6/5/17&

Schema Therapy for Narcissism

Wendy Behary
President, 2010-2014
The International Society of Schema Therapy
Director, Schema Therapy Institute NJ-NYC
&
Carlos Rojas
Advanced Trainer-Supervisor
Schema Therapy Institute NJ-NYC
(Chairperson:-ISST-Committee-on-Spanish3Language--
Countries-Certi7ication)-
!

“Malice”)))

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When%Triggered%by%the%
Narcissist%%
&
!Punish%
!Permit%
!Give%In%
!Avoid%
!Fight%Back%
&

&
&
&
A)Highly)Effec1ve)Approach)for)Dealing)
with)the)Difficult)Issues)of)Narcissism)in)
the)Treatment)Room!)

%
Quick%Overview…%Schema%Therapy%
!
“Integra*ve,!Evidence1Based!Psychotherapy!
Model!offers!effec*ve!outcome!with!difficult!
treatment!popula*ons”!!!!!!!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Founder:!Dr.!Jeffrey!Young!

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Early%MaladapFve%Schemas%(EMS)%
%
“…broad,%pervasive%themes%regarding%oneself%
and%one's%relaFonship%with%others,%developed%
during%childhood%and%elaborated%throughout%
one's%lifeFme,%and%dysfuncFonal%to%a%
significant%degree."%&
& &&
Schema)Therapy:)A)Prac11oner's)Guide,)
)))))))))))))))))))))))))))))))))))))))))))))))))))))))))))!Jeff&Young,&et&al.&&

Schemas%and%Modes:%%
%%%%%%%%%%%%%%%%%%%%%%%%%%%%(Traits%&%States)%
&
Ac*vated!under!certain!condi*ons!and!
usually!promo*ng!intense!affect,!body!
sensa*on,!and!self1defea*ng!ac*ons!or!
inclina*ons…!“Condi*ons”!that!typically!
mimic!earlier!experiences!of!frustrated!
unmet!needs.!

Personality%Traits%and%States:%
%Nurture/Nature)

Early%Experience%%
+%
Temperament% Personality%

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Early%MaladapFve%Schemas&
&
! %Abandonment%%
! Mistrust%&%Abuse%
! EmoFonal%DeprivaFon%
! Dependence%%
! Vulnerability%
! Enmeshment%
! DefecFveness/Shame%
! Social%IsolaFon%
! ApprovalWSeeking
%
! Failure
! Subjugation
! Self-Sacrifice
! Unrelenting Standards
! Negativity
! Entitlement-Grandiose
! Insufficient Self-Control
! Emotional Inhibition
! Punitiveness

Origins%of%Narcissism%

! Insufficient Limits
! Used or Manipulated

! Conditional Approval &

Hypercriticalness

! Rejection & Social Exclusion

! Loneliness & Isolation

Unmet%Childhood%Needs%%
in%Narcissism%
! UncondiFonal%Love%&%A[enFon%

! Holding,%Nurturance%&%AffecFon%

! Acceptance%&%Praise%

! Empathy%&%Understanding%

! RealisFc%Limits%
! Trust%

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4%Types%of%(Schema)%Modes&

! Innate Child

! Maladaptive Coping

! Internalized Caregiver/Parent

! Healthy Adult/ “Good Parent”

&

Schema%Modes%In%Narcissism%%(1)%
%
! Lonely,%Unlovable%Child%%%
%%%%Isolated,%unloved,%alone,%rejected%
%%“average”,%%not%special,%empty,%socially%unacceptable%%
%%%WW)Triggered)by)loss)of)valida1on)and)special)status,)and)by)
absence)of)distrac1on)or)s1mula1on)

! %SelfWAggrandizer%(Superior,%EnFtled%Mode)%

%%%%Overcompensates%for%Lonely,%Unlovable%Child%

Schema%Modes%in%Narcissism%%(2)%
%
!More%About%the%SelfWAggrandizer%%
%%%EnFtled,%CompeFFve,%StatusWSeeking,%Superior,%CriFcal%of%
others,%NonWempathic,%Envious…%
This)is)the)default)mode)for)most)narcissists)
! Detached%SelfWSoother%/%SelfWSFmulator%%%%

%%%Workaholism,%SFmulaFonWSeeking,%AddicFons,%Solitary%
Interests–%%to%avoid%triggering%the%Lonely%Child%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%)))
)))Usually)triggered)when)alone,)in)the)absence)of)immediate)
sources)of)valida1on)

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Narcissists%in%%
InFmate%RelaFonships%%(1)%
! RelaFonships%are%experienced%primarily%as%sources%of%
approval%and%validaFon.%Approval)becomes)a)subs1tute)
for)nurturance%

! Limited%empathy%(except%in%Lonely%Child%mode)%

! Feels%frequent%envy%because,%when%someone%else%receives%
approval,%narcissist%feels%as%if%a[enFon%( nurturance )%
has%been%taken%away%from%him%%

Narcissists%in%%
InFmate%RelaFonships%%(2)%
! The%love%object%is%ogen%idealized%iniFally%because,%by%
gaining%approval%from%a%perfect%person%or%partner,%their%
value%feels%heightened%(compensaFon%for%DefecFveness)%
! The%partner%is%devalued%gradually%during%course%of%
relaFonship%
&

Some%Obstacles%In%TreaFng%Narcissism%(1)%

! Not%Enough%LEVERAGE%

! Many%deny%they%have%any%internal%
psychological%problems%
! Rarely%report%painful%emoFons%or%thoughts%

! Direct%CBT%a[empts%to%challenge%enFtlement%
usually%fail%

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Some%Obstacles%In%TreaFng%Narcissism%(2)%

! Refusal%to%do%homework%or%exercises%

! Desire%to%control%treatment%&%maintain%oneW
up%posiFon%relaFve%to%the%therapist%
! Therapist’s)schemas)are)triggered)&)usually)
impede)progress)

MeeFng%Core%Needs%%
%
%
Correc1ng)Biased))
Emo1onal)Experiences)
)
%
)
)

The%Therapy%RelaFonship%)
&
)
)
Fundamental)Strategy:)
(Within)the)Limits)of)the)
Therapy)Rela1onship)))
Adap1ve)ReXParen1ng))
&)ReXScrip1ng))
&

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ESSENTIAL%ELEMENT%
)
)
Empathy)
(The)Golden)Nugget))

EMPATHY%

%
%
Iden1fica1on)with)or)vicarious)
experiencing)of)the)feelings,)thoughts,)or)
aZtudes)of)another))
&

%
%
%
%
&%
%%
%
ImitaFon%and%IntenFon…%
%
“Monkey%SeeWMonkey%Do?”%
Mirror%Neurons%
&
&
)
Mirroring!People:!The!Science!of!Empathy!
!and!How!We!Connect!with!Others,!Marco!Iacoboni!
&

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Gallesse,%Rizzolaj,%Iacoboni%
“The&discovery&of&mirror)neurons)in&the&
frontal&lobes&of&macaques&and&their&
implicaHons&for&human&brain&evoluHon&is&
one&of&the&most&important&findings&of&
neuroscience&in&the&last&decade.&&
Mirror&neurons&are&acHve&when&the&
monkeys&perform&certain&tasks,&but&they&
also&fire&when&the&monkeys&watch&someone&
else&perform&the&same&specific&task.&&
&

Con1nued…)
There&is&evidence&that&a&similar&observaHon/acHon&
matching&system&exists&in&humans.&The&mirror&
system&is&someHmes&considered&to&represent&a&
primiHve&version,&or&possibly&a&precursor&in&
phylogeny,&of&a&simulaHon&heurisHc&that&might&
underlie&mindreading.&&
Today,&mirror&neurons&play&a&major&explanatory&
role&in&the&understanding&of&a&number&of&human&
features,&from&imitaHon&to&empathy,&mindreading&
and&language&learning.”&
&&&&&&&&&&&&&)©)Inten1onal)Communica1on)Partners,)2012)

Difficult%Issues%and%%
Our%ReacFons%

&
Ac1vated)Survival)System)
BioXSocial)Drivers))

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When%Feeling%Threatened…%%
Fight%–%Flight%–%Freeze%–%Faint%

Maladap1ve)Coping)Modes)

! Compliant%Surrender%

! Detached%Protector%

! OverWCompensator%

When%Feeling%Threatened…%
Schema%Modes%AcFvate%%
%
“Our&current&mood&state,&coping&
behaviors&&&cogniHons”&
We&may&flip&into&maladapHve&modes&when&
core&needs&are&not&met&and&our&schemas&are&
triggered.&

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%Schemas%%%%%%%%%%%%%%% % % %%%%%%%%%Early%Experience%%%%
DefecFveness%%% Unlovable/Shameful%
SelfWSacrifice%%%%% Resentment/Guilt%
Mistrust%/%Abuse%% Abused/Used%
SubjugaFon%%%% Controlled%
UnrelenFng%Standards%% Demanding%
Abandonment%% Unpredictable,%Alone%
Enmeshment% Smothered/Helpless%
EmoFonal%DeprivaFon% Misunderstood%
EnFtlement% & &&&&&&&&&&&&&&&& Superior,%Special%
&

%Schemas % % % % % %Early%Experience&
Schemas%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Early%Experiences%
%
Social&IsolaHon&&&&&&&&&&&&&&&&&&&&& &Excluded,&Misfit&
Dependence&&&&&&&&&&&&&&&&&&&&&&&&& &Helpless,&Indecisive&
Vulnerability&to&Harm&&&&&&&&&&& &Loss&of&Control&
Failure&to&Achieve&&&&&&&&&&&&&&&& &Inferior&to&Peers&
Approval&Seeking&&&&&&&&&&&&&&&&&& &DoubHng&Worth&
Insufficient&SelfbControl&&&&&& &FrustraHon,&ImpaHent&
EmoHonal&InhibiHon&&&&&&&&&&&&&SHfled,&Constrained&&
PuniHveness&&&&&&&&&&&&&&&&&&&&&&&&&&&Unforgiving,&Judging&
NegaHvity&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &Guarded,&PessimisHc&

Breaking%Free%

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Exercise:%
Harnessing)Realness)
)
)
)
)
Iden1fying)Our)Own)
))))))))))))
“Triggers”)&))Reac1ons&

! Therapist’s%Posture:%%“Sensing%the%Story”%
–%DifferenFaFng%the%Past%from%the%
Present.%
! Linking%and%Labeling%MaladapFve%
ReacFons%and%SelfWDefeaFng%Pa[erns.%
! Understand%and%Hold%Accountable%%%
&

Empathic%ConfrontaFon%

%
Photos%and%Audio%FlashWCards%
)
! “Pictures”%tell%stories…unlock%
memories…engage%emoFonal%
reacFons.%%%
! The%“voice”,%as%a%transiFonal%object,%
can%provide%helpful%reminders%as%well%
as%comforFng%and%lively%a[achment%to%
the%therapy%relaFonship%during%the%
midWsession%days.%

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The%Audio%Flashcard%

! Customized/Personal%TransiFonal%Object:%
! AnFcipaFng%the%Triggers%to%Anger%
! IdenFfying%What%“WE”%are%Up%Against%
! Praising%Good%Work%WW%%Courage%to%feel%
! Allowing%Angry%Child’s%EmoFons%
! PracFce%Exercises%with%Vulnerable%Child%
! ForFfy/Internalize%the%Healthy%Adult%Mode%

The%Photo%%"%Discovery%
&
&
&
%
%
%
%

%
Power%of%DifferenFaFon:%
Then%%vs.%Now %
%

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Goals%of%Therapy%for%%
Narcissism%in%Mode%Terms%%
Teach the Healthy Adult to:

%
Help%Lonely%Child%to%feel%nurtured%and%
understood,%and%then%to%understand%and%
nurture%others%%

Goals%of%Therapy%for%%
Narcissism%in%Mode%Terms%(2)%
%
%
!Confront%SelfWAggrandizer.%%Help%paFent%give%
up%enFtlement%&%need%for%approval%and%
validaFon,%as%Lonely%Child%takes%in%more%
genuine%nurturance%%
!Reduce%Detached%SelfWSoother/SelfW
SFmulator%behaviors%in%favor%of%true%
nurturance%

Progression%of%Therapy%%(1)%
! Establish%equality%and%respect%first%in%the%therapy%
relaFonship.%Be%firm%and%asserFve%
! Explore%origins%of%detachment%from%other%people%
and%of%selfWaggrandizement%
! Introduce%concept%of%the%Lonely%Child;%confront%
resistance%to%imagery%by%exploring%obstacles%%
! Use%imagery%to%access%Lonely%Child%

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Progression%of%Therapy%%(2)%
! Label%other%modes;%dialogue%with%each%mode%
individually%%
! Discuss%importance%of%allowing%Lonely%Child%to%
connect%inFmately%to%someone%in%paFent s%life%
! NegoFate%with%maladapFve%modes%to%overcome%
blocks%to%inFmacy%
! Generalize%changes%in%session%and%in%imagery%to%
relaFonships%outside%therapy%

Strategies%for%%
Working%With%Narcissism%%
in%the%Therapy%RelaFonship%%(1)%
! Confront&approvalbseeking&behavior&without&
devaluing&paHent.&&( I&care&about&you&b&not&
your&performance&or&appearance )&
! Confront&enHtled&behavior&without&devaluing&
paHent.&Set&limits.&&( I&care&about&you,&but&I&
also&care&about&myself&and&other&paHents.&&I&
cannot&give&you&special&treatment )&
&

Strategies%for%Working%With%%
the%Therapy%RelaFonship%%(2)%

! Confront&paHent s&criHcisms&of&therapist&&

! Help&paHent&idenHfy&feeling&of&empHness&
or&loneliness,&as&leverage&to&keep&paHent&
from&leaving&therapy&and&to&moHvate&
paHent&to&change&
&

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Strategies%for%Working%With%%
the%Therapy%RelaFonship%%(3)&

!Label&schema&modes&as&they&arise&

!&Rise&above&specific&incidents:&don t&
ajack&or&defend&oneself&
!&Maintain&view&of&narcissist&as&
vulnerable&at&the&core&
&

Integrated%Strategies%(1)%

&&&1.CogniHve:&Restructure&thinking&related&to&schemas;&&&&&&&&&&&&
develop&healthy&voice&to&create&distance&

&&&2.ExperienHal:&The&use&of&imagery&to&idenHfy&schema&
links&and&operaHve&modes.&

%
Integrated%Strategies%(2)

3.Therapy&relaHonship:&focus&on&therapy&relaHonship&to&
provide&limited&reparenHng,&and&to&heal&schemas&&&&
coping&styles&triggered&in&sessions&

4.Behavioral&pajernbbreaking:&assign&and&rehearse&
behavioral&and&interpersonal&changes&related&to&
presenHng&problem;&Break&dysfuncHonal&life&pajerns&

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! PreWempFve%Measures%
! Implicit%AssumpFons%
! Benefit%of%the%Doubt%
! Limit%Sejng%
! AdapFve%ReWParenFng%
! ConfronFng%Detachment%&%
Word)Craaing:))) Aggression%
Empathic)
Confronta1on)

3%of%th
e%Mo
Issues st%Challeng
%In%Tre i
atmen ng%
t%

Detached%Modes%
EnFtled%Modes%
Angry%Modes&

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IntegraFng%Concepts%From%
Interpersonal%Neurobiology%&

Bringing%The%Brain%On%Board:%
1.MiHgaHng&Issues&of&Shame&and&Avoidance&&&
&
2.Schema&AcHvaHon&
Implicit&&Memory&AcHvaHon&

Working)With)the)
Detached)Protector)
Using%Empathic%
ConfrontaFon%to%deal%with%
Avoidance,%including…
Defiant%Avoidance!%

Importance&of&recognizing&how&the&
Detached%Protector%mode&blocks&
access&to&the&Child&Modes&
&&to&emoHons&in&general&

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Bypassing%the%%
Detached%Protector%(1)%
! Label%the%Detached%Protector%mode%in%the%session.%
Help%paFent%to%recognize%signs%of%the%Detached%
Protector.%
! Explore%development%of%mode%in%childhood%and%
empathize%with%its%adapFve%value%
! Review%pros%and%cons%of%detaching%in%the%present,%
as%an%adult%
! PracFce%dialogues%between%the%Detached%Protector%
and%Healthy%Adult%modes%(Gestalt%empty%chair%
technique)%%

Bypassing%the%%
Detached%Protector%(2)%
! Begin%imagery%to%access%Vulnerable%or%Angry%Child.%
Ask%paFent%to%close%eyes%and%picture%self%as%a%child.%
"What)does)she)look)like?)How)does)she)feel)right)
now?”))

! Explore%emoFons%of%the%child.%

! Bring%the%Detached%Protector%into%the%image%with%
the%child;%iniFate%dialogue%between%the%2%modes%to%
contrast%them%

%
%
“Bullying)&)Cri1cal”))
Narcissis1c)Modes)
%
&

USING%EMPATHIC%CONFRONTATION:%
A)“HIGH)ROAD”)APPROACH)
%

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LISTENING%TO%ANGER%
%
%

Anger:%%%%
Mode%–%Driver%–%%Refrain%
&%
! Childlike%VicFm%–%% %Helplessness%
) ) ) ) )“I)hate)you”)
! Adolescent%Bully%–% %Unfairness%
) ) ) ) ) ) )“I’ll)show)you!”)
! Resenpul%Adult%–% %%Defensiveness%%
)) ) ) ) ) ) )“How)dare)you!”))

%
IMPORTANT%and%MEANINGFUL%
MESSAGES%
%
“How)unfortunate,)Joe…Your)
message)got)lost)in)the)delivery”)
)

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“I’m)Exhausted…)Worried”)

Or…&

Treatment%ImplicaFons:%
(Informed%by%Unmet%Needs)%
RecepFve%vs.%ReacFve%
%
! Angry%/%Enraged%Child:%%Embrace,%Link%

! Angry%/%Defiant%Protector:%Confront%%

! Angry%Punisher%/%Demanding%CriFc:%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
% % % % % %Set%Limits%
&
&
&
&
&
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Video&DemonstraHon&

%
Thank%You%for%Listening!%
&
&&&
&
%
%
!www.disarmingthenarcissist.com%
!h[p://www.schematherapy.org/%%
!h[p://schemasociety.wildapricot.org/%
!wendy.behary@gmail.com%

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