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Western Psychotherapy: Have We Cultivated an Age of Narcissism?

Posted on 20 Nov | 4 comments
"Narcissus." Photo by Adi Ness (2000).
"Narcissus." Photo by Adi Ness (2000).

I spoke with a fellow psychotherapist this weekend at the Sixth Annual Conference for the Existential Humanistic Institute in San Francisco about a topic that seems to be presenting itself to me in many circles. It is a topic that I have been motivated to explore because of personal experiences I've encountered, as well as academically and professionally. We were discussing the breakdown of relationships and commitment in our country. He asked me what I thought the reason was for this, and my answer was "I think we give up too easily when things are difficult."

His response, paraphrased, was that Western psychotherapeutic models are so focused on self, they fail to teach people how to consider their impact on others when faced with important life choices. He also stated that this has been a major critique by British Existentialists of United States Existentialists. I have no sources to cite regarding the disparity between British and US views. I can state very plainly that if so, I believe the British are correct. I have felt disturbed by notions of health that I see fairly bright and sensitive people posit, and the most frequent is in regard to finding and remaining loyal to a fixed sense of self. On the contrary, it seems to me that our Self changes in context and is always existing and forming in relation to others. To deny that we are reliant on others seems almost delusional. However, to admit our reliance on others requires vulnerability: the virtual nemesis of the narcissist.

Narcissism is traditionally viewed as a personality disorder in the clinical world. In sum, it is the inability to accept one's inherent vulnerabilities and weaknesses, and an inflated sense of Self as impervious to flaws or failures. The most noteworthy sign of narcissism is a lack of empathy for others and a shunning—even an exploitation in some extreme cases—of weakness. Indeed, there is a hyper-individual quality to narcissism. The protection of one's self-image is all consuming and the primary motivator in life.

There is a part of me that wants to contest that all narcissism is oriented in the personality. I know far too many people who seem to adhere to what I would call narcissistic defenses (don't we all, really?), and I don't experience them as narcissistic people. I do, however, believe that their narcissistic defenses are often misguided, and I will dare say that the misguidance comes in the form of Western psychotherapy.

One of the most important lessons I've learned as a psychotherapist was when I served as Program Director for a residential treatment program for people with chronic/acute mental health diagnosis. People would come into my office, most often to vent about their problems with other residents and sometimes staff. I would then facilitate a group or help the residents with life tasks, and see the very problems residents complained about firsthand. Often times, it was grossly apparent that there was another aspect of the conflict that residents did not share with me when we met privately.

Now, I don't believe that residents were insincere or dishonest when they expressed to me what troubled them about their relationships. However, it did become very clear to me that their defensiveness impeded their ability to empathize with or even view the experience of the other. I learned fast that helping residents develop this capacity was important.

I am acutely aware of how much we want to support our clients as therapists. We want to help them develop ego strength, and often tread lightly around their vulnerabilities to avoid ruptures in the relationship that may occur if we move too quickly to test the boundaries of their notion of self. I also believe that in this respect, we are often times far too ginger with our clients. Perhaps we are inadvertently encouraging a narcissistic stance by aligning against the other, somewhat like an overprotective and enmeshed parent? I've seen it. I'm sure I've also unwittingly done it. It's important to remember however, that narcissism in the classic sense isn't just developed from neglect. Sometimes narcissism is developed because children are not challenged and are the center of overindulgence. Therapists can overindulge as well.

The West is fond of the "Self." Our entire history is built on migration and separation to preserve our rights. "The Declaration of Independence," probably one of the most important documents in the United States, is a direct testament to our value of independence. I am not going to approach this as a mistake. I am, however, going to explore the other side of existence—relatedness and interdependence. The evolution of contemporary thought is moving away from independence and toward interdependence. Ecology, physics, and now psychology, are exploring how we are all interconnected and impacted by one another. If we hunt one species to extinction, another species will probably suffer and go extinct. However, another species may thrive as a result, and yet this thriving may have another negative impact on another species. Interspecies relationships count. This is a far cry beyond just caring about our own species.

Still, human beings seem to be losing sight of this. With encouragement to always "put the oxygen mask on yourself first" and "I'm not responsible for your feelings" (which is really a refusal to take responsibility for one's actions and a gross statement of disregard for another person), we forget to remember how much we would miss the other if they be so unfortunate as to leave us or die, or that what we say and do can hurt other people. If other people get hurt, it does not make them weak. It makes them human.

Another narcissistic trait tends to be the resentment and shaming of people who display vulnerability and need. It is viewed as "weak," but truly this is quite a split. Although I do believe there are people who can exploit the empathy of others by trying to evoke guilt, I still believe that there are people who exploit "I have to take care of myself first" to a degree that is narcissistic. Yet, if encouraged by the professionals to think in this way, how can we call them narcissistic? They believe this is the healthiest course of action. Perhaps they are just doing their best and disoriented by the very collusion against others that we perpetuate via our desire to be supportive.

This relates to existential psychotherapy because of the common notion that existentialists are consumed with "Self" and "existential aloneness." This is a popular place to begin with existential psychotherapy, and more likely a reflection of interpretation based on the cultural Zeitgeist, when people were trying to break away from an overly-enmeshed culture that impeded people's ability to thrive, explore, and be different. Still, there was a dark side to this exploration that our current adults are still feeling the aftermath of. I think of the song, "Easy To Be Hard" in the musical Hair. A young wife has been abandoned by the father of her child so that he can go "find himself." She stands in the snowy city with their young child after he chides her for wanting to know if he is fathering the child of another woman, and he storms away as she breaks into song. The poignant lyrics show that this time of liberation also had some very dire consequences when people blew off their responsibilities to their loved ones to go explore their personal freedoms, and yet, ironically, were so passionate about social issues. The song begins with "How can people be so heartless?" and bridges into "especially people who care about strangers, who care about evil and social injustice." Oddly, the very people who were out fighting for the rights of others were ignoring the very people they claimed to love, oftentimes leaving behind a trail of broken families and abandoned children.

In contrast to this concept of finding one's Self, a very basic tenant of existential psychotherapy is, as Orah Krug so often demonstrates in her discussions and writing, the "in-between" aspect of relationships. In Existential-Humanistic Therapy (2010), Schneider and Krug highlighted the importance of Self, Other, and the quality of relating as three basic processes to attend to. Some people may need to explore how they are impacted, and yet, other people may lack a sensitivity to how they impact others. This is indeed a very important aspect of learning to be a responsible, agentic person in the world. When we do not help people discover how they impact the world, we not only deprive them of the opportunity to develop empathy, we also deprive them of the opportunity to feel agentic. A sense of personal agency is derived from the ability to impact. In essence, it helps one build ego and helps one transcend ego at the same time. What a beautiful paradox.

We can also begin to draw on Eastern spiritual and cultural traditions to round out our Western approach to psychotherapy, as many academics and clinicians are already doing. Ruth Richards (2001) stated:

A mutual encounter is a discipline requiring openness, risk, synergy born of trust and willingness to learn, all of which arises from a shared commitment to a larger good than an individual's agenda, ego issues, or idea of self. The relationship becomes the priority and risks are taken for it. The conversation moves beyond defensive maneuvers or wishes to be seen a certain way. (p. 293)

Richards then so poignantly illustrated the creativity involved in our intimate relationships when we move beyond the one-sidedness of self and into viewing relationships as a priority:

Now consider mutuality as a creative art form—a give and take—this time a mutual painting on a joint canvas. There is a flexible co-creation, new sharing and understanding. One is both receptive to the other and active in turn. There is openness, a willingness to hear and an almost magical joint painting of a new context that includes the truth of both parties. It may also include things we do not necessarily want to see or know. Yet, to honor the relationship, we ourselves may need to change. (p. 299)

That very change that Richards discussed is inherent of Kirk Schneider's proposition of the fluid self—a self that constricts and expands in relationship to context and the environment. We acknowledge that we have something at the center, and yet, that something is not fixed. In fact, rigidity could be our demise. It is the ability to adapt that, paradoxically, increases the likelihood of our survival. In addition, Schneider (2009) addressed the importance of encounters with others for our growth and well-being, asking, "what is joy but engagement, the maximal encounter with the challenges and opportunities of life—and my, how we have failed to engage as people, though we have inured ourselves with comforts," (p. 14).

Kirk Schneider's notion of the fluid self is akin to the Buddhist notion of emptiness, explored by Jose Tirado in his reflections of how to improve Western psychotherapy. Tirado (2008) suggests that "since Buddhism argues that grasping onto the notion of a Self is at the root of the most essential existential human problem, Buddhist critiques of this notion of Self might helpfully address the narcissistic emphases of psychology," (p. 74). Tirado suggested that emptiness is experienced negatively by Westerners, whereas perhaps emptiness could be related to a place where infinite possibilities rest, stating:

This concept directly challenges the very notion of an independent, inherently existent self and therefore offers an initially uncomfortable but possibly groundbreaking palliative to some of the most pressing psychological difficulties in the human condition. The positive interpretation of emptiness allows for a philosophically deconstructed yet healthily adapted self that responds to psychological challenges with neither narcissistic myopia nor dissociative fragmentation. (p. 74)

This is in line with one of the most basic goals of existential psychotherapy: to make the unconscious conscious and thus expand beyond what we believe to be who we are and how the world is.

In sum, I encourage clinicians to think about how they assist clients not only in developing ego strength, but also in reaching beyond the ego into what Alicia Lieberman of the Child Trauma Institute referred to as the "we-go." Ego development may be an important precursor to developing the “we-go.” I think of how William James (1892) challenged our concept of Self due to our tendency to compartmentalize our consciousness, which he posits is fluid and beyond the pockets of experience we create with our . However, William James also affirmed the undeniability of our experience of "Self." There must be a reason for this, and self-preservation is vital. The purpose of this critique is not to discourage people from developing boundaries that keep them alive and well, but also to remind people that this is only one part of our existential potential. Optimal health enables openness that moves beyond self-preservation. Ultimately, the hope would be to transcend the ego once strong, exploring the world, and discovering aspects of ourselves, both positive and negative. What better way to do this than through the oddly beautiful challenge of our relatedness?

References
CIP Film Production (Producer) & Forman, M. (Director). (1979). Hair [Motion Picture]. USA: CIP Film Production.
James, W. (1892). The streams of consciousness. In Classics in the History of Psychology, Chapter 11, 09/06/2001. http://psychclassics.yorku.ca/James/jimmy11.htm

Richards, R. (2007). Relational creativity and healing potential: The power of eastern thought in western clinical settings. In W. E. Smythe, J. D. Pappas, & A. Baydala (Eds.) Cultural healing and belief systems (pp. 286-308). Alberta, CA: Brush Education.

Schneider, K. J. (2009). Awakening to awe: Personal stories of profound transformation. Lanham: Jason Aronson.

Schneider, K. J., & Krug, O. T. (2010). Existential-humanistic therapy. Washington DC: American Psychological Association.

Schneider, K. J. (2004). Rediscovery of awe: Splendor, mystery, and the fluid center of life. St. Paul, MN: Paragon House.

Tirado, J. M. (2008). The Buddhist notion of emptiness and its potential contribution to psychology and psychotherapy. International Journal of Transpersonal Studies, 27, 74-79.

-- Candice Hershman

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Comments and Discussions

Wow - I wish I had seen these

Wow - I wish I had seen these comments earlier . . . I don't receive blog feedback. But I would like to respond:

First, I am asking that people take my comments in context to the entire article. As a regular attendee of Alanon meetings, I would posit agreement about co-dependents using care of others as an unconscious manipulation. Absolutely. However, I don't misunderstand the comment about the oxygen mask at all. In fact, the entire point of this article is the misuse and misunderstanding of that concept to excuse being narcissistic. I think that concept applies to some contexts. However, if my child is sick in the middle of the night I have agreed to care for them by the very act of giving birth - to put their needs above mine in certain situations. I may need sleep desperately, but they need a mother to care for them. That is part of being an adult and making a commitment.

My issue is with the denial of our interdependence. As I have stated very clearly in this article (please go back and reread) . . . ego development is essential, but it is hopefully not the end product. We do not develop healthy egos in a vacuum . . . it is relationships that help us with that. It is a very interesting paradox. We need others and yet we need do develop some self reliance as well. I would say that neither is more true than the other, but rather two needs that co-exist and seem to oppose, when in actuality, we only view them as opposites. Per my view, to admit our need for love and help from other people is a very important step in growth that requires a tremendous amount of risk and vulnerability. Remember, the entire AA program is built on getting help from other people. It is the kind of help that counts. But that is different from co-dependence.

And I have seen the co-dependent philosophy get exploited to a disturbing degree - I've seen people use it to not take responsibility for their impact on others. If you throw a rock through someone's window, and they cry, and you state that you are not responsible for their feelings . . . well, I would argue that this is just a way of not taking responsibility. "I AM NOT RESPONSIBLE" is the key focus of "I am not responsible for your feelings. In fact, it is typically the addict's favorite fallback. It is very adolescent, per my view. And co-dependence is the opposite "I am responsible for everything, and I have complete power to fix it." What would be ideal is an acknowledgement of how we impact each other and a sincere and conscious ability to ask for what we want without being manipulative - both ends of the spectrum can do this, both hyper-enmeshment and hyper-disengagement.

I am pointing this out because I believe that hyper-disengagement is just as large a problem as hyper-enmeshment. Balance is the key.

Other people grow our food. Other people pay us, and we work for them. When we put plastic in the ocean, birds ingest it and die. We impact each other. Acknowledgement of this is just as important as learning to not be co-dependent. Once again, interdependence. Balance. As someone who has worked hard on co-dependence, I understand the need to be conscious of my motives. But I'm not going to swing to the other end of the spectrum and adopt the narcissism and ignorance of my impact on others of an addict either. It is a both/and, not an either or. This is my personal bias and criticism of how people interpret those programs. If we swing to far to the other side, we're going to create a whole new set of problems.

I wish I'd seen these comments earlier. I hope you get the responses. I appreciate the thoughtful feedback.

I was always very helpful and

I was always very helpful and philosophical with regards to helping others. My father passed just over 8 months ago, then my grandfather 2 months ago & my nephew was born prematurely at 26 weeks, 2 weeks after my grandfather passed. My nephew is currently very ill and his long term health does not look good currently.

This year has brought me closer to my wife, however, I have developed a very focused and selfish philosophy. I resigned from my job and decided I wanted more from life. I sat with my father and watched him suffer until his final passing from a brain tumour. I am not religious and I do subscribe to the european existential values.

My point is that the individual can be rudely awakened by life circumstances and then choose to live life in a more focused, selfish or narcissistic way. Once you see the horror of real life there is no going back.

You misunderstand and misuse

You misunderstand and misuse some of the basic principles of Codependents' Anonymous.
Putting "the oxygen masks on oneself first" means we must take care of ourselves so that we will be able to have a self to help others with. Codependents take care of everyone but themselves, they are self-neglectful yet seek to control others. We all must be self-caring and self responsible first, no one is responsible for meeting our needs but us; only through being self compassionate first are we then able to relate to others as someone who can care for and be compassionate for others.

"To deny that we are reliant

"To deny that we are reliant on others seems almost delusional" there's no almost about it.

My guess is that narcissistic people don't feel good about themselves - were probably demeaned and/or ignored in childhood. Our culture still encourages this - despite much verbiage to the contrary.

I think by helping people focus on unmet needs it is possible to help them open to their situation and the others in it.

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