The Narcissistic Family: Diagnosis and Treatment - Excellent Book - Early Classic

The Narcissistic Family: Diagnosis and Treatment

The Narcissistic Family: Diagnosis and Treatment

Published on March 21, 2010

If you are confused about your own people pleasing tendencies, need for external approval, and even your own feelings, I suggest you read The Narcissistic Family: Diagnosis and Treatment by Stephanie Donaldson-Pressman and Robert M. Pressman.

In their work as therapists, the authors discovered an unusual trend - patients with traits similar to adult children of alcoholics, but no evidence that their parents were substance abusers. Moreover, many of the patients did not recall any overt abuse as children. So why then were these patients exhibiting the dysfunctional psychological, interpersonal, and work traits of abuse survivors?

The answer was a different type of dysfunctional family. Coined by the authors as the narcissistic family, what these patients all had in common was that as children, the needs of their parents took precedence over their needs. This is in contrast to healthy families, who put the needs of their children first. Without further explanation, this discovery might not seem wholly worthy of the label ‘dysfunction'.

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So to explain, a basic goal for most families is to raise healthy children who will one day become independent adults. In a healthy family, parents work to accomplish this task by assuming responsibility for their children's emotional and physical needs. Over time, parents gradually teach their children to be independent by allowing them to assume responsibility for meeting their own needs in a developmentally appropriate manner. Thus, the primary work of children is to learn to become independent adults. Along the way, they learn to identify and act on their feelings, wants and needs. Parents take care of their own needs or seek help from adults. As a bonus, the children have also learned how to be good parents through the process of observational learning.

In narcissistic families, this basic goal becomes skewed and the meeting of parental needs becomes of primary importance for the family. This twist generally takes place some time after infancy, as the authors point out that most children of narcissistic families were well cared for as babies. In fact, it is mostly likely to occur some time after the child begins to differentiate him or her self from the parents and begins to assert their own needs. This normal developmental process is difficult for parents who are most concerned with fulfilling their own needs as a result of job stress, physical or mental disability, or lack of parenting skills, to name a few reasons. To compensate, the parents fight back, ignoring the child's needs and at the same time forcing the child to respond to their own by withholding attention and affection until they do so. In this way, the children's emotional needs go unattended and they are deprived of the opportunity to experience gradual independence and learn about themselves. Instead, they learn to wait to see what their parents expect and then react, negatively or positively, to those expectations.

The consequence of this parenting style is that the children become a reflection of their parents' expectations and are deprived of the opportunity to be unique. Furthermore, the children learn to ignore their feelings or become completely detached from them altogether. As a result of having no emotions on which to direct their actions, the children become dependent upon others for guidance. This is the process of becoming what the authors term a reactive and reflective individual.

The tendency towards reacting and reflecting will follow children of narcissistic families into adulthood. Eventually they are likely to become distressed by their own pervasive need to please others, chronic need to seek external validation, and difficulty identifying their own feelings wants and needs. They tend to suffer from a myriad of emotional stressors including anger that lies just below the surface, depression, chronic dissatisfaction, and poor self-confidence. Many also struggle with indecisiveness as they have learned to make decisions on the basis of other's needs and expectations. Interpersonally, they tend to share a history of failed romances and have difficulty trusting in others. Sometimes their inclination towards distrust is shattered by periods of total self-disclosure, usually made injudiciously, and met with poor outcome. At work they are overachievers, workaholics even, that are never satisfied with their success.

So why bother to identify yourself or your patient as a survivor of a narcissistic family? The answer is that there is hope for improvement. Identification is just the first step. Please check back for part two including steps for recovery.

If you see these traits in yourself or your patients I strongly recommend The Narcissistic Family: Diagnosis and Treatment . It is written for therapists, but includes great strategies and tips for healing appropriate for survivors.

The Narcissistic Family: Diagnosis and Treatment (Part II)

5 steps for recovering from a narcissistic family

Published on March 24, 2010

In my last post, I the reviewed the narcissistic family model originated by authors Stephanie Donaldson-Pressman and Robert M. Pressman in their book The Narcissistic Family: Diagnosis and Treatment. I promised to review the author's model of recovery and recommendations for improvement.

The key to recovering from a narcissistic family and thereby improving one's adult self is acceptance. To move on, the adult survivor must accept the full reality of their childhood and the effects that their experiences had on their development, which includes who they are today. In doing so, they must acknowledge two things: First, that they were not responsible for the events of their childhood, and second that they must take full responsibility now. The point of acceptance, the authors note, it not to place blame on parents or caregivers, but for the individual to acknowledge reality, which encompasses taking accountability for positive change today.

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Fives stages of recovery are outlined in the book. The stages are outline in the context of a therapeutic relationship. As such, they are designed for facilitation by a therapist. Nevertheless, I believe the concept of each is helpful to the casual self-help reader.

Stage One: Revisiting
The first step toward recovery is revisiting the reality of childhood. In doing this, the individual is encouraged to accept that as a child, they never had control. They are also encouraged, as adults, to give up any fantasy they might harbor of somehow creating an ideal family of origin.

Stage Two: Mourning the Loss of the Fantasy
In this stage, the individual mourns the reality perceived from stage one - that they never had, and cannot create, an ideal family of origin. The authors comment that many individuals return home for family events like Christmas or weddings believing that "this time it will work out." The purpose of this stage is to remove pointless hope for the fantasy family, which frees emotional energy for the here and now.

Stage Three: Recognition
Here, the individual acknowledges the vestiges of being raised in a narcissistic family. They come to an understanding of particular personality traits or behavioral patterns (i.e. people pleasing) and must accept that, although the traits are dysfunctional now, they did help them to survive throughout childhood.

Stage Four: Evaluation
This stage flows from the traits recognized in stage three. The individual assesses their current selves, which includes the personality and behavioral traits they now exhibit, and decides which to keep and which to change. Traits to be changed tend to include those that have proved dysfunctional for the adult.

Stage Five: Responsibility for Change
The final stage is the actual implementation of change. The individual takes responsibility for themselves and works to replace dysfunctional behaviors with more functional ones.

In the book, each step is explained thoroughly with helpful techniques and case examples designed to assist the individual along the way. What follows are more tips and case examples used to illustrate areas of dysfunction common to adults from narcissistic families.  Below are a few examples.

Area of dysfunction: Problems with assertiveness, including identifying and communicating feelings to others:

As a result of their upbringing, these individuals may have difficulty identifying their feelings or even buried them altogether. Thus, they have difficulty discussing them and their wants and needs with others. The authors suggest a simple exercise commonly used to teach effective communication skills called, "I feel...I want". So, instead of slamming doors when your husband failed to make plans for your birthday, for example, state, "Joe, I felt hurt when you did not make dinner reservations for my birthday. I want you to do that now (next year)."

Area of dysfunction: Problems with setting boundaries:

Many individuals from narcissistic families are uncomfortable setting boundaries for fear of disappointing others. To overcome these tendencies and gain more personal control the individual must learn to live with some disapproval. The authors lay out eight rules for learning how to set boundaries with others. Here are a few:

"Correction, appropriately expressed, is not destructive, hurtful, or shame inducing."

"One's needs cannot always be met by others, but they can always be appropriately articulated to others"

"Feelings do not need justification - one always has a right to one's feelings"

If you like these tips for self-improvement, I suggest you check out The Narcissistic Family: Diagnosis and Treatment. You will find more detailed strategies for dealing with issues I briefly addressed above and also information on those I have not addressed here including, decision making, deferment of gratification, building trust and improving intimacy, sex, and friendships.