https://www.youtube.com/watch?

v=AIPL6MZBgQ0&t=911s

Elliot Greenebaum

On Narcissism 4: Nancy McWilliams

I generally look forward to any good psychodynamic explanation of narcissistic inner

dynamics, and there is something in Nancy McWilliams descriptions that is particularly to
the point and helpful. She teaches at Rutgers University’s Graduate School of Applied &
Professional Psychology, and she is author of Psychoanalytic Diagnosis and is Associate
Editor of the Psychodynamic Diagnostic Manual. I really like her style of describing and
explaining inner dynamic and I get back to her books as support for diagnosing when I
encounter a client with psychodynamics that is perplexing for me.

In this talk she once again demonstrates her ability to make complicated things clear
without compromising the depth of understanding.

First of all, she looks back to dual phenomenology of narcissism, the fact that narcissist can
appear both obviously grandiose and on the contrary very shy, either arrogant or depleted.
This time she cites Glenn Gabbard and his division to “oblivious” and “hypervigilant”
narcissist. As she says, in both cases, it is a self-esteem maintenance issue. I would add also
well-known but somewhat counterintuitive fact that one person can shift through these two
phases, either long-term or even more quickly, changing places on idealization-devaluation
seesaw, depending on how circumstances support or frustrate their grandiosity.

She rightly points out that diagnosing based on DSM makes it difficult if not impossible to
diagnose this other kind of more hidden, depleted version of narcissism, as DSM describes
only the arrogant type. She says that based on that we would probably diagnose depleted
narcissist as having depression. This depression is more of an “empty” kind, based on shame
rather than guilt. Their grandiosity’s support has been lost for a moment, and they came
crushing. They sometimes come to therapy searching for what is lost, asking (or secretly
wishing) therapist to make them popular, successful, rich, etc. or lamenting about these
qualities being out of reach. Unfortunately, they don’t know how to be happy any other way
and feel ok as they are.

How do you get this way?

As in her books, she very realistically describes two family atmospheres that are rich ground
for breeding narcissism – one is of course hypercritical with perfectionistic expectations, and
other is, on the contrary, uncritically idealizing. (I read somewhere that Jungians call it
projecting a “golden shadow” on a child, and I think it is a very apt metaphor, describing
both the idealization and constrictive quality of these projections). It also rings very true for
me as a parent that it is a social wave of trying to correct for distortions of previous
generations – the pendulum swings to the other side and probably always will, influencing
our collective conscious and unconscious. (I read family therapist Ron Taffel describing
shifting of tendencies in literature and theory on raising children, and this trends really
contrast in almost comically drastic way). In these idealizing families child can feel that she
or he is great as long as they deliver narcissistic satisfaction to a parent, but otherwise they
don’t have a sense of who they are besides that and can feel empty. It is a lonely life of
being a satellite or as Kohut would say a “self-object” of a narcissitic parent.

I like how McWilliams puts it: “… if the kid feels that the parent needs them to be perfect
and is distorting them into perfect being, they are not getting any message that they are
ordinary, flawed, naughty, problematic qualities are part of them and acceptable because
they are human beings.”

On problems in love:
As she says – there is an emptiness about it “and the most painful thing about emptiness is
the inability to love other people as they are”, because they don’t know how it is to be loved
as they are. They tend to idealize very quickly into the relationship and to become also very
abruptly disappointed and cold. As partners they are hypercritical and they try to mould
other person into perfect half with constant efforts to “improve” them. I very much agree
that it is painful watching them how they self-sabotage because they lack the basic skills for
repairing the relationships – saying “sorry” and “thank you”. (I recall a client who asked me
to dictate him word for word an apology for a boyfriend that he “ghosted” previously – he
was at that point in therapy that he finally felt that it is not ok to treat other people like
that, but didn’t have the capacity to formulate a simple straightforward apology).

“When you’re taught that you need to be a false self, a grandiose sort of person, you can’t
genuinely apologize, because that’s admitting a flaw, and you can’t genuinely thank,
because that’s acknowledging a need… Two things that are most needed to repair the
relationship are out of your capacity…”

Also very true is that sometimes they try to make things right by giving gifts or praises as
apology and gratitude substitutes, just not to actually have to say thank you and sorry.

On treatment:
Here she only sketches in a couple sentences duality of treatment suggested since Kohut
and Kernberg, but for anyone interested, she goes more into this in her books, giving many
valuable directions.

Another quote that is especially true for this kind of clients: “It is really important that
therapist be fully authentic… You can’t do really good psychotherapy by applying a formula
to anybody.”

And charmingly and jokingly offering the missing part to narcissistic phenomenology, she
concludes the interview with a question to the interviewer: “Good enough?” 
BELESKE:

2 versions – arogant and depleted

Gabbard – oblivious narcissis – i am wonderful and everybody should worship me

And hypervigilant – where is my next self-esteem supply coming from, i need a confirmation
that i am ok,

Doesn’t like DSM - IV

90s – shifting criteria towards description of behaviours

It describes arrogant version – which is a defence against

It is an issue of self-esteem maintenance

It doesn’t have a category for depleted narcissist – we would probably diagnose it as having
depression – narcissistic version is I am empty, I don’t know who I am, I need someone to
make me popular and famous, powerful, and I don’t see where I am going to get that
(it is a shamed and not guilt depression)
“If only I am rich and beautiful and connected” coming to therapy “I need you to make me
popular” and don’t have another concept how to feel and be ok

How do you get this way? Your truer, more authentic qualities, especially your feelings,
were not fully excepted and recognized by your family of origin, and that created that you
have to be false and that you had no value. One version of to create this problems is to be
supercritical all the time (why an A, why not an A+) and the child will always feel not good
enough and desperate to be good enough and to feel valued, but another way to do it is to
say “you’re wonderful, you’re terrific and if the teacher criticizes you I’m gonna go and tell
her thing or two”, we’re seeing a lot of that in Western cultures, because we’re trying to
overcorrect for previous versions, but the kid can get the same message… if the kid feels
that the parent needs them to be perfect and is distorting them into perfect being, they are
not getting any message that they are ordinary, flawed, naughty, problematic qualities are
part of them and acceptable because they are human beings. So you can create somebody
with a big problem with a core sense of who they are by any kind of distortion to try to
make them into a child that parent needs to reflect good on them as a parent… in a
literature we find that people tell us histories that makes it sound us they are treated as
narcissistic extensions, that sheds great light on the parent… we all do this to some extent,
but if this is a constant, chronic message, the kid learns that it fulfils a function to parent’s
self-esteem, but who are you?

There is emptiness about it… and the most painful thing about emptiness is the inability to
love other people as they are. They are chronically critical and trying to improve they
partner. They can idealize other people and that is as close as they get to falling in love.
They don’t have concept of being love for who they are.
Problem in relationships – criticize others for not taking care of them, you should divine my
needs, shame about asking … shame is at the root of narcissistic problems

(if I ask: did you make your needs explicit – I get: what do you mean needs?)

In couple therapy, I get them to actually say, but it is very hard…

Especially acknowledging dependency on other people… normal interdependency, we

require forgivness of our friends and partners when we make mistakes, we feel gratitude
when people meet our needs…

When you’re thought that you need to be false self, a grandiose sort of person, you cant
genuinely apologize, because that’s admitting a flaw, you can’t genuinely thank, because
that’s acknowledging a need… 2 things that are most needed to repair the relationship are
out of your capacity… so you end up doing apology substitutes, that leave people cold…
(undoing without saying sorry)

Unformulated, unnamed feelings, (not rage or envy), especially more nuanced feelings
(being sad, regretful, tender, mixed feelings)… it is not neurotic unconsciouss sadness, you
never learned…

TREATMENT
Always been a controversy – partly because they have different…

Kohut said – we all have this, parent is not good enough to idealize in the first place or they
resist seeing them as human (not taking children’s deidealization), and therapy is getting
them back to that developmental path

And other is getting is them off that path – devaluation of anything you envy, show them the
needs, shame and envy underneath that

Some patients are better candidats

It is really improtant that therapist be fully authentic

You can’t do really good psychotherapy by applying a formula to anybody

Good enough? 