**Author’s Note: Other than public figures or people identified in the media, all other persons in this book are either composites of individuals the author has worked with and/or have been given different names and had their personal identifying information altered to protect and respect their confidentiality.
Cheri had called and set up the couple therapy for herself and her husband Jaymes. She said they have some communication problems they wanted to work on. Cheri got up quickly when the therapist came into the waiting room. About forty-ish years old, she could have been any suburban housewife, professional, administrator, nurse, teacher, and mother of three. Well-groomed and eager, she also seemed a bit nervous. "I'm Cheri and this is my husband Jaymes." Jaymes was about mid-forties- a large man. Jaymes looked up from the magazine he had been reading and slowly unfolding his formerly athletic frame from the couch. With a deep resonate voice, he said "Pleased to meet you," as he looked the therapist intently in the eyes. "Is it Doctor? I didn't see it on your brochure." The therapist clarified having a Masters level clinical license and hence, had not earned an honorific of "Doctor." When they entered the office, Jaymes veered off to look at the therapist's display of license, diplomas, awards, and other certifications. "Hmmm..." said Jaymes as he scrutinized the framed credentials.
Cheri quickly took a seat across from the therapist's chair, while watching Jaymes. After a half minute or so, the therapist said to Jaymes, "Have a seat," directing him to a chair next to Cheri. "Humph," grunted Jaymes as he left the credentials and sat down. "So, what brings the two of you here?" asked the therapist as a generic therapeutic opening. "Well," began Cheri hesitantly, "we've been married for ten years after being together for three years..." Jaymes interrupted, "We knew each other for three or four years, but we didn't get together until I started at marketing department at the tech start-up. So that makes it about one and a half years before we got married." "Anyway," continued Cheri, "we have some problems communicating, so we thought couple counseling might help." She looked to Jaymes for confirmation and for him to speak. Jaymes paused a moment, sighed, and began, "Yeah, Cheri has problems communicating what she wants to me and has trouble understanding what I want. She wanted to try counseling, so I thought I'd give it a shot."
The therapist asked Jaymes, "What do you think is not working well for you in the relationship?" "Well, I'm pretty ok unless Cheri has problems. You must have seen this stuff... these problems before... haven't you? How often do you do couple therapy? I see your diploma up there on the wall. I know they have a good engineering program and a prestigious business school. What's their reputation for psychology... or couple and family therapy... or whatever they call it to prepare you to be a therapist?" And for most of the rest of the session, Jaymes conducted an interrogation of the therapist's professional credentials: license, training, education, theoretical orientations, experience as a couple therapist specifically and as a therapist in general, and personal relationships and marital circumstances: married? divorced? break-ups? quality of relationship? Alternately feeling professionally naked and demeaned, the therapist felt compelled to defend hard-earned and well-deserved educational and professional credentials. It took a conscious and difficult effort, but the therapist was able to get a bit more background about their relationship before the session ended. At the end of the session, the therapist felt uneasy asking for the session fee due in no minor part to Jaymes' slight rolling of his eyes and barely perceptible sigh. In the next session, Jaymes began by identifying all the things the therapist did incorrectly in the first session! Ambush! Expecting invested and respectful, if nervous clients, the therapist instead had been ambushed.
The therapist could have been a licensed Psychologist with a doctorate degree and entitled to be addressed as "Doctor." That was not the issue. The therapist could have been educated at the most prestigious institutions, with multiple awards, publications, and acclaimed by professional peers. The therapist could have been a blend of therapist and theoretical icons such as John Gottman, Sigmund Freud, Virginia Satir, and Salvador Minuchin with a bit of Mother Teresa, the Dalai Lama, and Oprah Winfrey thrown in. Credentials, experience, and competency mattered less to Jaymes than his need to maintain superiority and avoid any vulnerability to potential criticism of an omnipotent self-image. Although, Jaymes and Cheri presented for couple therapy, the therapist had made a critical therapeutic error to assume that intimacy and connection were the mutual goals for therapy between the partners. Cheri had made a similar mistake many years before. Although Cheri thought she had found a wonderful life partner, as their relationship progressed she had discovered that Jaymes was instead like a scorpion in the bed. Whether one rolled on top of it or it crept silently and unsuspected under the sheets, it could strike at any time. While Jaymes verbally professed the same desire as Cheri for intimacy and connection, Cheri had regularly suffered the stings of Jaymes' deadly precise words inflicting cruel wounds upon her. He had another agenda over and above the partnership.
Similarly, despite professions of a desire to improve intimacy and connection, these were not really the mutual goal shared between the couple and the therapist. Although, both partners verbally and overtly aligned with intimacy goals that the therapist offered, Jaymes had more urgent lifelong needs that drove his behavior. Not just the first session, but also any effective therapy might be waylaid in the face of Jaymes compulsively asserting narcissistic goals. His narcissistic needs define himself and thus, also define the couple's relationship to a large degree. As a result, his narcissistic issues also completely would compromise if not sabotage couple therapy, if the therapist does not identify them. The therapist must to recognize the scorpion in therapy- that is, the narcissist in the session room. Or, the therapist will also suffer Jaymes' sting. The therapist got a taste of the sting in the first session. A sting is what a scorpion has. Stinging is what a scorpion does. Even if the therapist accurately diagnoses narcissism in one of the partners, and therapy shifts to include dealing with the narcissism, the process of therapy and successful therapeutic outcomes become significantly more difficult. Ignoring or missing the narcissism moreover, virtually dooms effective couple therapy. And will make the therapist question his or her own competence and/or become frustrated and angry with the narcissistic partner.
SEVEN DEADLY HABITS
William Glasser in the article "Counseling with Choice Therapy: A New Mental Health Model" (CAMFT Therapist, Jan/Feb. 2005) named seven deadly habits that sting. These habits can destroy all relationships. They are:
7. Bribing or Rewarding to Control
It would behoove partners and couples to reframe from or minimize these deadly habits. The couple therapist should therefore be alert for these deadly habits and work with the partners to eliminate such behaviors, as well as helping them develop positive behaviors. Glasser also names seven caring habits that he feels facilitate healthy intimate relationships. These are
Most couples and probably all therapists already know these two sets of relationship behaviors or habits facilitate or harm intimacy and trust. They know that they should not be "mean" or negative to each other, and that they should be "nice" instead. However, problematic relationships and consequently effective therapy is not merely about knowing what to do and not do. Partners who can refrain from negativity and being "mean" and can consistently act nicely and positively probably function relatively well and happily as couples. They are also less likely to need couple therapy. Or, if such partners have glitches in their relationships, they are more likely to activate previously learned communication and behavior to restore intimacy; or are more likely to utilize lay recommendations and pop psychology (including couples retreats, self-help books, relationship advice columnists, family, friend, or pastoral advice). When they realize that they are engaged in negative relationship damaging behavior they are able to follow the advice of Bob Newhart (YouTube, viewed January 6, 2012) in his comic skit as a psychotherapist. They can rather readily "Stop it!" And conversely, start it… start the nurturing healing behaviors that build intimacy and trust. Occasionally, relatively healthy partners arrive for couple therapy needing only some basic communications training and therapeutic guidance from the therapist. They also can "stop it." For example, refrain from the seven deadly habits. Or, "start it" by regularly and sincerely practice the seven caring habits. Couple therapy is easy efficient and both partners and the therapist feel fulfilled.
And then, there are the individuals who are difficult to work with although they may conceptually understand and articulate both the negative behaviors to avoid, eliminate, or minimize and the positive behaviors to activate and maximize consistently. However, in spite of such impressive recitation, they somehow cannot follow through in the couple's daily interactions. Criticizing, blaming, complaining, nagging, threatening, punishing, and bribing or rewarding to control among other negative behaviors may be regular dynamics in the relationship. Or they may only occasionally manifest but with vicious intensity… with emotional or psychological surgical precision in some cases or with gross brutally in other couples. Besides the poisonous sting, the deadly habits or aggression may be repeated pinpricks of being subtly discounted, control or domination- socially, physically or financially, emotional or psychological or spiritual water torture, or crude clearly brutal physical abuse. Resisting the seven deadly habits may be of particular difficulty for individuals with narcissistic tendencies or narcissistic personality disorder. Many of the therapeutic approaches and theoretical orientations to couple therapy can be waylaid by narcissistic energy from one or both partners in a couple. The therapist could barely get past a generic opening question with Jaymes before being overwhelmed with narcissistic defense mechanisms. Resistance, manipulation, and intensity can ambush the therapist who fails to note narcissistic personality disorder or narcissistic tendencies in the relationship. These issues can be anticipated and more effectively incorporated into the therapy. The therapist may be unfamiliar with narcissistic personality disorder and/or have frustrations that he or she did not recognize originated from narcissistic issues in a client.
Guidance from other therapeutic assessments may also be significantly complicated by narcissism. For example, an indicator of marital satisfaction is seen in the degree "to which partners differ in their respective levels of social individuation. It appears that, in such mismatched dyads, it is the partner who is high on social individuation who is the more dissatisfied, presumably because the low social individuation partner fails to respect the strong distinction between self and other ('what's mine is mine and what's yours is yours') that the high social individuation partner needs to establish and maintain" (Charania and Ickes, 2007, page 205). The individual with very high social individuation may also be a narcissistic individual. His or her status and success is his or hers alone. "With regard to social individuation, it is important for counselors to know that individuals who score high on social individuation find it difficult to be satisfied in a relationship with a partner who seems to habitually ignore, discount, or otherwise fail to respect the strong distinction between self and other that these individuals need to establish and maintain. In therapy, this is often referred to as the issue of 'boundaries,' and the availability of our social individuation measure might make it easier for counselors to identify those couples for whom this issue is likely to be a continuing problem" (Charania and Ickes, 2007, page 206). The complementary characteristic is social absorption or the degree to which individuals are interdependent. Someone low in social absorption would tend to have issues in an intimate relationship since "an individual who habitually resists becoming behaviorally interdependent with others would be uncomfortable and relatively dissatisfied in a marital relationship because the marital relationship is the quintessentially interdependent relationship." Despite Jaymes' off-putting behaviors with the therapist and his instinct to criticize Cheri, he also wanted and was challenged by the intimacy the relationship offered... or demanded.
The narcissist would find being dependent in any form, including interdependence challenging to his or her sense of omnipotence. He or she would minimize what may be substantial contributions to his or her well-being or success from the non-narcissist partner. Getting the narcissist to give more than perfunctory and insincere appreciation to his or her partner may be very difficult. This can become very difficult over time, as the partner may be very high in social absorption. The relationship would likely not be reciprocal and the inequality of support can erode relationship satisfaction. This was true for Cheri who found their early relationship satisfying but more and more felt unfulfilled over time. "The big question, of course, from a therapeutic standpoint, is how to help improve satisfaction in marriages in which one or both partners are low in social absorption. Should you try to help partners who are low on social absorption to learn to tolerate, and even enjoy, greater interdependence, or should you try to help the partners of individuals who are low on social absorption to learn to tolerate, and even find things to value in, their partners' strong need for behavioral autonomy?" (Charania and Ickes, 2007, page 206). The narcissist would find therapeutic guidance to tolerate greater interdependence to be fundamentally ego dystonic. Valuing the partner may be difficult unless he or she is serving the narcissist. Service is considered his or her entitlement rather behavior to be appreciated. The narcissist may find a low social absorption partner tolerable if the narcissist's needs are met and the partner makes little or no demands for anything. Reciprocality however is not something the narcissist believes in or practices.
Further complicating using social individuation and social absorption to assess a couple with a narcissistic member, can be the marked difference between the narcissistic behavior that resists dependence and the underlying narcissistic wounds that crave attachment. Deep wounds cause the narcissist to fear disappointment and crushing pain from risking and losing closeness. Social individuation and social absorption would then be more complex to assess in the narcissist. There may be inherent problems in a couple with a narcissistic partner. On the one hand, the narcissist may be high in social individuation/low in social absorption- he or she after all is '"special." The non-narcissist partner who gains his or her identity and self-esteem in the narcissist's status and behaviors may have low individuation/high absorption. While this works for the couple- often earlier in the relationship, the non-narcissistic low individuation/high absorption partner's emersion in the narcissist's activities may trigger the narcissist's need to separate and maintain autonomy. As a result, the issue of boundaries is inherently complicated between the partners. The narcissist, such as Jaymes both desires the other partner's adulation, but may be smothered and threatened by it. The other partner subsumes his or her ego to the narcissist's needs but eventually becomes resentful of being deemed insignificant. High social individuation/low social absorption behaviors may be hiding high social absorption desires for closeness in the narcissist. These contradicting energies may confuse both the partner- Cheri, for example and the therapist.