Understanding Narcissistic Abuse:
The word narcissism has received a lot of attention of late and, as a result, has entered the public vernacular. Healthy narcissism is reflected in a generally positive sense of self (yet with a recognition of one's limitations), appropriate self-care, and being an advocate for one's needs. Pathological narcissism is something entirely different. Persons with pathological or malignant narcissism have a greatly inflated sense of their own importance and worth, and tend to maintain their grandiose sense of self-esteem by means of denigrating and diminishing the value of those around them. Also, because pathological narcissists believe that they are never at fault, they externalize responsibility for interpersonal problems onto other people.
There are significant costs to living with, being raised by, or working for a person with malignant narcissism. Having a close personal or professional relationship with one of these people is frequently associated with increased depression and anxiety (one never knows when the narcissist will explode with rage) as well as a decreased sense of confidence, competence, and psychological resources. Gaslighting is common: this term is used to describe abusive behavior, specifically when an abuser manipulates information in such a way as to make a victim question their ability to accurately discern reality. Gaslighting intentionally causes the victim to doubt their memories or perception of reality. When the partners or children of highly narcissistic people come to therapy, they frequently blame themselves for all the relationship problems (as they were blamed by the narcissist), have become highly self-critical, and feel helpless to get their needs met in relationships. A central part of the therapy is to help them understand how the manipulation, gaslighting, and constant devaluing that has taken place in that context has left them with both a poor and inaccurate sense of who they are and what they deserve. Throughout my clinical practice, I have been working with the many faces of narcissistic abuse, and I believe I have special insight into the machinations of these abusers.
Exit/Recovery from High Control Groups & Relationships
Toxic relationships can be found in intimate relationships, high-control family systems, and destructive cults. What all of the foregoing have in common is the use of emotional manipulation, physical abuse (not always), and coercive control/persuasion with the goal exploiting and frequently injuring recruits and followers. This often results in "behavioral and personality changes, loss of personal identity, cessation of scholastic activities, estrangement from family, disinterest in society, and pronounced mental control and enslavement by cult leaders." (from Cults and the Family).
We usually think of "cults" as outside-the-mainstream religious groups, but cults are defined by their use of control to "manage" followers, not by the content of their beliefs. A group may have unusual beliefs, but this does not make it a destructive cult. A destructive cult is usually totalitarian in structure and has an overriding belief that the "ends justify the means." Coercive persuasion or thought reform leads to the breakdown of critical thinking and causes the individual to become increasingly pathologically dependent upon the group leader(s). Cults can be religious in their doctrine (Children of God; Unification Church), political (QAnon; White Power groups; Terrorism groups); or apocalyptic (doomsday cults).
One-on-one cults, often called "cultic relationships," are deliberately manipulative intimate relationships between two persons where there is a significant power imbalance exists that is used to exploit, control, and abuse the less powerful member. Some of the early warning signs are the push of the person in power to move the relationship rapidly, "love-bombing" (a term used to describe making the follower feel incredibly special and overwhelming them with gifts, attention, promises, etc.). There is frequently an effort to cut off other meaningful relationships, push the victim to drop out of school or leave their employment. Many of these abusive partners meet some or all of the characteristics of the malignant narcissist.
Finally, excessively controlling family systems can fit into this category as well: making developmentally inappropriate decisions for their members surrounding issues of friends, school, activities, appearance, etc. Authoritarian families use fear and guilt to program their members into believing that their lives are worthless outside the family, and they may threaten to expel members who dare to show autonomy. This may include disallowing any contact between the banished member and the remainder of the group/family. (This is a common tactic among ex-members of Scientology.)
If you are an ex-member of any of the above types of destructive cults or cultic relationships, your sense of reality has probably been damaged, more so if the relationship lasted a long time. An education-focused therapy can help you understand the machinations of these destructive cults and to regain trust in your own judgment, perceptions, and worth. If you are the parent or family member of someone who has been lured into a situation where they are losing their identity, where they have undergone significant personality change, or where they have been isolated and not allowed contact with friends and family, an educational consult may help you better understand what has happened, and perhaps how you can regain healthy contact with the manipulated/abused person you love.
Failure to Launch Young Adults:
Another area of expertise is working with the parents of young adults who appear to have become "stuck" in their lives, and who are not maturing and taking on the expected developmental steps of emerging adulthood: not completing school, failing to get work that can support them, relying excessively on their parents in a manner that is inappropriately dependent. When the families contact me, they are frequently at a loss ("nothing we do seems to motivate him") and are desperate for some clear direction and interventions. Sometimes this kind of coaching remains with the therapist only working with the parents; sometimes, the young adult becomes the client because they, too, are concerned with their lack of progress. Becoming a functioning young adult is hard enough and now COVID-19 threatens to sabotage the independence of even more late teens and young adults. Getting help before these patterns become entrenched is critical. If this is an issue in your family, please contact me for assistance in helping your adult child move toward greater autonomy and responsibility.
Eating & Substance Use Disorders:
Since the beginning of my clinical practice, I have been working with adolescents and adults who are struggling with eating and substance abuse issues. This was the area of my research in graduate school, and I have continued to help clients develop healthier coping mechanisms so that they can either significantly decrease or entirely end their reliance on these costly methods of managing the stresses of everyday life. These issues take a toll on the physical, psychological, and interpersonal functioning of persons who depend on alcohol, drugs, binge eating or constant food restriction for regulating their mood and self-esteem. These are hard problems for which to seek treatment: frequently there is enormous shame and intermittent denial about the severity of the problems. If you or someone close to you has a substance use or eating disorder, at the very least, set up a diagnostic session to determine whether it is time for a change.
Treatment of Personality Disorders:
The treatment of the more disturbed (and frequently, disturbing) personality disorders is different from therapy for the painful conditions of everyday life: depression, anxiety, sleep disturbances, etc., and requires a clinician with training and experience working with these clients. Furthermore, some persons with these personality disorders (or "self disorders") have been referred to therapy by family members or other significant people in their lives. As such, the first part of the treatment involves an assessment of the individual's motivation for change and commitment to treatment. Frequently, persons who have been diagnosed with Borderline Personality Disorder feel that this is untreatable and, thus, feel helpless and hopeless. My experience is that it is an entirely treatable disorder when the person is committed to doing the therapeutic work to effect lasting change. It is not a short-term therapy, but real and permanent change is possible. Treatment of Narcissistic Personality Disorder is difficult because many of these people are not in sufficient distress to remain in psychotherapy long enough to make real progress, and they frequently have to look at some of their beliefs and behaviors in a manner that is quite uncomfortable. Again, with adequate time and commitment, these people can learn to become more empathic and less manipulative in their daily lives