Co-Narcissism: How We Accommodate To Narcissistic Parents
Abstract: This article introduces the term "co-narcissism" to refer to the way that people accommodate to narcissistic parents. I use the term narcissism here to refer to people with very low self-esteem who attempt to control others' views of them for defensive purposes. They are interpersonally rigid, easily offended, self-absorbed, blaming, and find it difficult to empathize with others. Co-narcissistic people, as a result of their attempts to get along with their narcissistic parents, work hard to please others, defer to other's opinions, worry about how others think and feel about them, are often depressed or anxious, find it hard to know their own views and experience, and take the blame for interpersonal problems. They fear being considered selfish if they act assertively. A high proportion of psychotherapy patients are co-narcissistic. The article discusses the co-narcissistic syndrome and its treatment, and gives case examples of patients who suffer from this problem.
How Psychotherapy Works: The Concepts of Control-Mastery Theory
Introduction: Control-Mastery theory was formulated by Joseph Weiss, MD in the 1960's. Weiss, a psychoanalyst, found that the Freudian model of psychotherapy did not predict and could not account for improvements in some of his patients, and he began an intensive study of these cases in order to better understand the therapeutic process. In 1972, in collaboration with Harold Sampson, Ph.D., Weiss founded the Mt. Zion (now the San Francisco) Psychotherapy Research Group, which since that time has been engaged in the development of the theory, research, and teaching. The theory Weiss created is about the origins of psychopathology and how the patient works in psychotherapy to overcome his or her problems. He proposed that in attempting to adapt to unhealthy psychological environments people develop invalid, negative beliefs about themselves and others that make them unhappy and prevent them from living effective and satisfying lives. It is these beliefs that are the basis of psychopathology. (Examples of such beliefs are "I should be unhappy as my mother is or she will feel lonely and blame me," "I must have low self-esteem so that my father will not feel threatened by me," "If I express my emotional needs to my parents or others I will be unduly burdening them".) At the heart of the theory are two concepts: that people have unconscious control over their defenses, and that they have a wish to master their problems and unconsciously organize their behavior in an attempt to do so. In psychotherapy, the therapist's task is to understand the patient's unconscious plan to solve his or her problems and to help the patient to do so.
The Patients' Search For Safety: The Organizing Principle in Psychotherapy
Abstract: This article presents the Control-Mastery view that patients organize the process of their psychotherapy in their search for psychological safety with the therapist. According to this theory, people unconsciously assess their social environments for signals of safety and danger, relaxing their defenses when it seems safe to do so. In therapy, patients test to find the safety with the therapist which would free them to be less defensive in that relationship, and, ultimately, in all their relationships. Understanding how patients' activity in psychotherapy is organized by their search for safety can simplify the treatment process for the therapist and help to guide the therapist's interventions. Clinical examples are used to illustrate these ideas.
The Structure of Psychotherapy
Abstract: The view that psychotherapy patients unconsciously organize their therapy process in the service of their treatment goals has been advanced and empirically supported by Control-Mastery theory proponents. This article discusses the patient's plan according to Control-Mastery theory and shows how it is made explicit in the Diagnostic Plan Formulation. It describes how the plan formulation can be used to guide the therapist's interventions, and shows how it creates a structure that organizes the whole therapeutic enterprise. A case example is given to illustrate the therapeutic clarity and power that can result from the use of this approach.
Freeing Oneself From Pathogenic Adaptations
Abstract: Control-Mastery theory, proposed by Joseph Weiss, is receiving increasing acceptance among psychotherapists. Two main tenets of the theory are that psychopathology is caused by pathogenic beliefs, ideas about oneself and the world which interfere with healthy functioning, and that people attempt to disconfirm these beliefs by testing their validity in their interactions with the therapist. I suggest that pathogenic beliefs are more accurately and profitably seen as pathogenic adaptations, modes of acting, thinking and feeling which seem required of them by others. I also offer a modification to the testing paradigm called passive-into-active testing. Both of these changes make the theory more powerful, improve its internal consistency, and make it easier to apply.
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The following files are versions of the Diagnostic Plan Formulation form. The diagnostic plan formulation concept was originated by the Research Group as a research tool and used to study numerous cases. I have adapted the group's concept to create several forms that have been helpful to clinicians in organizing case material and in developing hypotheses about how to pass patients' tests.
Diagnostic Plan Formulation: Therapist-Patient
(This is a graphic of the Therapist-Patient DPF form and may be downloaded and distributed freely.) This version of the Diagnostic Plan Formulation is the one I am currently using. It adds a section for considering the plan formulation for the therapist, as well as that for the patient, to help understand and acknowledge the therapeutic process as an interaction between two people. A discussion of this revision may be downloaded as the Discussion of the Therapist-Patient DPF
Diagnostic Plan Formulation Form: Revision 1
(This is a graphic of Revision 1 of the DPF, and may be downloaded and distributed freely.) Revision 1 of the Diagnostic Plan Formulation Form replaces the "Insights" column with a column for "Therapist-Initiated-Interventions", and adds a column for "Therapist Factors." The rationale for these changes may be downloaded as the Discussion of DPF Revision 1
Diagnostic Plan Formulation: Original Version
(This is a graphic of the original DPF form, which may be downloaded and distributed freely.) This version of the Diagnostic Plan Formulation Form is the one used in my 1996 and 1997 articles. The use of this form is discussed in those articles, along with demonstrations of its use with specific cases.
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The Experience of the Therapist
This is a discussion of the invisible person in the psychotherapeutic relationship, the therapist. The therapy relationship is, most fundamentally, a relationship, and yet almost all the attention is usually focused on just one of the people in the relationship, the patient. Both people determine the quality and value of the relationship for each person, and in this paper I explore some of the issues related to this viewpoint.
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