Wendy Behary, M.S.W.

Wendy Behary: Schema Therapy for Narcissism

By Lynn Mollick

              On July 29 at Café Vivace, Wendy Behary addressed a sold-out audience of NJ-ACT members on using Jeffrey Young’s Schema Therapy for treating narcissism. (We apologize to members who were turned away.)

Schemas & Schema Modes

              Wendy explained that narcissistic patients believe that “no one can love me for me.” Defectiveness/Shame is their fundamental schema. These patients experience the following additional schemas: Mistrust/Abuse, Emotional Deprivation, Social Isolation, Subjugation, Unrelenting Standards, Entitlement/Grandiosity, and Insufficient Self-control.    

Schema Modes are clusters of schemas that become active when narcissistic patients experience strong emotions. These patients commonly experience three Schema Modes: 

            1) The Lonely Child whose self-esteem is easily injured and feels unloved, average, and isolated.

            2) The Self-Aggrandizer who is competitive, status-seeking, and critical of others and who feels and acts superior. 

           3) The Detached Self-Soother or Self-Stimulator who overworks, talks intellectually and compulsively, and/or abuses drugs.  

Treating Narcissism

            Schema Therapy focuses on Schema Modes rather than the individual schemas. In treating narcissism, one important goal is to develop and strengthen the Healthy Adult mode. The Healthy Adult mode can then:

            1)  Help the Lonely Child feel understood and accepted so that the patient can understand and accept others;    

            2)  Confront the Self-Aggrandizer and help the patient give up entitlement and the excessive need for approval; and

            3)  Weaken the Detached Self-Soother/Self-Stim-ulator by teaching mindful acceptance of negative affect and developing better interpersonal relationships. The Healthy Adult replaces the Self-Soother with true nurturance and self-acceptance. 

            Effective treatment requires narcissistic patients to experience the feelings of vulnerability characteristic of their Lonely Child Mode. Because these feelings are almost always out of the patient’s awareness, Wendy recommended using imagery, flash cards, and  role playing to help patients experience their Lonely Child mode.

            Imagery: Ask the patient to imagine, describe, or recall situations which evoked or will evoke the Lonely Child.

            Flashcards include statements that describe the Lonely Child mode and the Healthy Adult response. These cards can be either written cards or oral recordings. Patients should refer to these cards between sessions whenever they experience their Lonely Child.

            Role playing: First the patient articulates the Lonely Child’s thoughts and feelings, and the therapist responds as the Healthy Adult, nurturing the Lonely Child. Later the patient and therapist reverse roles.

The Therapeutic Relationship

            Wendy recommended discussing the narcissistic patient’s interactions with the therapist. She warned that patients’ narcissistic behaviors will evoke the therapist’s dysfunctional schemas and may lead to therapeutic blunders. 

            To work with the therapeutic relationship effectively, therapists must remember that the patient’s offensive behavior is rooted in feelings of worthlessness. Wendy recommended “empathic confrontation” to:

            1) Address approval-seeking and criticism of the therapist;

            2) Help patients identify schema modes as they arise in session;

            3) Help patients experience their feelings of vulnerability; and

            4) Reveal the therapist’s emotional reactions, especially feeling hurt by narcissistic patients’ criticisms and attacks, to help patients understand how their behavior affects others.

            Narcissistic patients produce low scores on Young’s Schema Questionnaire and frequently deny they need therapy. They are usually referred by family members, friends, or courts. Therapists must remind these patients of the negative consequences they are likely to experience if they do not change. At the same time, therapists must avoid shaming the patient. It’s helpful to say “it’s not your fault you’re this way, but it’s your responsibility to fix it.” 

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