More threads by David Baxter PhD

David Baxter PhD

Late Founder
The Narcissistic Family: Diagnosis and Treatment
March 21, 2010
by Marisa Mauro, Psy.D.

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'.

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.
 

David Baxter PhD

Late Founder
The Narcissistic Family, Part II

The Narcissistic Family: Diagnosis and Treatment (Part II): 5 steps for recovering from a narcissistic family
by Marisa Mauro, Psy.D., Psychology Today
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.

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.

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.
 

gloria

Member
I know I could have just hit the thank you button and been done but then I wouldn't have been able to tell you what this article did for me. I have been in therapy for six months now and have finally excepted the fact that I am an adult survivor of child abuse. Once I finally considered that to be an option I decided to start researching and reading everything I could about ASCA and what I read scared me. I saw my current behaviours reflected in too many of the stories but was having a problem connecting the dots. Yes, my childhood was definitely a disaster, a lot of times there was next to no food and we would eat the same dish (rice and gravy) for weeks at a time, we wore rags to school and was constantly made fun of (it didn't help that we changed schools every six months) but I wasn't sexually abused and I wasn't beaten (my brothers got those), I was constantly praised and told how pretty, smart, and loved I was so I didn't see where I fit in to the ASCA thing but thanks to this article I now see what kind of abuse it was and what direction I need to go in to start healing. I saw my therapist today and she totally agrees and suggested the book The Emotional Incest Syndrome. I am hoping this book is the beginning of the end. I'm sorry this was so long but I just wanted you to know how grateful I am and to thank you for posting this.
 
I've read parts of this book while sitting in Barnes and Noble. It is expensive ... $60.00 I think. (Though I am sure Amazon has it cheaper)

I don't think either of my parents were pure malignant narcissists. At least I don't believe my father was one. My mother may be because she lacks true empathy. She can display empathy as an act ... but to me it doesn't feel sincere. She wants credit for being empathetic without actually being empathetic. My father had a nurturing side to him and I can distinctly remember it as a child. I get warm fuzzies when I think about some of the things he did when I was little. I can remember crawling in his lap and he would hold me close and kiss me. My mother was never like that once we could walk. Instead, she was always sick, going somewhere that required her to dress in beautiful clothes (and required us to compliment her) or otherwise demanding attention for whatever she felt was a crisis for her. Mainly it was some sort of exaggerated drama.

Late in his life my father went a little crazy. No one could ever figure it out, and it may have been some sort of dementia, but to this day I think my mother drove him crazy. She was a master liar and manipulator and took responsibility for nothing. If she dropped a glass it was because the maid did not dry it properly and it was slippery. If dinner was overcooked it was because the oven malfunctioned. But if one of us (me or one of my siblings) did something she believed reflected poorly on her everything suddenly became "about her."

The interesting thing to me about the narcissistic family is how often we seek out relationships as adults that are similar to our family of origin. I know I did that and I married two women who created the same sort of drama I experienced as a child.
 
How does one recover from a dysfunctional family when they won't go away? (rhetorical question because I know the answer)

My 94 year old mother has dementia/depression and is in Assisted Living. There is no one else to pay her bills (not my money, hers - I just have Power of Attorney) except for me which means I have to have interactions with her. Sometimes I go for a month or more without dealing with her in person or by phone, but lately she has started calling me. She mainly complains about where she lives, how the people all steal from her and her newspaper subscription.

Today she called and started telling me how much she hated living there and how people were taking all her valuable things. I told her I was sorry she was unhappy, but there was nothing I could do and there was no other place for her live. (She keeps trying to invite herself to my house which I keep rejecting because once she comes here she won't leave.) These calls almost all come between 2-4 after her nap. She has dreams and wakes up and believes them to be real (or a memory) and calls me. If she leaves a message and I call her back several hours later she doesn't remember.

But she called twice today. The second time was several hours later and she left this long, convoluted message about how she thought she had upset me and was I alright and how sorry she was about everything and how worried she was about me ... then she launches into her speech about how everyone is stealing all her fine things from her and how she hates living there and doesn't have any friends. Then she ends it with, but I guess I'll just find a way to make do.

Drives me crazy because she tries to take care of everybody's feelings because she thinks she is in charge of everything and no one can manage without her. It also keeps her from facing the fact that she is dying (or will die soon) so she is completely out of touch with her own feelings. Three years ago she had a mental breakdown of sorts and I was able to see the "real" her. The sad, scared and lonely old woman. For a brief period of time I had real empathy for her because what I saw was real. I actually wanted to be her advocate. But she so quickly recovered her "false persona" and began caretaking again that I lost that empathy. That brief parting of the curtain was over in the blink of an eye.

My brother committed suicide because of her "golden child" treatment of him. Nobody was good enough for him except her. I was the forgotten child and now I'm thrust into the role of the "golden child" while my sister remains the scapegoat. (She can't do anything right.)
 

Retired

Member
It also keeps her from facing the fact that she is dying (or will die soon) so she is completely out of touch with her own feelings.

Does that mean your Mother has a diagnosed terminal illness or condition?

My 94 year old mother has dementia/depression and is in Assisted Living.

Does she have awareness to know you and is she accurately oriented in time?

Is her depression being addressed?
 
Steve, she takes Prozac, Remeron, and Aricept.

I'm really just referring to her general mortality and the fact that her advancing age puts her closer to death.
 

Retired

Member
her advancing age puts her closer to death

Isn't that true for any of us? Or a person can be struck by a car or lightening at any moment regardless of age. I know people in their eighties and nineties who live as though they have a hundred years ahead of them while I have seen people in their twenties ready for the mortician.

I was just curious about why your Mother's potential mortality colored your view of her behaviour and seems to be a source of frustration to you:

Drives me crazy because she tries to take care of everybody's feelings because she thinks she is in charge of everything and no one can manage without her. It also keeps her from facing the fact that she is dying (or will die soon) so she is completely out of touch with her own feelings.

While I admit as we get older, there is a realization that there might be fewer years ahead of us than behind us, I don't know think thoughts of death should influence our behaviour. I've known people with a diagnosed terminal illness, who were given a timeline for their time to live, who lived their lives in the end and interacted as though they had a hundred years to go,

I have also noticed people who live in institutionalized homes for elders often become paranoid about their surroundings and their personal security.

Could it be your Mother is not receiving enough intellectual or emotional stimulation combined with a lack of physical exercise, as is common in many assisted living facilities?
 
No, I don't think its true for all of us. Certainly, we all can die at any minute, but her life expectancy at 94 is 2.8 years. She also has an abject fear of death (see post above) and it colors her attitude. She also threatens suicide repeatedly. Usually just to me, but she has slipped up and said it to her psychiatrist. (That sounds like a contradiction but it isn't. Her suicide threats aren't real ... they are designed to get her way.)

Her dementia and caretaker attitude makes it difficult for me to get along with her. The truth is, I've never gotten along with her because she's a fraud. I'm 60 years old ... I don't need or want a 94 year old woman, who can't take care of herself, trying to take care of me or my feelings. I'm capable of doing that for myself.

At this point in her life she is what she is and she is not likely to change. Her mask of haughtiness and pretentiousness is failing her but it is still strong enough to trigger strong emotions in me which is why I have as little contact with her as I possibly can.
 
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