7. Partner Matches w/Narcissist - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Scorpion in the Bed, The Narcissist in Couples and Couple Therapy
Chapter 7: PARTNER MATCHES WITH THE NARCISSIST


In the midst of not liking the individual with narcissistic personality disorder and liking the partner, the therapist may once again wonder why the partner has chosen and stayed with someone who is alternatively charming and annihilating.  The question may be "How is it that someone who seems relatively intelligent, personable, capable, and often attractive by most social criteria, would tolerate such unpredictability and abuse?"  The answer in part is that the individual with narcissistic personality disorder may find someone with one or another personality disorder that "matches" up or has motivation to tolerate the problematic behavior.  Couple therapy is often difficult. Working with someone with narcissistic personality disorder is often difficult in individual therapy.  Working with a couple with a narcissist partner is often even more difficult.  Further compounding couple therapy is the partner to the narcissist, often has significant emotional, psychological, and mental dysfunctional processes as well.  The narcissist seeks out relationships that maintain and maximize his or her grandiose stance.  In childhood, "His friends are his admirers, people who will reinforce this sense of self and help maintain feelings of esteem. If he does have a special talent then he will indeed utilize this to the utmost, and seek to capitalize on it. To the extent that circumstances permit, he will be a snooty, stuck-up show-off, a snob, and a vain, self-centered, self-congratulatory peacock. After all he has something others want, and they will have to pay to get it in the only coin that counts; they must laud him, be obsequious, fawn upon him, heap adulation on him, or otherwise act to reinforce the sense of specialness and vanity" (Noshpitz, 1984, page 22).

As the individual matures and becomes interested in intimate romantic relationships and/or the social expectation is of the individual partnering up at a certain age, the basic requirements for friends are applied to the couple's relationship.  Somehow both the friends and the partner must endure narcissistic behavior such as condescension, "insulting others' intelligence, refusing to go out with someone who was not 'good enough,' avoiding talking to people who were 'low life,' associating mainly with high-status people, pointing out the faults of others) and extreme attention to one's physical appearance (watching one's biceps, looking in a mirror while talking to others, commenting on weight loss, walking around with one's chest out, frequent grooming" (Buss and Chiodo, 1991, page 201).  The partner puts up with the narcissist's self-absorption.  When the partner gets attention, he or she gets put down subtly or overtly depending on the narcissist's relative charm and/or the presence or absence of witnesses.  The therapist needs to resist being similarly treated.  "Two of the primary indicators of NPD are a grandiose sense of self-importance and strong feelings of entitlement (American Psychiatric Association, 2004).  A partner who fits most compatibly with these traits is one who feels grandly unimportant, inferior, and unentitled.  Though two such people may match well, the relationship is not mutually advantageous or supportive, and it can be quite dysfunctional.  Oldham and Morris (1995) recommended individuals with dependent and 'self-sacrificing' personalities as good matches for the individual with NPD because such giving individuals 'find happiness in fulfilling the needs of others' (p. 94).  On the other hand, these authors specifically warned that the needs of individuals with dependent and self sacrificing styles will go unmet by an individual with NPD" (Boldt, 2007, page 147).  The other partner however will have endured his or her needs being unmet for often many years before entering into therapy or beginning to consider ending the relationship.  Or, is tired of the repeated sting of disrespect and mistreatment.  On the other hand, despite years of enduring second-class status, he or she may come to therapy still committed to find ways to stay in the relationship.

PLEASER
Boldt (2007, page 148-49) described "Joan was overcooperative and too giving, a 'doormat,' a Pleaser who always put others first. Her husband, Pete, demanded that she limit herself to taking care of the children, keeping the house spotless, and attending to his social and sexual needs. She gave up her own interests and preferences, putting them dead last, with the emphasis on 'dead.' She might have liked a little more respect for her own needs, but as an exhausted, over-extended 'superwife' and 'supermom,' she barely noticed the loss. Although she was anxious and depressed, she hid her feelings because her husband reacted to them with anger and accusations that she was useless. He demanded that she be happy and content with the upper-class life that he had given her. Depleted by her exhaustion, the continuing lessening of her self-esteem, and the constant focus on pleasing him, her feelings of helplessness increased. As Pete became more and more critical and emotionally abusive, Joan became more anxious to please. The more she tried to please him, the more demanding, selfish, unemotional, and hard-to-please he became. Having lost touch with her self-esteem, she agreed that her inability to please him was her fault. His angry outbursts and verbal abuse raised such fear that she obsessively tried to keep him happy. The more submissiveness Joan exhibited, the more contemptuous and abusive Pete became."

This type of person's goal is to maintain the relationship at all costs.  He or she does the majority of the work to sustain the relationship.  Having love and approval from the partner is essential.  The narcissist demands and dominates and this partner attempts to "please and give and elevate" the narcissist.  He or she feels inadequate and unlovable.  Anticipating what pleases the other person is a way to get the approval that his or her worth depends on.  He or she always tries to be what the other wants him or her to be- nice and cooperative all the time.  Despite being treated badly, others are always put first in order to keep the relationship.  Others determine whether or not he or she is okay based on if he or she has pleased by them.  The pleaser follows others who are always better than him or her.  They set the rules and mood and have the relevant opinions. "The Pleaser makes a perfect partner for the self-centered, self-absorbed, and demanding person who- must-be-superior. The person-who-must-be-superior will reaffirm the partner's belief that pleasing him or her is the only worthwhile goal in life."  The Pleaser is extremely good at reading people.  He or she will often desperately seek others approval in a variety of manners.  "The Pleaser can display worthlessness, use flattery, or perform humiliating favors to bribe the person-who-must-be-superior to be nice back to him or her. The Pleaser is like a chameleon with no real sense of self so" (Boldt, 2007, page 149).

The narcissist readily discounts the Pleaser's opinions, feelings, and interests.  This disapproval or rejection is devastating, but the Pleaser may also be very used to it.  The Pleaser intensifies the pleasing behavior, which feeds "the person-who-must-be-superior's hollow self-esteem even more. The Pleaser's thoughts and interests are too other-centered. Focusing only on the person-who-must-be-superior, the Pleaser neglects his or her own needs and makes excuses for the person-who-must-be-superior's lack of empathy. The Pleaser prefers to keep an emotional distance because it provides some insulation against the rejection, disapproval, and criticism that seems only one displeasing step away. Occasionally, the person-who-must-be-superior will exhibit short-lived kindness and thoughtful ness toward the partner. This keeps the Pleaser working nonstop to please the person-who-must-be-superior. Anger is a dangerous emotion for the Pleaser as it threatens the relationship. The Pleaser only gets angry with himself or herself for failure to please. Anger is useful to the person-who-must-be-superior because it intimidates the partner and keeps him or her compliant" (Boldt, 2007, page 150).  Although the therapist may find the Pleaser attractive and likable, when interventions to have greater self-esteem and resist placating self-demeaning behavior are ignored, he or she becomes likely to lose respect for the Pleaser.  How and why someone becomes a Pleaser would be a significant and often involved process of individual therapy.  In couple therapy, this has to be processed simultaneously with the problematic dynamics of the partners.  The common recommendation for partners to first go through individual therapy reflects the complications.  It may be that the partner who had been a Pleaser through life and the relation had gone through individual therapy and/or some other formative growth process and is now less willing to continue in the role.  This would be the potential impetus that has disrupted a previously operational dysfunctional system.

VICTIM
"Dave operated from childhood as a casualty Victim, knowing only how to submit to or hide from abusive others. Married to Carol, an abusive wife, Dave recognized his pain, but he felt helplessly paralyzed. He was isolated, suffering, and he had never learned to defend himself in any effective way. As the abuse and fear grew, Dave could not think of effective ways to protect himself and reverted to his childhood strategies of hiding or submitting. Perhaps, he thought, he was just destined to suffer. Focus on his past kept him feeling helpless and believing that others were very powerful. The only way he had learned to communicate deeply about himself was centered on the painful experiences of his life, subjectively all he had. He believed he could only get attention and love by appealing to the pity and affection of people who liked to be heroic lifesavers. But when they protected and pitied him, they only increased his helplessness and feelings of inadequacy. Some even did this purposefully. They also strengthened his focus on his injuries and suffering rather than on building strength and recovery. On the rare occasion when Dave tried to fight back, Carol's vicious retaliation resulted in more injuries and stronger feelings of helplessness for him" (Boldt, 2007, page 150).  The Victim's basic relationship goal is to gain attention or love through others' pity for his or her suffering.  The other person is always the powerful character, while as the Victim he or she is weak and helpless.  Believing him or herself to have not power or control over what happens and innocent and naive, he or she feels perpetually in danger.  Life is hostile to the Victim as he or she is a targeted for some special reason.  Other people are either victimizers or saviors.  "The helpless, powerless, and inadequate self-image of the Victim makes him or her extremely vulnerable to the seductive dominance of the person-who-must-be-superior."

Since the Victim feels so vulnerable, he or she is attracted to the cocky and assertive energy of someone with narcissistic personality disorder as a powerful protector.  Being submissive to this person is an acceptable trade for protection.  When verbally, emotionally, or otherwise abused, the Victim can be easily convinced it is his or her fault and/or accept an apology and promises that the behavior is an aberration and will not reoccur.  "The Victim's expectations that life is dangerous, that he or she will be hurt by an abuser and then attended to by a protector, come to life in this cycle. The Victim will stay in the cycle because, paralyzed by fear, he or she is not even aware that he or she has the power to leave such a relationship. Further, he or she knows no other way to get attention, pity, or love. If the Victim tries to take some action, he or she may stand up to the person-who-must-be-superior and fight.  When the Victim loses the battle to the person-who-must-be-superior's rage, the Victim's feelings of helplessness and victimization are reinforced with hopelessness and the cycle continues.  As abuse and love may be unfortunately interrelated in the Victim's mind, he or she does not realize that loving attention should come from compassionate, kind people" (Boldt, 2007, page 151).  The Victim can be depleted by the narcissist and become habituated to an emotionally negative and barren existence.  He or she can be so used to suffering to lack awareness of personal suffering or imagine any other existence.  Thus, the narcissist can continue to exploit and abuse the Victim and keep him or her in perpetual state of fear.  The therapist intuits that the self-perception of helplessness and the role of Victim must have earlier antecedents in his or her life.  As in the case of the Pleaser, the Victim may have begun some process of growth to gain some inkling of self-empowerment.  Entry into therapy may reflect a fundamental but tentative shift towards a different identity.

POTENTIAL FOR VIOLENCE
The therapist may find that an individual can be so familiar with mistreatment that he or she is ignorant or in denial regarding abuse suffered.  Or, the individual may feel that his or her mistreatment is deserved.  Acknowledging the abuse becomes tantamount to being exposed as a deeply flawed partner.  As a result, he or she can become a convenient or available Victim to someone driven by narcissistic needs.  The therapist may get not overt indication of domestic violence from the histories of the relationship as presented by either partner.  Both partners may collude to present a relatively benign pattern of misunderstandings and miscommunications bringing them to therapy, as opposed to coming because of domestic violence.  Upon specific direct questions or with a slip of the tongue, one or the other may admit to some physical contact.  The therapist must be alert to the possibility of domestic violence when first sensing narcissistic energy in a partner.  "In a review of the literature, Craig (2003) identified the male individual with NPD as one type of perpetrator of domestic violence. Safety is the critical issue in cases of abuse. Therapists should follow a treatment protocol for domestic violence (e.g.. Walker, 1996) and be sure the client is safe. In this case, treatment must always be conducted on an individual basis. Even in the absence of physical abuse, couple therapy easily becomes another way the person-who-must-be-superior can oppress and verbally abuse his or her partner while trying to impress and look superior to the therapist. Partners are almost always suffering from acute or chronic traumatic stress, so the abused person can appear to be the 'problem' with such symptoms as anxiety, depression, or obsessive and rigid behavior (Cascardi, O'Leary, Lawrence, & Schlee, 1995)" (Boldt, 2007, page 153).  

The therapist needs to remember that individuals with narcissistic personality disorder may be more likely to act out aggressively.  Their vulnerable sense of self and intractable patterns for coping presupposes them to be triggered by narcissistic injuries.  Deep frustration and intensive rage erupt when carefully constructed but fragile narcissistic mechanisms are challenged.  Since such individuals often need consistent outside positive confirmation from his or her intimate partner (or associates, employees, etc.), the absence or failure of such validation can be experienced as an intentional rejection or abandonment.  The consequence is entitlement for emotional rage and aggression.   "This is understood as an effort by these individuals to reestablish their usual sense of self-integrity and well being. Self-righteous rage requires revenge, or punishment of the offender, in order that humiliation is repaired and a sense of self, although infantile and grandiose, be reinstated. Noshpitz characterized these individuals' experience of narcissistic injury as equivalent to a territorial threat and, therefore, a threat to the literal survival of the self.  Aggression in these patients is their necessary and often only form of 'self-defense.'  For individuals with a pathological narcissistic self-structure, suicidal and homicidal behaviors may become equivalent final common pathways depending on the availability of a selfobject to blame and the availability of depleted grandiosity or primitive defensive options" (Watson et al., 1994, page 611).  

While the narcissistic rage may "only" express in emotional, mental, and spiritual aggression, the therapist needs to be vigilant about the increased possibility of physical violence.  Many narcissists are very charming and present extremely well socially.  They would tend to be on their best behavior in couple therapy and attempt to "seduce" the therapist.  As with the couple's relationship, the therapist-client relationship with the narcissist can be very smooth and pleasant until there is stress.  While the narcissist may restrain him or herself in therapy, at home such restraint may not be practiced.  The narcissist holds very deep issues that are often beyond his or her awareness, or have been rationalized and compartmentalized outside conscious feeling.  The potential for impulsive acting out comes from "…the differential inability of these patients to identify and express affect specifically related to the recent narcissistic injury.  The evaluating clinician may tend to be reassured by the patient's lack of expressed distress and, therefore, have a propensity to underestimate the risk of potential violence" (Watson et al., 1994, page 618).  While aggressive hurtful behavior may be impulsive, its manifestation may range from being very cool, dispassionate, and quasi-rational to very heated self-righteous anger.  The difference in expression represents individual patterns among different narcissists.  Some individuals consistently express coldly and others express consistently rageful.  Or, there may be a range of expression within one individual with both cool and hot expression depending on mood, circumstances, overall stress, and degree of disinhibition due to alcohol use, for example.  Impending separation such as divorce may intensify the overall stress and degree of narcissistic injury and could create greater potential for violence.

Watson et al. (1994, page 618) offered the following clinical profile of impending violence: 1. Narcissistic personality disorder or severe narcissistic traits;  2. Recent or current narcissistic injury-often involving rejection by a loved one;  3. Inability to acknowledge painful or angry affect related to the injury;  4. A history of episodic, behavioral dyscontrol or impulsivity when under stress;  5. Availability of a weapon.  High narcissistic individuals who have recently suffered a narcissistic injury caused by an intimate partner may not have sufficient self-awareness to attempt resolving the hurt.  Such individuals would unknowingly tensely hold the wound making them prone to being provoked by some later incident or perceived threat.  The therapist may note "observable emotional distress, but an inability on the part of the patient to identify this distress."  This "combined with the availability of a weapon, complete a picture of an individual at risk for violence toward himself and/or the individual perceived to be responsible for the injury. The absence of an available offending selfobject for individuals in this same circumstance may be just as worrisome for impending suicide" (Watson et al., 1994, page 621-22).

The therapist may have difficulty recognizing rage beneath the surface and potential subsequent violence.  Narcissist individuals while prone to narcissistic injury and resultant rage and aggression, do not necessarily show a general pattern of rage and aggression.  The "identifying appropriate affect was confined to the particular injury and subsequent rage they were facing."  Emotional responses to other non-narcissistic hurtful issues in their lives tend to be socially appropriate.  They also do not have aggressive fantasies that may be typical of habitually violent individuals or paranoid individuals.  Narcissists have difficulty in identifying personal rageful or aggressive aspects.  "Bursten…describes the need to idealize significant others in the face of aggressive behavior toward them.  Idealization of the significant other, as well as of the relationship, must be maintained in order to insure a sense of self, and therefore, the anger and wish for retribution must be split off and not recognized.  Evidence that spouse batterers score lower on anger scales and that violent offenders express less aggression on projective testing than nonviolent offenders further supports the notion that some people prone to commit violent acts toward important others may be unable to face their rage."  

While some narcissists are aware of shame and rage and at risk for violence, some individuals are not and cannot be aware or own their vulnerability to injury.  Since they are unaware or deny narcissistic vulnerability and their potential for narcissistic injury, they circumvent not just personal introspection but also therapeutic intervention.  "Their painful affects cannot be directly addressed, thus limiting the clinician's ability to safely assess their dangerousness. Furthermore, the patients themselves are less able to identify these feelings and draw on available support to ease their pain" (Watson et al., 1994, page 618). As opposed to chronic violent offenders who seem to have absent or insufficient control of aggressive and violent emotions, some narcissists may be characterized as being over-controlled.  They may lack a history of violence in school, the community, and in the relationship.  However, when the reality of control and the illusion of security and grandiosity are broken down during a volatile interaction with the partner, the pent up frustration and rage can be explosive.  The therapist should be alert the possibility of violence of highly controlling narcissists without a history of violence and in the absence of overt threats, if and when that control is threatened.  Not only would the possibility of divorce constitute a devastating threat to narcissistic vulnerability, but entry into couple therapy and ones exposure to a third potentially critical party- the therapist, be similarly triggering..  The author's book- "How Dangerous is this Person?" is available at https://www.smashwords.com/books/view/313775 for a more extensive discussion of narcissistic violence along with a wider spectrum of assessing for danger or violence potential in individuals.  

MARTYR
"Pat gravitated toward the self-defeating side of the Martyr.  Her husband, Fred, was often drunk and harshly demeaning, but she bravely suffered his insults.  When he demanded her full attention, she willingly gave up her own interests. When he punched her, she endured. When her children encouraged her to leave their father, she clung to her religious ban on divorce and proclaimed the righteousness of her cause to them and to all who would listen.  Pat made a public display of her suffering, and it gave her social power and rewards she had never experienced. Some saw her as a saint for putting up with Fred, expressing their admiration of her endurance. Her devotion to her cause of converting her alcoholic husband was so rigid that it consumed her life, but she felt the suffering was worth it. By putting all her focus on this cause, Pat avoided the responsibility for the direction her own life should take and felt noble while doing so" (Boldt, 2007, page 151-52).  The Martyr works against his or her self-interest.  The goal is to willingly suffer for some imagined higher purpose with some later reward for the sacrifice.  He or she looks to another for opportunities for suffering (even death) based on this belief system.  The rigid moral code makes the Victim noble and superior to others who are unwilling to suffer… and will not be rewarded later since they hold no great cause.  Enduring a difficult or miserable life is desired to serve some ideology.  Getting others to join in his or her martyrdom is important.  Yet, the Martyr believes that he or she will get paid back for all the sacrifices and suffering.

It is not surprising that the narcissist can find the Martyr appealing.  "The self-defeating Martyr attracts exploitive partners with his or her excessive self-sacrificing behavior, and he or she discourages those who would provide comfort or appreciation.  The Martyr believes that suffering eventually brings a reward, so he or she actively puts personal needs in last place and naively overlooks his or her partner's oppression and abuse. The unconscious attitudes about the value of suffering make the Martyr very vulnerable to the worst kind of abuse. Unfortunately, the abuse the Martyr receives is more a reinforcement to endure and suffer than a deterrent to the relationship. A zealous devotion to unfortunate causes may lead the Martyr to try to convert the person-who-must-be-superior.  The person-who-must-be-superior has enough of what looks good to be the 'right' cause and enough 'bad' for the Martyr to convert to goodness.  However, the Martyr's attempts may be dangerous because criticism usually enrages the person-who-must-be-superior" (Boldt, 2007, page 152).  The disruption of changing the rules of the relationship (while simultaneously and contradictorily, trying to maintain the core roles of Martyr and superior) may be the reason to enter couple therapy.  However, when the therapist offers guidance to reduce his or her suffering, the Martyr may be very resistant.  Suffering is key to the Martyr's identity and critical to future fulfillment.   Beyond not avoiding mistreatment, he or she may seem to instigate it.  It becomes easy for the therapist (and others) to blame the Martyr for the choices that cause the pain.  "The Martyr engages in these behaviors because he or she has been taught that standing up for one's beliefs leads to victory over life, to sainthood, and to immortality.  A self-defeating Martyr has also learned that these behaviors lead to attention, sympathy, and moral superiority.  Some self-defeating Martyrs believe they are so bad that only the worst kind of suffering can redeem them" (Boldt, 2007, page 153).  The therapist may also find him or herself validating the martyrdom by feeling sorry for him or her.

STRATEGIES FOR PLEASER-VICTIM-MARTYR PARTNERS
In addition to general strategies presented by Kohut and Kernberg, the therapist should integrate specific strategies to deal with the high fragile self-esteem of the narcissist.  The narcissist arrives in individual, couples, or family therapy sometimes because self-esteem and self-worth has crumbled in the harsh reality of life and relationship problems.  Drugs, alcohol, or other dysfunctional behavior has seeped into life destructively. The partner is often a co-addict, enabler, or otherwise intricately involved as a complementary agent.  This is tough therapeutic work with deeply narcissistic issues accompanied by dysfunctional partner issues.  The therapeutic conversation can easily be drawn into addressing behavioral choices and patterns of behavior as an individual and in relationships.  Enduring behavioral change that lead to functional living, remains important to assessment and the ultimate goal of therapy.  However, the therapist needs to work on several parallel courses simultaneously.  Both partners have his or her distinct but complementary underlying issues as well as the relationship issues.

"To create sustainable change, Glickauf-Hughes and Wells suggest differentiating the intrapsychic from the interpersonal aspects.  In terms of intrapsychic aspects, the authors discuss the importance of helping the masochistic individuals learn to ask for their dependency needs more directly.  They tend to be ashamed of these needs and mistrustful that others can meet these needs.  The marital work can be quite successful if the therapist focuses on the masochistic individuals, helping them be more assertive and gain increased self-esteem.  This can be done concretely through helping them gain better self-assertion skills and by pursuing various things in their lives that provide self-esteem.  As a result, they will give up some of this need to live vicariously through their partners.  The masochistic partners can be given permission to accept some pleasure from the successes of the narcissistic partners" (Links and Stockwell, 2002, page 527).  The challenge of this approach lie partly in how willing the partner is able to risk becoming more powerful and assertive in the face of the narcissistic partner.  If the partner is intimated, then therapist directives may be subverted.  The intensity and degree of embedded habit to defer to the narcissist may run deep from childhood experiences of domination by powerful authority figures. The partner may be so intimidated and fearful of the narcissist's potential rage and likelihood of punishing him or her that following through being more expressive and assertive can be difficult.  This adds to the challenge of this approach but does not eliminate the theoretical validity of the approach.  Sudden or extensive changes may not be possible because they disrupt the existing balance too extensively.

The Pleaser may be similar to or the same personality that Links and Stockwell refer to as the masochistic partner.  The orientation of the Pleaser to meet the needs of others can be mutually beneficial if both partners are Pleasers.  However, it can become masochistic when the other person is narcissistic.  The Pleaser seeks reciprocal caring that may be lacking with the narcissistic partner.  Boldt (2007) suggests the following tactics for working with the doormat Pleaser.

1. In keeping with the central theme of the Pleaser, help the client to move toward a more flexible, common-sense goal and become a Pleaser who pleases himself or herself as well as others. The client can still find a place in life by being the one to maintain warm and happy relationships, but the give and take is balanced.
2. Educate about the give and take in balanced relationships and establishing healthy priorities. Was there a parent or other adult who was supportive and loving?  This is a history to tap into to find support through difficulties.
3. Develop a sense of Who I Am. This can be done with such exercises as journaling (Pennebaker, 2004), lifestyle exploration (Powers & Griffith, 1987; Shulman & Mosak, 1988), or any exercise that encourages positive self-reflection.
4. Teach and practice assertiveness skills that help the client learn that there is a position between submission and aggression.
5. Have the client develop his or her own list of needed changes. If it is your list, the client may only be pleasing you and not making any real changes.
6. Help the client find or create environments where it is safe to practice expressing his or her opinion, making his or her own decisions, and expressing his or her anger or frustration assertively (Boldt, 2007, page 154).

Boldt suggests the following tactics for working with the casualty Victim:

1. Listen to the client's story with compassion about three times. Three is usually enough. Make certain the client knows that his or her experiences with dominant, aggressive, and abusive others are not acceptable. They should never have happened.
2. Eventually, switch the focus from compassionate witness of the client's stories of injuries to what he or she is willing to do to move toward the solution and healing of the injuries. Movement toward "survivor" means healthy acceptance of difficulty and pain while learning self protection.  The client needs to know that the clinician can initially be of help in getting him or her to safety. But the client also needs to know how to make the changes that will increase self-help.
3. Be sure the client can identify the red flags that signal abuse in relationships.
4. Educate the client about healthy relationships and help eliminate beliefs that keep him or her away from relationships that are based on love, mutual respect, and equality.
5. When the client is ready, encourage the recognition that while difficulties and pain are inevitable parts of life, suffering is optional (see FrankI, 1970).
6. Initiate the process of forgiveness. Forgiveness is for the client, not for the abusers. It does not mean to forget. The client should remember what happened in order to avoid such relationships in the future. Forgiveness means understanding and letting go of the past, so it eliminates the ongoing power of the abuser over the victim.

Boldt also suggests the following tactics for working with the self-defeating Martyr:

1. Because the client is averse to seeking help, ask what he or she would like from therapy and how you can help. The client may not know exactly what he or she wants from therapy, but he or she does know what kind of help is tolerable.
2. As long as the client is safe, in keeping with the Martyr personality style, respect the suffering and do not try to take it away. Encourage movement toward ways the client might be a useful example in society through defending his or her beliefs.
3. Help the client recognize his or her authentic goal and live out his or her highest values.
4. Encourage the client to develop a sense of personal direction in life.  Can he or she explore his or her personal journey and discern its path?  Spiritual direction, life lines charts, or journaling exercises help.
5. Work on problem solving, especially Whose Problem Is It, Anyway? This may allow the client to use generosity to others in an appropriate way, without giving too much of himself or herself.
6. Help the client make himself or herself the "cause" and do the work, as difficult as it may be (emphasize "difficult") to make the self a worthwhile cause. The client's skill is in transcending the painful and inevitable problems of life and death, so the difficulties of change are no obstacle (Boldt, 2007, page 154-155).

The masochistic individual or the Pleaser, Victim, or Martyr can be someone with a personality disorder such as dependent personality or borderline personality disorder.  Boldt's suggestions are very sound but can run headlong into the characterological challenges of the partner, as well as the resistance of the narcissistic individual.  Abandonment or rejection anxieties or insecure adult attachment styles can cause the individual to sabotage or avoid therapist attempts to empower the individual to be more assertive in self-care and a more balanced relationship.  Asserting self-worth may have been very difficult for the partner from esteem deficits from deep in his or her development.  A warped sense of identity as the Victim or Martyr may be wrapped around accepting negative treatment from the narcissist.  Boldt makes final recommendations starting with a qualifying clause, "Once safety has been achieved and the client is ready to take action…"  The challenge with the partner of a narcissistic is that safety can be extremely difficult to achieve.  His or her inherent insecurity prior to getting involved in the relationship, and the tiptoeing on eggshells over years for fear of triggering narcissistic rage will carry over and through the therapy process and attempts to change.  Nevertheless, Boldt's recommendations remain sound.  They include the following:

1. Help the client make use of anger, anxiety, and depression as signals to change. This can help defeat feelings of powerlessness and fatigue which accompany them.
2. Outline the changes the client thinks are necessary but be sure to ask the client what change(s) he or she is willing to make. This discourages dependence and continued suffering and shows faith in the client's abilities. It can be the beginning of empowering him or her to take action.
3. Be patient. Given the isolation, submissiveness, and aversion to asking for help that is characteristic of these personality styles, the client has already shown great courage by seeking help. Allow him or her to proceed at his or her own pace.
4. Explore creative interests from childhood and encourage the client to rekindle them. Childhood may hold more clear memories of contented interests and worthwhile passions lost in this abusive relationship.
5. Encourage the inherent strengths of the personality that help develop or restore self-esteem, creativity, and capability (Boldt, 2007, page 153-54).

The therapy would thus attempt to shift the partner fundamentally from who he or she had been in the relationship.  If he or she had been able to different in the first place, joining or staying in the relationship with the narcissist hypothetically would not have occurred in the first place.  A more powerful person who was tolerant of being alone and brave enough to confront inequities would not have been acceptable for the narcissist either.  In addition, the narcissistic individual would have to have the capacity to allow for the partner's personal growth and re-balancing the relationship that fundamentally means his or her getting less.  Or, he or she would have to allow for self-definition and worth to be challenged.  "The narcissistic individuals can be helped to give up some of their grandiose goals and to experience and accept some of the unwanted parts of their own dependency needs. Narcissists can be guided to foster and endorse some of the independence of their masochistic spouses in order to avoid feeling engulfed or smothered" (Links and Stockwell, 2002, page 527).  This recommendation is conceptually simple but often highly complex in practice.  The therapist may need to seek small incremental evolution of assertiveness, while managing the couple's reactions to the changes.  Specifically, the therapist needs to manage the narcissist's reaction of being challenged and the other partner's hesitant desire yet deep yearning for change.  This means that intrinsic to empowering the partner, the therapist must also facilitate the narcissist's ability to tolerate the challenge and modulate problematic narcissistic responses to the threat.

The therapist needs to stay aware of the long-term dynamics of the couple.  Every behavior, action, and reaction is embedded in compelling patterns that have served the couple, however dysfunctionally and at great cost.  The patterns may have arisen unconsciously and/or been accepted without overt examination over many years.  They have "worked" well enough until recently, and the partners have been either ignorant or somehow complicit in not confronting them.  "Interpreting the projective identification of the couple dance of pursuer/avoider is an essential aspect of the therapy. According to Middelberg, the narcissistic spouses deny dependency needs because neediness is equated with losing oneself.  Their spouses deny the need for autonomy to avoid abandonment anxiety.   Middelberg interprets the projective identification by beginning at the interpersonal level and then moving to the intrapsychic level.  With regard to interpersonal goals, the couple therapist should focus on helping the couple become less enmeshed with each other.  They need to develop a better perception of their separateness and become aware that they project aspects of themselves onto each other.  They often have been very unaware of their own and their partners' needs, feelings, and behaviors (Links and Stockwell, 2002, page 527)."  Lack of awareness may however, been intentional as denial serves to avoid confrontation and the consequences that confrontation may cause.

When the partners are receptive to identifying, taking ownership of, and addressing dependency needs, therapy would proceed more readily.  If the intensity of abandonment anxiety is high or intolerable, breaking through one or both partners' denial may be very difficult.  The strategy suggested of working on the interpersonal level, that is behavioral issues often leads to subsequent work on the intrapsychic level.  Moreover, attempts to address and prompt shifts in interpersonal or behavioral patterns may immediately trigger intrapsychic vulnerability and reactive harm.  Therapy may focus on improving communication for direct expression of needs and desires.  Therapy guides each partner to become more conscious of his or her process and behaviors with anger, especially as it shifts into rage.  The narcissistic partner needs to learn how to constructively express anger.  The other partner has to be able to express more overtly rather than through passive-aggressive behaviors.  "As the couple progresses, they will develop a more realistic vision of their relationship and a more realistic vision of the gratifications available from their relationship" (page 527).  One or both partners may have held idealized perceptions of what a relationship and what their relationship should be about.  Accepting that theirs is a less than perfect fairy tale relationship, but instead is a human and deeply flawed relationship may be a tremendous loss to the individual and joint sense of selves.  In order to mourn this loss, the therapist may need to help each partner delve deeply into how such idealized perceptions developed from their life experiences.  Intrapsychic work may require psychodynamic and family-of-origin exploration.  "Often, this work requires the therapist go over their history and have them retain the constructive parts but grieve for the destructive parts of their relationship.  They can give up aspects that were immature and fostered the 'prince-and-princess' relationship while retaining facets that provided for stability and security" (Links and Stockwell, 2002, page 528).


ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
phone: (510) 614-5641
fax: (510) 889-6553
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