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Dr. Keane
Dr. Keane, Therapist
Category: Mental Health
Satisfied Customers: 1768
Experience:  Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
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Do you know of any effective treatment for narcissistic

Customer Question

Do you know of any effective treatment for narcissistic personality disorder or am i basically just stuck with it? My set of personality "issues" jusy makes me chronically unhappy and those around me more so. Also I'm sure there is an awareness of this, but the neat distinctions between 'types' and disorders don't really stand up in practice - narcissistic, paranoid, borderline and depressive all seem to be interchangeable to some extent, with, in my case, narcissism - born out of immense lack of self-worth (I think) - being the most consistent with my experience. Anyway, 8 years of therapy and prozac, nothing much changes. Any advice. Or should I just say 'live with it'?
Submitted: 7 years ago.
Category: Mental Health
Expert:  Anna replied 7 years ago.
Hi Jack,

Good for you that you're wanting to work on this. In my professional experience, I've always seen the treatment of Borderline Personality Disorder similar to that for NPD, but keeping someone in treatment and motivated to change has been the problem. There has been some good research in the last few years on using Cognitive Behavior Therapy with BPD, and it's generating very good outcomes. I suggest that you research CBT and integrate that into your therapy - it will do you well.

Amazon book page

On the page above, scroll down for the book, the workbook (very good one) and the book on DBT - also very usefull.
workbook-- look at this sounds good, but I haven't read it. I've read the other 3 and use them in my practice.

Thanks for the opportunity to help you out today. Hang in there and keep working toward the solution.

good blog page

Customer: replied 7 years ago.
Thanks Anna. To be honest I'm not sure this gives me much more advice than a quick internet search would have done. I mentioned using some CBT before; I know there are no magic bullets but I would have hoped for a bit more clinical insight than a couple of links to amazon pages and a book you havent read, and a 'hang in there!'. This is greatly worth paying for I'm afraid. Sorry, Brendan
Expert:  Dr. Keane replied 7 years ago.
Hi Brendan
I have worked with quite a few people and their families who were diagnosed with NPD. If you can give me some more information about yourself, when you were diagnosed, what caused you to seek help and what your family life is like, friends, work responsibilites and some personal information such as siblings, children, married or not I will be better able to help you. You don't have to be stuck with anything but it is a pretty complicated personality to understand and each person may respond to different combinations of therapies. Once I have the info I will get back to you with my thoughts on your particular composite. I will be offine for an hour or so.
Customer: replied 7 years ago.
Hi thanks Dr Keane
I was informally 'diagnosed' by my therapist (who thinks labels are just a form of lazy thinking and can be applied to most of the population by the way) and also by a psychiatrist who suggested that I had what he would generally describe as generally some form of 'personality' syndromes, although he was reluctant to label it as I think the practice here views labels as somewhat arbitrary and possibly counter-productive and unreliable - which I agree with to some extent (the experiment where psychiatrists 'presented' themselves as patients to mental hospitals and all got 'diagnosed' and labelled with a disorder was an enlightening one). None-the-less I think there is some value in some of this and to be honest I quite prepared to try to work with things that work for me - although I'm also prone to thinking that we may be just what we are and that 'fixing' ourselves is a bit of a waste of time and a distraction. Anyway.. I was going through a particularly bad depression at the time and the psych also diagnosed 'dysthymia' - i.e. long term moderate depression.
Lifewise, I'm in a 2 year relationship with a great woman, no kids, I have a responsible, exciting and quite stressful job which involves me travelling globally which is great; I have some (a few) great friends but I tend to be slightly avoidant sometimes and can hide away from the world a bit and avoid social situations when I'm feeling down - although I an also be on really top entertaining form. Probably the most troubling things to me are a sense of being cold to people close to me and careless, very interested in my own needs but blind to theirs (I dont mean sexually, but emotionally); and also being quite obsessed with my 'place in things' at work - needing praise, recognition, etc all the time yet feeling threatened, rage at being 'challenged' etc all the time too (narcissist 'feed' etc). I must say if I check out the narcisssist diagnostic list I hit many of the attributes but I'm not totally indifferent to others by any means but do end to relate to people based on my needs; I'm also not totally unaware of my faults - in fact I often 'crash' and become highly self-critical.
I'd say I'm living with all of this but also feel a bit dead, and permanently depressed underneath, despite ssri's, years of therapy etc.
I've always been a bit sexuall ambivalent also - been attracted to good-looking young men which complicates things although not unfaithful.
My fear is that I get colder with time and stop caring for the person I am with - I'm often pretty oblivious to her needs and its endangering our relationship; and I only wake up when she talks about leaving and then i often feel frightened. It's all a bit predictable I know, but I feel a bit stuck and also a bit cowardly in some ways - depending on people but not seeming to have anything emotionally to give back. My emotional numbness really confuses me to be honest - I wouldnt choose to be like this but I'm also a bit tired of apologising for myself......oh blimey!!!
Customer: replied 7 years ago.
PS the 'narcissist' label came out a few years (maybe 3) in therapy, the psychiatrist visit was about 3 1/2 years ago..
Expert:  Dr. Keane replied 7 years ago.
Hi Brendan
In some ways I agree with the therapists..for me, most "labels" are for jars..not people. if you had to walk about with your labels on a shirt what would it read? would it all fit on the front of your shirt.That's an exercise I give my patients.
From your information and please note that this is online and not in person I am not so sure that you are a narcissist in the highest truest form. You sound like you use "the wall" (I'll say more on that in a bit) to keep yourself protected. Your dysthymia is probably "part" of a good diagnosis since you can be avoidant when you need to hide and entertaining when you want or need to be (possibly for being viewed as top notch at work) constant low grade sadness. The wall...we all have walls that we use for various reasons. You are cold and careless about those close to you. Maybe you do that to those close to you so that the people outside your immediate world see you as capable and uniquely admirable, so you can pretend you are not threatened and seen as the responsible, important person in the the workplace when in fact you do not feel that way about yourself at all, something a unrehabitable narcissist would not see in themself. You did not mention any family of origin so I can't go further on that part but I am sure there was something somewhere that plays a role in your behaviors and beliefs . I would tend to be more inclined to a diagnosis (which is opinion only) that is depressive more than anything else. It's curious also that you admit to being attracted to good looking men, is that being curious or a fear? Emotional numbness? Gosh, don't let me feel!!
I do not believe you need to apologize for who you are, I believe you are tired of trying to figure out who that really is, and although you have tried therapy and prozac what type of therapy are you involved in? In my experience working with true total narcissist's I find people who have the lowest of low self esteem or fear of finding out who they really are, but have been either been placed on a pedestal and told they were God's gift to the world or someone who due to their childhood experience needs the praise, glory and need for people to jump when they say jump and ask how high. They do not have to follow the same rules of society that others beneath them do.
So what do you do to help yourself? You have a very extrinsic view of the world. You say you used success, failure, travel, love of others as a means to help (in addition to therapy and prozac). Have you ever discussed or explored "self-hatred" in your therapy sessions. What's on the inside of you that speaks to you every day? Think about this for a bit. I have to leave my office to go home and will check back when I settle. Tell me what is going through your head as your read this.