book

MCWILLIAMS ON NARCISSISM
Freud term 1914 "primary narcissism" = approximately Piaget's 1937 "primary egocentrism"
in which for the newborn the world and self are felt as one
p168 term borrowed from Greek myth of Narcissus, the youth who fell in love with his reflection in water and died of longing, but Freud had no cure
Alfred Alder 1927 and Otto Rand 1929 wrote on topics that would now be considered narc
but were estranged from Freud and are less well known
narcs have probs w self esteem and are "hard to construe solely in terms of drives and unconscious conflicts, and are correspondingly hard to tx by reference to conflict-based models of therapy. A deficit model seems to fit their experience better: There is something missing from their inner lives."

CH8 p168
narc = personalities organized around maintaining their self-esteem by getting affirmation from outside themselves

narcissistic supplies = supports to self-esteem
pathological narcisssism = disproportionate degree of self-concern, not ordinary response to approval, sensitivity to criticism



p184
injury to self esteem-->anyone may behave temporarily like a narcissistic character
defenses-->preserve self esteem
more than with other psych conditions, narcissistic concerns are ubiquitous and can easily be situationally incited
to qualify as characterologically narcissistic: longstanding, automatic, and situation independent patterns of subjectivity and behavior

p185 currently overdiagnosed poss esp by psychodynamic clinicians
concept often misapplied to pts w situation specific rxns and to psychopaths, depressed, OCD and hysteric personalities (ddx)
"Any nonnarcissistic person can sound arrogant or devaluing, or empty and idealizing, under conditions that strain his or her identity and confidence. Medical school and psychotherapy training programs are famous for taking successful, autonomous adults and making them feel like incompetent children. Compensatory behaviors like bragging, opinionated proclamations, hypercritical commentary, or idealization of a mentor are to be expected under such circumstances. Phenomena like these are sometimes referred to in the psychoanalytic literature as comprising a "narcissistic defense" (e.g., Kernberg, 1984)."

psychopaths "do not emotionally understand compassionate attitudes; they scorn a sympathetic demeanor as the mark of weakness."

TREATMENT CONCEPTS
develop self-acceptance
deepen relationships
dynamic psychology
basic security and identity
the self as opposed to ego
self-esteem regulation
attachment and separation
developmental arrest and deficit
shame

P169 Psychoanalytically influenced social theorists ... have argued that the vicissitudes of contemporary life reinforce narcissistic concerns. The world changes rapidly, we move frequently, the media exploit our insecurities and pander to our vanity and greed; secularization dilutes the internal norms that religious traditions once provided. In mass societies and in times of rapid change, the immediate impression one makes on others may be more compelling that one's integrity and sincerity, qualities that are prized in smaller and more stable communities where people know each other well enough to make judgments based on someone's history and reputation."

SOURCES
11/10 lecture by Jacqueline J West, PhD
Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised, 1987
The Theory and Practice of Group Psychotherapy, Yalom, 1995
Psychoanalytic Diagnosis; Understanding Personality Structure in the Clinical Process, Nancy McWilliams, 1994

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