Prof. Sam Vaknin (YouTube, Twitter, Instagram, Facebook, Amazon, LinkedIn) is the author of Malignant Self-love: Narcissism Revisited (Amazon) as
well as many other books and ebooks about topics in psychology, relationships, philosophy,
economics, international affairs, and award-winning short fiction. He
is Visiting Professor of Psychology, Southern Federal University, Rostov-on-Don, Russia (September,
2017 to present) and Professor of Finance and Psychology in SIAS-CIAPS (Centre
for International Advanced and Professional Studies) (April, 2012 to present). Here
we talk about his work on treating narcissism with Cold Therapy.
Scott
Douglas Jacobsen: Narcissism seems lifelong, immutable. You have commented,
eloquently, about Narcissistic Personality Disorder and the lifetime ‘devoured’
by it, in an Instagram post (vakninsamnarcissist, 2020).[1]
Yet, your intervention, Cold Therapy, is effective with Narcissism (and
depression). What was the original insight into the first developments of Cold
Therapy?
Prof.
Sam Vaknin: That, exactly like Borderline Personality Disorder,
Narcissistic Personality Disorder is a post-traumatic condition, a form of
complex trauma. So, Cold Therapy is based on two
premises: (1) That narcissistic disorders are actually forms of CPTSD; and (2)
That narcissists are the outcomes of arrested development and attachment
dysfunctions. Consequently, Cold Therapy borrows techniques from child
psychology and from treatment modalities which used to deal with PTSD.
Jacobsen:
In “Cold Therapy and Narcissistic Disorders of the
Self” (Vaknin, 2018), you list “four misconceptions about pathological
narcissism.”[2] Why have
those been the misconceptions, in particular?
Vaknin:
Pathological narcissism is not merely a regression
to an earlier childhood developmental phase, although such infantilization is a
core psychodynamic of the disorder. There is so much more to it than that!
It is
also not only a psychological defense, although narcissistic defenses and
cognitive distortions play a key role in the pathology.
Narcissism
is not simply an organizing principle or a schema, though, like every addiction
(to narcissistic supply, in this case), it helps the addict to make sense of
the world (is hermeneutic) and provides goal-orientation and direction. It
comes replete with rituals, order, and structure (is an exoskeleton).
Finally,
it is not strictly a personality disorder. The personality is intact and highly
adaptive. Narcissism is a post-traumatic condition, amenable to trauma
therapies. Like in every other form of complex trauma, emotions get
dysregulated or repressed and cognitions get distorted.
Jacobsen:
How are narcissistic disorders complex post-traumatic conditions, and forms of
arrested development and attachment dysfunctions? How are both pampering and
punishing a child, or an adolescent, forms of abuse in the creation of a
narcissist?
Vaknin:
Pathological narcissism is a reaction to prolonged
abuse and trauma in early childhood or early adolescence. The source of the
abuse or trauma is immaterial – the perpetrators could be parents, teachers,
other adults, or peers. Pampering, smothering, spoiling, and
“engulfing” the child are also forms of abuse because they do not
allow the child to separate from the parent and to confront reality as an agent
of personal growth and development.
See
these:
http://vaksam.tripod.com/narcissismglance.html
http://vaksam.tripod.com/npdglance.html
http://vaksam.tripod.com/journal42.html
https://web.archive.org/web/20161025014451/http://metapsychology.mentalhelp.net/poc/view_doc.php?type=de&id=419
Narcissistic
and psychopathic parents and their children – click on the links:
https://groups.google.com/forum/#!topic/NARCISSISTIC-PERSONALITY-DISORDER/kA1vtsqWAiI
The
Genetic Underpinnings of Narcissism
http://vaksam.tripod.com/journal43.html
The
early childhood traumas of the narcissist prevent him (or her) from completing
the process of separation-individuation. S/he is not permitted to develop
boundaries and to become an individual. S/he freezes in time as a Puer
Aeternus, a Peter Pan.
The
narcissistic child reacts by avoiding the offending and hurtful parent, an
insecure attachment style that becomes entrenched throughout the lifespan. He creates
the False Self and outsources many Ego boundary functions, rendering him
dependent on the appraising gaze of others to buttress his grandiose, inflated
self-image. Gradually, he develops an addiction to confirmatory input
(narcissistic supply) because he cannot regulate and stabilize his internal
environment without it.
Jacobsen:
What portions of the nervous system in early childhood and early adolescence
seem most impacted by the long-term abuse and trauma to create Narcissism, if
known?
Vaknin:
Not known. There are many studies about the
neuroplastic effects of childhood abuse and trauma on the brain, but none of
them is specific to NPD. There are studies about brain abnormalities in
Borderline and Antisocial Personality Disorders (psychopathy).
Jacobsen:
How are narcissistic disorders interpersonal disorders rather than disorders of
the self?
Vaknin:
The concept of “individual” which regrettably
permeates modern psychology is counterfactual. We are formed fully via
relationships with others. To conceive of the Self as an outcome of
narcissistic introversion (Jung) is disastrously mistaken.
Disorders
of the personality are, therefore, problems in inter-relatedness (as the object
theorists in the UK in the 1960s had postulated). Narcissism is no exception.
The DSM V has adopted this stance in its Alternate Model of NPD (p. 767). I had
been advocating it since 1997.
Jacobsen:
What are the goals of Cold Therapy?
Vaknin:
The main two therapeutic goals are to render the
False Self redundant and so drive it to atrophy (“use it or lose it”) and to
eliminate the need for narcissistic supply and the dysphorias that accompany
its deficiencies.
In
short: to get rid of the grandiosity dimension in Narcissistic Personality
Disorder (NPD).
To
process trauma via skilled reliving (owning the trauma and surviving
retraumatization);
To
foster more adaptive functioning that is not dependent on outsourced
regulation, cognitive distortions (like grandiosity), and artificial constructs
(like the False Self);
Replace
negative coping (such as avoidance, withdrawal, defiance, or fantasy) with
positive coping strategies;
To
integrate distressing materials (thoughts, feelings, memories);
To
lead to the internal resolution of dissonances, resulting in an equilibrium and
homeostasis;
Help
the client to evolve life skills such as resilience, empathy, and ego
regulation.
Jacobsen:
Why are no known, well-established therapies effective in the treatment of
narcissistic disorders?
Vaknin:
Behavior
Therapy
Replaces problem behaviors with constructive ones via conditioning and reinforcement.
Cognitive
Therapy
Changes negative automatic thoughts and schemas that lead to attributional and other biases as well as errors in order to alter problematic behaviors and dysfunctional feelings and behaviors.
CBT
Third
wave of behavior therapy:
Primacy
of therapeutic relationship, learning principles, analyze triggers and
environmental cues, explore schemas and emotions, utilize modelling, homework,
and imagery.
Dialectical
Behavior Therapy (DBT)
Developed
by Linehan in 1993 to treat BPD, but used with other personality disorders and
disorders of mood, anxiety, eating, and substance abuse. It is deployed mainly
with female patients in inpatient or residential settings.
Emphasizes
emotional and affect regulation rather than cognitions.
Concerned with how were schemas formed via dialectic conflicts: seeks to connect affect and need to cognitive inference processes and belief systems so as to be reinterpreted with greater self-awareness.
Identifies fixation or perseveration causes by early developmental deprivation and protective attentional constriction.
Examines effects of negative reinforcement through emotional avoidance or inadequate coping skills rewarded through the partial reinforcement effect.
Involves
individual therapy, group skills training, phone contact, and therapist
consultation. Focuses on using validation and problem solving to counter severe
behavioral dyscontrol, issues of quiet desperation, problems of living, and
reducing incompleteness.
Cognitive
Behavior Analysis System of Psychotherapy (CBASP)
Developed
by McCullough and adapted by Sperry. Not used with BPD.
Clients
learn to analyze life situations and manage daily stressors. They evaluate
which thoughts and behaviors prevent desired outcomes.
Elicitation
and remediation: questions about the situation, the client’s role and
functioning in it, and the desired outcome lead to a revision of
counterproductive behaviors and cognitions.
Replaces
emotional reasoning with consequential one.
Mindfulness-based
Cognitive Therapy (MBCT)
Developed
by Teasdale.
Fosters
aware focus on thoughts, feelings, and experiences in the present with an
attitude of acceptance and without analysis or judgment.
Pattern-focused
Psychotherapy
Developed
by Sperry
Pattern:
predictable, consistent, self-perpetuating style of thinking, feeling, acting,
coping, and self-defense. Can be adaptive (competent) or maladaptive
(inflexible, ineffective, inappropriate, cause symptoms, impair functioning and
satisfaction).
Therapy
consists of replacing hurtful maladaptive patterns (situational interpretations
and behaviors) with helpful adaptive ones.
Schema
Therapy
Developed
by Young
Changes
maladaptive schemas: 18 enduring and self-defeating ways of regarding oneself
and others, arranged in 5 domains. Schemas are perpetuated through coping
styles: schema maintenance, avoidance, and compensation.
Schemas
can be reconstructed, modified, interpreted, or camouflaged.
TABLE
1.2 Maladaptive Schemas and Schema Domains
Disconnection
and Rejection
• Abandonment/Instability: The belief that significant others will not or cannot provide reliable and stable support.
• Mistrust/Abuse: The belief that others will abuse, humiliate, cheat, lie, manipulate, or take advantage.
• Emotional Deprivation: The belief that one’s desire for emotional support will not be met by others.
• Defectiveness/Shame: The belief that one is defective, bad, unwanted, or inferior in important respects.
• Social Isolation/Alienation: The belief that one is alienated, different from others, or not part of any group.
Impaired
Autonomy and Performance
• Dependence/Incompetence: The belief that one is unable to competently meet everyday responsibilities without considerable help from others.
• Vulnerability to Harm or Illness: The exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent it.
• Enmeshment/Undeveloped Self: The belief that one must be emotionally close with others at the expense of full individuation or normal social development.
• Failure: The belief that one will inevitably fail or is fundamentally inadequate in achieving one’s goals.
Impaired
Limits
• Entitlement/Grandiosity: The belief that one is superior to others and not bound by the rules and norms that govern normal social interaction.
• Insufficient Self-Control/Self-Discipline: The belief that one is incapable of self-control and frustration tolerance.
Other-Directedness
• Subjugation: The belief that one’s desires, needs, and feelings must be suppressed in order to meet the needs of others and avoid retaliation or criticism.
• Self-Sacrifice: The belief that one must meet the needs of others at the expense of one’s own gratification.
• Approval-Seeking/Recognition-Seeking: The belief that one must constantly seek to belong and be accepted at the expense of developing a true sense of self.
Overvigilance
and Inhibition
• Negativity/Pessimism: A pervasive, lifelong focus on the negative aspects of life while minimizing the positive and optimistic aspects.
• Emotional inhibition: The excessive inhibition of spontaneous action, feeling, or communication—usually to avoid disapproval by others, feelings of shame, or losing control of one’s impulses.
• Unrelenting Standards/Hypercriticalness: The belief that striving to meet unrealistically high standards of performance is essential to be accepted and to avoid criticism.
• Punitiveness. The
belief that others should be harshly punished for making errors.
Sperry, Len, “Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders: Assessment, Case Conceptualization, and Treatment”, 3rd Edition, 2016, Routledge
Transference-focused
Psychotherapy
Developed
by Kernberg
Infants
form internal representations of self-others (objects) connected via affect. A
personality disorder occurs when positive and negative representations fail to
integrate later in life. Such splitting affects all relationships, including
the therapeutic one.
Transference
to the therapist exposes the faulty relationship template and allows for its
empathic correction. Identity integration is accomplished as the patient
experiences negative emotions in a safe environment.
Mentalization-based Treatment (MBT)
Developed
by Bateman and Fonagy.
Experience
secure attachment and enhancing impulse control by empathically and
insightfully reflecting on and correctly labelling one’s state of mind,
especially one’s powerful emotions, and cognitive errors. This leads to
improves relational skills.
Developmental
Therapy
Developed
mainly by Blocher, Citright, and Sperry
Regards
problems in personal growth and needs satisfaction on a dimensional continuum
from disordered to adequate to optimal.
Cold Therapy
Developed by Vaknin
Jacobsen:
What are the first steps in formal identification and opening treatments of a
narcissist with Cold Therapy?
Vaknin:
The client present with a diagnosis of NPD by a
clinician.
Cold Therapy consists of
the re-traumatization of the narcissistic client in a hostile, non-holding
environment which resembles the ambience of the original trauma. The adult
patient successfully tackles this second round of hurt and thus resolves early childhood
conflicts and achieves closure rendering his now maladaptive narcissistic
defenses redundant, unnecessary, and obsolete.
Cold Therapy makes use of
proprietary techniques such as erasure (suppressing the client’s speech and
free expression and gaining clinical information and insights from his
reactions to being so stifled). Other techniques include: grandiosity
reframing, guided imagery, negative iteration, other-scoring, happiness map,
mirroring, escalation, role play, assimilative confabulation, hypervigilant
referencing, and re-parenting. It is proving to be an effective treatment for
major depressive episodes (see this article about the link
between pathological narcissism and depression and this article about depression and
regulatory narcissistic supply in narcissism).
More about the therapy:
https://www.scribd.com/document/349440458/Cold-Therapy-Seminar-Level-1-Lecture-Notes
http://www.opastonline.com/wp-content/uploads/2018/08/cold-therapy-and-narcissistic-disorders-of-the-self-jcrc-18.pdf
Jacobsen: Thank you for the opportunity and your time, Professor Vaknin.
Vaknin: Thank
you again for your interest in my work.
References
Vaknin,
S. (2018). Cold Therapy and Narcissistic Disorders of the Self. Journal
of Clinical Review & Case Reports, 3(6), 29-36. https://doi.org/10.33140/JCRC/03/06/00005
vakninsamnarcissist.
(2020, January 31). [Prof. Vaknin reflects on life with NPD and the creation of
Cold Therapy]. Instagram. https://www.instagram.com/p/B7-0NCdgQxg/.
Footnotes
[1] Vaknin’s Instagram post (2020), in full, stated:
What a cruel irony it is that I have
developed Cold Therapy – the first ever effective treatment (cure, really) for
Narcissistic Personality Disorder (NPD) – too late to benefit from it myself.
I am 59 years old, my health is failing. My mental illness had consumed my life
– is still devouring it – as surely as the bush fires ravage homes in
Australia, leaving only the ashes of Me behind.
WARNING
I will block anyone who gives me the feel good New Age crap about how it is
never too late in life. Life has an expiry date beyond which it is all blood
and tears and stools and wallowing in your own stench of decomposing physical
and mental decrepitude. So back off with your American anodyne platitudes about
how every age has its charms. Old age sucks 100%. We lie to ourselves about it
in order to survive somehow in the face of our own vanishing dismemberment.
NPD is the slowest invisible cancer – but of the soul and mind. It is spiritual
AIDS with nothing to abet it. It is all-pervasive, relentless, and merciless.
It starts at age 3. It causes people around the narcissist to hurt and torment
him purposefully and profusely as a way of getting back at him for his
egregious abuse. It is Inferno and I have been its Dante since 1995. No
Beatrice can help me, no god, no healer. I have been doomed by my own
progenitor to a life of itinerant, profound, debilitating hurt, unlovable,
shunned like a leper, feared and loathed and mocked in equal measures.
It is with impotent rage that I bequeath Cold Therapy to a world I care nothing
for or about. Rage at the injustice of healing and aiding millions with my
pioneering work since 1995 – except the only person who most deserved my love
and my devotion and my succor: Sam.
See
vakninsamnarcissist (2020).
[2]
Vaknin, in “Cold Therapy and Narcissistic Disorders of the Self” (2018),
stated:
a. It is not only a regression to an earlier
childhood developmental phase;
b. It is not merely a psychological
defense;
c. It is not simply an organizing
principle or a schema;
d. It is not a personality disorder.
See
Vaknin (2018).
Image Credit: Sam Vaknin.
