Friday, December 26, 2014

Dr. George Simon interviewing a classic Narcissist.

This is what dealing with my mother, and my ex's P, D and J was/is like. It amazes me that these are the people I attract considering my communication abilities and my high level of logic. Of course, it is most likely my empathy that dooms me to attract these lovely specimens. 
Dr. George Simon is the preeminent expert on manipulative aggressive personality disorders and how to deal with those who have them!
In last week’s post, I illustrated some of the cardinal features of malignant narcissism through a case example excerpted from my book The Judas Syndrome.
Today’s example comes from one of the therapy vignettes featured in the last chapter (chapter 7) of my book Character Disturbance. It’s a fairly lengthy vignette but it illustrates so many aspects of narcissism so well that I’m reproducing it all except for some minor edits (for brevity’s sake), and I hope the discussion about the vignette itself as well as my commentary will provide folks with a sufficient understanding of the problems ego-inflation in the extreme can cause.
Although I didn’t give him a name in the book, for the sake of discussion, we’ll call the person in the following vignette “Tom.” He was referred to me by another therapist for evaluation and recommendations about a treatment plan. I’ve highlighted in boldface and italicized certain parts of my interchange with him to aid in the discussion. Here’s how it went:
CLIENT: Hey, how’s it goin’ George? Well, today’s the day, huh? The big shrink’s gonna tell me what he thinks (smirks).
THERAPIST: As I promised you last time, I am going to share with you my opinion about what I see as a problem. And I’ll give you some suggestions about what you would need to work on in therapy. Then, I will give your therapist a copy of my report.
CLIENT: Well, what’s the verdict, doc? You’re a doctor of what…philosophy…. psychology? Is that like a real doctor, or what?
Evelyn's Comment: Notice Tom trying to cut the Doctor down and to diminish his credentials!
THERAPIST: As we talked about the first time, I’m a psychologist. I’m not a medical doctor. All of my training is in psychology. My area of specialty is personality and character. As we have discussed this at length before, perhaps we’d better get on with my assessment.
CLIENT: Go ahead. Shoot.
THERAPIST: I think that, for you to have fewer of the kinds of problems you’ve been having, and in order to be a better person in general, you need to make some changes in the kind of person you are – some basic changes in your personality. At your age, that won’t be easy, but I think that’s what you’ll need to do.
CLIENT: What about my personality?
THERAPIST: Mostly, you lack good “brakes.” Also, you tend to think too much of yourself, and you tend to pay too little heed to others in your life and their needs.
Evelyn's Comment: Notice the Doctor has identified three (3) issues Tom needs to work on!
CLIENT: I’m not sure what you mean, bad brakes.
Evelyn's Comment : NoticeTom only questions the issue with the "bad Brakes" but does not have an issue with thinking too much of himself or paying little heed to others in his life and their needs!
THERAPIST: I think you understand that when you want something, or want to do something, you don’t hesitate or stop and think about it first. In fact, you don’t stop at all. You don’t back-up, back-off, or give-in when you should. You’re in full-throttle mode in the very times you really need to be thinking about applying the brakes.
CLIENT: And you can tell all this after just a couple of visits?
THERAPIST: As we discussed earlier, I consider much more than just our visits, which is why I’ve consulted with your therapist, interviewed some of your family, looked at your history, and given you some tests. I’ve also made some important observations about the kinds of attitudes you display and behaviors you exhibit. I consider my opinion accurate.
CLIENT: Even if no one else has ever told me that before? Dr. Brady thinks I probably have depression. But you think I’m just a bad person. So, he’s wrong and you’re right, huh?
THERAPIST: I can’t speak for anyone else. I’m giving you my opinion. And, of course, you didn’t hear me say you were a bad person. I said you’re a person with poor brakes. I meant exactly what I said.
CLIENT: Dr. Brady says my anger is a symptom of depression. Maybe that’s what it is. Maybe all I need is a pill.
THERAPIST: Anger can indeed be a sign of depression, especially when it is out of character for the person. But I’ve carefully reviewed your history. There were many times when you were on a mission of sorts – taking no prisoners – fighting hard to get what you wanted – and you weren’t angry at all. Many times, when you showed anger, it seemed more to intimidate those who opposed you – a tactic as opposed to a genuine feeling. You seemed to do whatever you had to do to get what you wanted without care for whom you hurt, and you ended up losing in some way. If you had put on the brakes, you might have really won. Then you got upset because you’d made a mess of things. How long have you had a problem putting on the brakes?
CLIENT: I just don’t see how you could be so sure after just meeting me. You don’t really know anything about me. I mean, you’re saying some pretty heavy things here. Besides, I like me. Lot’s of people like me. They love me at work, and I do great at my job. Make good money. But you tell me I’m all messed up.
Evelyn's Comment: Notice how Tom tries to change the subject and get off topic and manipulate himself out of what he perceives as criticism even though he is being evaluated that he has a problem. He tries to turn it around and insult the Doctor!
THERAPIST: You ask how I can be so sure. I think you would know better than anyone else whether any of what I have said to you makes sense. And, of course, you know that I’m not suggesting you need to change everything about yourself. What I am saying is that, as an aggressive personality, you have to learn when and when not to pull out the stops, and when and when not to put on the brakes. You also need to get a more balanced sense of self-worth. It seems to have really riled you that anyone might have accurately assessed your character. You actually helped confirm most of my hunches when you started out this session using the tactic of leveling; that is, trying to intimidate me by subtly denigrating my credentials, trying to throw me on the defensive. I think you need to stop all the very destructive behavior that I outlined for you on the worksheets I gave you, and which I’m sending to your therapist as well. If you don’t work on correcting those things, you’ll keep hurting people and making a mess of your relationships. It won’t be easy, but you can do it. And you can start by doing some things differently, right here and right now.
Now, my question to you, if you remember, is how long you’ve had this problem…. I mean, with your brakes.
Client: My whole life.
Narcissists hate to think anyone “has their number,” so to speak. People who always see themselves as superior to others hate to see the field of “play” (i.e. social interaction) leveled.
They especially hate it when someone else in is a position of greater power or authority. “Tom” got really riled that I had the audacity to think I had him pegged. And he used just about every tactic I mention in In Sheep’s Clothing to reverse the “position” he was in (e.g., he uses the tactic of “leveling” by calling me by my first name, subtly demeans me with the innuendos about me not being a “real” doctor, etc., engaging in COVERT INTIMIDATION to put me on the defensive, etc.).
And there’s something else really interesting: he didn’t get upset and pretty much let it slide completely by when I said I thought he thought too much of himself and didn’t think enough about others.
He didn’t even get upset when I said it was his personality that was the problem. Rather, he got rankled at the notion of having defective “brakes.”
Although I didn’t mention anything about this in the book, there’s an interesting explanation for that. You see, Tom never minded others seeing him as somewhat overconfident or even haughty, nor did he care that much about whether others had a problem with him and the way he was (as attested to in his self-statements about his liking of the person he is).
He also didn’t see a problem with his “me first and everybody else should be able to fend themselves” attitude, either. But Tom always liked to think of himself as a person in total control (despite ample evidence in his history to the contrary). So it irked him that someone would call attention to his lack of inhibition over his impulses or his “defective” mental “brakes.”
Tom’s opening statement – the first thing he said when he entered my office and sat down – also illustrates a key point about aggressive personalities: the fight for position was already on and had begun even before he got there.
It was my job to hold position, without being sucked into a verbal and relational donnybrook, backed defensively into a corner, or being run over. I probably didn’t do a perfect job. But I thought the case was illuminating on this point anyway.
... But one thing I simply must point out is the axiom I’ve mentioned time and time again about encounters with character-impaired people whether or not those encounters occur within a formal therapeutic context: change, if it is to ever actually take place, ALWAYS occurs in the here-and-now.
After all the back and forth power-jockeying, impression-managing, manipulation, and game-playing, once sufficiently cornered and overwhelmed by the evidence of his lifelong problem and served notice that he could change how he operates if only he would make the choice to do so at any given moment, Tom finally does evidence some change.
He does this when he admits what I’ve said all along is a problem (i.e. when he says the problem with his “brakes” has been there “all my life”).
Now, of course, this is probably more of an instance of assent as opposed to genuine surrender.
But it’s a start. And as counter-intuitive as it seems, it’s really important to recognize the value of that small step in the right direction because it’s something that can be built upon.
And the process of re-building a severely impaired character is an arduous one that always has to start small.
I also want to make the point that the main reason I put this particular vignette in the book is because it illustrates so clearly just how differently potentially therapeutic encounters must be conducted when someone has a personality or character disturbance. No focus whatsoever on the ancillary and purely symptomatic features that might accompany the personality disturbance. Rather, a focus on the core “dynamics” of the dysfunctional “style.”
It’s the person’s interaction “style” itself that is the the problem, so that’s where the attention should be. And when elements of that style are accepted as dysfunctional and corrected, everything else gets better.
I can’t count the numbers (well into the hundreds and thousands) of times that exasperated folks have shown up at my office having repeatedly attempted therapeutic interventions to absolutely no avail because the real culprit responsible for all their distress (i.e. someone’s character) was never really confronted or dealt with.
Hopefully the readers will see a lot else here that looks familiar, resonates with them, and calls to mind other important principles I’ve mentioned in other posts on narcissism and character disturbance.
I’m really anxious to see the discussion on this one.
Share and Enjoy.

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