The Masterson Approach to Narcissistic Disorders of the Self
Loray Daws introduces the Masterson approach to narcissistic disorders of the self, exploring possible origins of such disorders before providing brief case studies of potential therapeutic approaches.
A responsive and vital ‘other’ is central to the development of a healthy evolving ‘self’. The optimally attuned mother supports the infant’s unique developmental ‘rhythm’, contains and transforms anxious experiences, and takes pride in the infant/child’s growing ability to master him/herself and the various environmental demands placed upon him/her. In time, the mothering other is also expected to help the child bridge the initially needed experiences of omnipotence to greater reality-oriented adjustment, wherein self-esteem and self-confidence is expected to remain partnered with reality rather than phantasy. According to Masterson:
“Healthy narcissism, or the real self, is experienced as a sense of self that feels adequate and competent, a feeling derived mostly from reality, with some input from phantasy. This sense of self includes appropriate concern for others, and its self-esteem is maintained by the use of self-assertion to master challenges and tasks presented by reality. The intrapsychic structure, which underlies this sense of self, consists of a self-representation that has separated from the object representation, has had its infantile grandiosity and omnipotence defused, and is whole – that is, it contains both positive and negative at the same time, and is able to function autonomously.” (1993:12).
When maternal attunement and mirroring falls short, various difficulties can arise in a child’s separation-individuation (SI) phase of development, especially in the ‘practicing’ sub-phase of SI as described by Mahler (1979a,b). During this sub-phase of SI, it is frequently noted that toddlers act ‘impervious’ to frustrations, knocks and falls, and seem ‘free’ to explore the world without any forethought of danger. The latter may be possible due to an intra-psychic experience of ‘oneness’ found within the mother-child orbit of the symbiotic phase of development.
During ‘rapprochement’, the following developmental stage, appropriate frustrations and limit-setting behavior seem to be increasingly present to support the child in learning and adapting to the larger world, wherein cause and effect plays an important role. This is thought to bring the child out of symbiotic omnipotence and imperviousness into the realm of ‘reality’ and differentiation; that is, the self and object representations become increasingly differentiated and thus less fused and omnipotent. Mother is turned to, relied upon, and actively used for refuelling purposes in reality as a differentiated other.
Theoretically, it seems possible that the narcissistic patient did not enter or complete the rapprochement crisis and, as such, the omnipotent dual unity may still exist intra-psychically. The illusion is kept intact by various defence mechanisms, while reality is continuously denied, manipulated and distorted:
“The fixation of the narcissistic personality disorder must occur before this event [rapprochement] because clinically the patient behaves as if the object representation were an integral part of the self-representation – an omnipotent, dual unity. The possibility of the existence of a rapprochement crisis doesn’t seem to dawn on this patient. The fantasy exists that the world is his oyster, he must seal off by avoidance, denial and devaluation those perceptions of reality that do not fit or resonate with this narcissistic, grandiose self-projection. Consequently, he is compelled to suffer the cost to adaptation that is always involved when large segments of reality must be denied.” (Masterson, 1981:12-13 italics added).
A possible explanation for such a state of affairs is that the mother (parent), due to her own conflicts, uses her child as a narcissistic extension, thereby stimulating the child’s grandiosity at the expense of reality considerations and limitations. For example: “you are perfect – the world is not”. To avoid abandonment through displeasure, the child has no choice but to accept the idealising tendencies of the mother: “If I am not perfect, I will be bad and abandoned.” Another developmental pathway is a rejecting mother (parent) who paradoxically forces a child to harbour omnipotent phantasies as a way to protect the self against extreme injury, vulnerability and aloneness.
The split internal world of the narcissistic patient
According to Masterson, given the developmental difficulties mentioned, an intra-psychic split develops that is characterised by two fused units. The intra-psychic structure (see figure) of the grandiose (manifest) narcissist consists of a grandiose self-representation and an omnipotent object representation “which have fused into one unit which is more or less continuously activated” (Masterson, 1981:29). The latter activation is to defend and protect against the underlying aggressive/empty object relations fused unit, and thus the possibility of depression.
Masterson also differentiated various ‘types’ of narcissistic pathologies. With the ‘exhibitionistic/manifest narcissistic disorder of the self’ one is principally aware of the defensively fused self-object relations unit, that is, a grandiose object representation that contains power, perfection and so forth, fused with a grandiose self representation of being perfect, superior, entitled, with its linking affect of feeling unique, adored and admired. The exhibitionist projects this fused unit while underneath defends continuously against the aggressive object relations fused unit that consists of a “fused object representation that is harsh, punitive and attacking, and a self-representation of being humiliated, attacked, empty, and linked by the affect of the abandonment depression that is experienced more as the self fragmenting or falling apart than as the loss of the object described by the borderline personality disorder.” (Masterson, 1993:18-20).
The abandonment depression can be activated or stimulated by true self-activation (following one’s own true wants and needs) or by the object’s failure to provide necessary nourishment, that is, perfect mirroring. Defences, such as devaluation, can restore the libidinal fused unit and push underground the negative object relations unit. The ‘free access’ to aggression can also serve as a way to coerce and manipulate the other to give the needed nourishment. This is especially evident in malignant narcissists, and those with psychopathic tendencies.
In contrast to the exhibitionistic disorder, the intra-psychic structure of the ‘closet narcissist’ differs from the exhibitionistic narcissist in that whereas the latter can seem impervious, dismissive and even callous towards its objects, the closet narcissist seems to be rather dependent on the object. The grandiosity of the self is protected by the projection of the idealized, all-good object and then by ‘basking in the glow’ of that object. This clearly may cause greater susceptibility to variance in mood, and closet narcissists thus have greater ‘access’ to dysphoric affect and depression. Closet narcissists are also frequently misdiagnosed as borderline; however careful tracking of their defence mechanisms will reveal the presence of fusion rather than clinging.
In the case of the ‘devaluing narcissist’, the much-needed grandiose self and the idealisation of the other seems absent, and what remains is an active state of deployment. According to Lieberman: “There is no grandiosity of the self or idealization of the other, but the child lives in a stage of siege, with paranoid, schizoid defences. In treatment, the patient’s fragmented self is defended against by projecting either the attacking object or the impaired self on to the therapist. Some of these patients will use the devaluing defence to maintain a derisive sense of superiority over people in their environments, whereas others will appear to be functioning at a low level, and can often be confused with patients with Schizoid Personality Disorder (2004:79).
Pearson, discussing analytic therapy with devaluing narcissists, conceptualises the devaluing state as the continuous and tenacious protection of the impaired vulnerable self by “discharging and projecting aggression associated with the internalised persecutory and the hungry envious self” (1995:310) through various intra-psychic and interpersonal mechanisms. They are as follows:
“1. Projection of the internalized harsh object and the rage associated with it. For these patients, the maxim holds: ‘The best defence is a good offence’. 2. Repudiation or co-opting of any independent source of help. This process defends against the twin threats of the separate existence of the object and the oral greed and envy of the self. 3. Refusal to relinquish unconscious wishes for omnipotence and entitlement associated with the internalised fused grandiose-self/omnipotent-object part-unit. 4. A vengeful talionic thwarting of the internalised object’s narcissistic goals, the latter representing power through Pyrrhic victory as the one sure victory. 5. Persistent reliance on projective identification as a means of coercing the therapist to resonate with and act out the projections. This means of communication offers the possibility for the therapist to recognize, contain, and ultimately interpret the dynamics associated with these primitive internalized self and object relations.” (1995:310-311).
Clearly the effective treatment of devaluing narcissists may prove to be more difficult due to the erosive quality of the continual projection of the aggressive unit. Finally, and in summary, according to Masterson: “The pathological narcissism of the exhibitionistic narcissistic disorder or the inflated false defensive self is experienced as being unique, special, adored, and admired. It is called a false defensive self because (1) it is based on phantasy, and (2) its purpose is to defend against pathological affect, not to deal with reality. The intra-psychic structure consists of a grandiose self-representation fused with an omnipotent object representation with the major emotional investment in the grandiose self, whose grandiosity is maintained by seeking perfection and the perfect mirroring of others. The pathological narcissism of the closet narcissistic disorder or the deflated false defensive self is experienced as feeling special or unique in the glow of the omnipotent perfect other. The intra-psychic structure consists of the same grandiose self fused with the omnipotent-object representation, except that the major investment is in the omnipotent-object representation that is idealized and projected on others, the grandiose self basking in the glow of the idealized object.” (1993:12-13).
Given the reliance on a continuously activated grandiose unit, the difficulty narcissistic patients will have with depression and general human failure can be properly understood. The elements of the abandonment depression experienced by the narcissist are similar to those of the borderline disorder of self – suicidal depression, homicidal rage, panic, guilt, hopelessness, helplessness, emptiness and feelings of void. Clinically, it seems evident that depression is not easily accessed or felt by the exhibitionistic narcissist due to the grandiose defensive structure, whereas the depression experienced by the closet narcissist contains feelings of shame, humiliation and falling apart. Envy is very present in narcissistic disorders as well as feelings of rage. Active avoidance of the experience of depression can be a stumbling block in therapy.
Attacking the grandiose fused unit head-on (through confrontation for example) may prove detrimental to the patient as well as the therapist. For the narcissist it is the interpretation of the narcissistic vulnerability that remains central in the Masterson approach. The algorithm is as follows: (a) Pain: During this part of the interpretation the therapist actively identifies and acknowledges the painful affect the patient is experiencing. (b) Self: Focuses on the impact on the patient’s self-experience and thus illustrates understanding. (c) Defence: Identifies and focuses on the defence(s) the patient is using to protect, defend and/or soothe himself from the painful affect.
A few examples may illustrate the Masterson approach to the various narcissistic disorders of self.
Manifest Narcissistic Disorder
Patient A consulted a clinician with the aim of gaining control of his ‘anger’ towards his wife as he felt she did not understand and acknowledge his needs. When she forgot to wish him a happy birthday first thing in the morning (their baby had been up all night with a fever) he was furious; he verbally attacked his wife for being over-involved with ‘the’ child and neglectful of his needs. He also threatened her with divorce if she did not ‘straighten herself out’. “You sound very hurt by what happened this morning (pain). I know it is so important for you to be understood and acknowledged by your wife… to be seen by her and be experienced as important; it must have felt very disappointing to you when she forgot your birthday (self). To protect yourself from these feelings you showed her your anger and by threatening to leave her you maybe wanted her to feel what you felt … rejected and misunderstood (defence).”
Closet Narcissistic Disorder
Patient B found it difficult to focus on himself and frequently turned to the therapist to start sessions by saying “I don’t know what to say, can’t you tell me … as you are the expert?” The response could be “It is difficult for you to start the session by trusting yourself (pain) as you may feel exposed, vulnerable and extremely aware of making a mistake and so disappoint me (self). To protect yourself from these feelings you turn to me to make the decision for you (defence)
Devaluing Narcissistic Disorder
Patient C grew up in a very dysfunctional family where she was constantly berated, humiliated and made to feel worthless. Despite the latter she would verbally attack any sign of her therapist’s understanding. The therapist responded: “You had to learn to be independent and thick-skinned to survive feeling put down by your family. It must be frightening to allow me to understand something of you, as you feel it will expose you and allow me to hurt you as well (pain and self). To protect yourself from this possible situation you put me down in the hope that I will do what others did and turn away from you (defence).”
The Masterson method enables the therapist, through the use and understanding of the developmental, self and object relations approach to narcissistic disorders, to remain therapeutically neutral and empathic in treating narcissistic patients. It is believed that the interpretation of narcissistic vulnerability will support the narcissist to relinquish various omnipotent defences and facilitate greater interpersonal and intra-psychic adaptation over time.
Loray Daws is a registered clinical psychologist in South Africa and a registered clinical counsellor and psychotherapist with the British Columbia Association of Clinical Counsellors (BCACC) and the Canadian College of Professional Counselling and Psychotherapy (CCPCP). He has more than 15 years’ experience of working with various psychiatric disorders. Loray has also completed the New York based Masterson Institute’s three-year post graduate training program in psychoanalytic psychotherapy for the treatment of the personality disorders. Loray serves on various directorates and faculties and has lectured and published internationally in the areas of personality, eating and psychosomatic disorders.
Lieberman, J. (2004). The Narcissistic personality disorder in Masterson, J.F. & Lieberman, A.R. (Eds) A Therapist’s Guide To The Personality Disorders: The Masterson Approach. A Handbook and Workbook (pp73-90) Phoenix, Arizona: Zeig, Tucker & Thiesen, Inc.
Mahler, M.S. (1979a). Infantile psychosis and early contributions in The selected papers of Margaret S. Mahler Volume 1 New York: Jason Aronson.
Mahler, M.S. (1979b). Separation-Individuation in The selected papers of Margaret S. Mahler Volume 2 New York: Jason Aronson.
Masterson, J.F. (1981). Narcissistic and Borderline Disorders: An integrated developmental approach New York: Brunner/Mazel.
Pearson, J. (1995). Mirrors of Rage: the devaluing narcissistic patient in Masterson J.F. & Klein R. (Eds.) Disorders of the Self: New therapeutic horizons. The Masterson Approach (pp299-312) New York: Brunner/Mazel.
Image: Manufactured Perfection by Chat Singh