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Simone Hoermann, Ph.D.Simone Hoermann, Ph.D.
A blog about the personality disorders (borderline, narcissistic, etc.) with a focus on research and therapy

It's Not Me -- It's You

Simone Hoermann, Ph.D. Updated: Jul 4th 2009

swan in the water reflecting on surfaceThe Professionals in Crisis Program at the Menninger Clinic in Houston specializes on treating successful professionals who had some sort of breakdown and are in need of an psychiatric treatment in an inpatient setting.  Many of the patients seen at this program have narcissistic issues or Narcissistic Personality Disorder proper. “Typically, we see people who have enjoyed great success”, says program director Dr. Michael Groat. “We see physicians, attorneys, business executives, accountants, artists, and other highly successful individuals.” he explains, “People with narcissistic personality are highly driven perfectionists and have high expectations to achieve. Most are also highly intelligent and these qualities have served them well in their careers.”

                              Many people with narcissistic personality disorder are driven, gifted, and intelligent. These qualities can be very beneficial and can help people get very far. However, they can also create difficulties as a person with narcissistic personality interacts with other people and it turns out that they are emotionally stunted and lack emotional capacities that allow for fulfilling and intimate relationships. As they go through their lives and encounter various stressors, they realize that a certain type of socio-emotional intelligence is missing. They don’t have important interpersonal skills such as empathy or the ability to understand other people’s states of mind, their intentions, or their feelings.  Often, they like to associate with people who are special and successful, but their relationships lack depth and intimacy. They tend to expect special treatment from others, but do not reciprocate, and in fact often treat others badly. Many times, they don’t feel that they have issues, but the people around them are suffering.

                              Dr. Groat recalls the case of an accomplished and wealthy CEO of a large company who was put on administrative leave and mandated into treatment because his staff and co-workers complained about how he treated them. “He called them idiots and put extremely high demands on them” recounts Dr. Groat, “He dealt with any type of remote failure or rejection by being angry and confrontational. He was quite a bully. We had to work very hard to help him realize his own contributions to problems, because he just wanted to externalize all blame.”

                              There is a difference between healthy and pathological narcissism. Healthy narcissism allows to people achieve, to have a healthy self-esteem and ambition. Healthy narcissism gives us a sense that we deserve good things and that we deserve to be respected and treated well by others. People with Narcissistic Personality Disorders, in contrast, have difficulty minding other people, and have a hard time engaging with others in an intimate way. They are mostly preoccupied with themselves and often shift rapidly between idealizing and devaluing other people. Frequently, they use other people to bolster their own self-esteem. “Many of our patients have difficulty dealing with the reality of what their limitations are, many see themselves as greater than reality, and then have trouble dealing with life’s setbacks.” adds Dr. Groat, “our treatment approach focuses on helping people get a more realistic view of themselves and others. Often, these interpersonal issues play out in the relationship between the patient and the therapist. Our treatment approach at Menningers centers around teaching people to mentalize, which has to do with the capacity reflect on themselves and other people.”  


Simone Hoermann, Ph.D.Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

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