Many textbooks (and many patients ...) claim that the psychodynamic therapies when applied to personality disorders are ineffective. Functional (cognitive, behavioral) treatments should be preferred in certain cases and regarding certain aspects of the disorder.

To a Narcissist, I would recommend a beavioral-cognitive-functional and less protracted type of therapy.

(1) Know and accept thyself. This is what you are. You are highly intelligent. You are very inquisitive. You are a Narcissist. These are facts. Narcissism is an adaptive mechanism. It is dysfunctional - but it saves you from a LOT MORE dysfunction or even a-function. Make a list: what does it mean to be a Narcissist in your specific case? What are your typical behaviour patterns? Which types of behaviour are counterproductive, irritating, self-defeating or self-destructive? Which are productive, constructive and should be enhanced DESPITE their pathological origin?

(2) Decide to suppress the first and to promote the latter. Construct lists of self-punishments, negative feedback and negative reinforcements. Impose them upon yourself when you exhibit one of the behaviours in the first list. Make a list of prizes, little indulgences, positive feedbacks and positive reinforcements. Use them to reward yourself when you display a behaviour of the second kind.

(3) Keep doing this with the express intent of conditioning yourself. Be objective, predictable and just in the administration of both punishments and awards, positive reinforcements and feedback and negative ones. Learn to trust your "inner court". Constrain the sadistic, immature and ideal parts of your personality (known as "superego" in psychoanalytic parlance) by the application of a uniform codex, a set of immutable and invariably applied rules.

(4) Once sufficiently conditioned, monitor yourself incessantly. Narcissism is sneaky and it possesses all your resources because it is you. It is intelligent because you are. Beware and never lose control. With time this onerous regime will become a second habit and supplant the Narcissistic (pathological) superstructure. All the above can be amply summed by suggesting to you to become your own parent. This is what parents do and the process is called "education" or "socialization". If your particular path to the adoption of this course is a particular therapy - go ahead. As a metaphor, a narrative, no therapeutic approach is better or worse than any other.


(1) Freud S. - Three Essays on the Theory of Sexuality (1905) - Standard Edition of the Complete Psychological Works of Sigmund Freud - Vol. 7 - Hogarth Press, 1964
(2) Horowitz M.J. - Sliding Meanings: A defense against threat in narcissistic personalities - International Journal of Psychoanalytic Psychotherapy - 1975;4:167
(3) Kernberg O. - Borderline Conditions and Pathological Narcissism - Jason Aronson, 1975
(4) Kohut M. - The Analysis of the Self - International Universities Press, 1971

Author's Bio: 

Dr. Vaknin has a doctorate in Physics and Philosophy. He has collaborated with Israeli psychologists and criminologists on matters related to personality disorders. During the years 1995-6 he studied the prevalence of personality disorders in the prison population in Israel. He is the author of "Malignant Self Love - Narcissism Revisited".

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