Wednesday, November 09, 2011

All About Me!

Psychotherapy is, by it's nature, a narcissistic endeavor.  That's not to say that the patient is a narcissist, but the journey itself is meant to focus on patient's interior life, and it's not always about the greater good.  In my last post, several commenters said they feel uncomfortable talking about themselves or worry that their therapist will mistakenly think they are narcissistic because they that talk about themselves in therapy.  

It's not at all unusual for people to express some discomfort about talking about themselves in therapy, or to comment, "all I do in here is complain,"  or "You must get tired of hearing people complain/talk about their problems, etc...."  

I won't talk for other psychotherapists because I only know how I feel.  It seems to me that the mandate of therapy is for the patient to talk about the things they have been thinking about.  The truth is that most people think about themselves and issues of the world are interpreted by individuals as they impact them.  Some people have lives that are very much focused around their immediate circle of events, the pain of their emotions, the distress of interactions with family, neighbors, friends, and co-workers.  Others may spend time discussing how the people around them are behaving in unproductive ways, and some people focus on their concerns about broader political issues that are important to them.  Most people don't come to spend their entire psychotherapy sessions discussing world events,  problems in developing nations, the European economy, climactic issues in other parts of the country, or other world events unless these things directly impact them, or they are things they are spending a lot of time thinking about.  

I like hearing about people's problems.  I may empathize or sympathize or say things I hope will provide some sense of support, or perhaps offe an interpretation that will give the issue a broader meaning in the context of the patient's life, but I don't generally feel burdened by other people's problem.  I am too busy feeling burdened by my own problems, and for the sake of my job, I get the luxury of being able to turn off my own problems and focus on someone else's internal world for 50 minutes out of the hour.  I like this and I get paid for it. 

Do I ever think a patient is narcissistic?  Well sure, if they tell story after story where they seem completely unable to see that another person might have a different point of view, or repeatedly recount events where they've behaved with complete disregard for the feelings of others or respect for the law.  For most of the people, most of the time, I think they're just people who come to therapy and they talk about themselves because that's what therapy is about.  Am I bored?  No.  Do I ever wish a session would end and I could finish the day and go home and change out of work clothes and chill out and think about my own stuff?  Yes, but that doesn't mean I find my patients boring, or that I don't care about them, or that I don't like listening , or that I don't like them.  I think it means that sometimes I'm human.

Mostly, I listen and try to be helpful.  I don't spend a lot of time judging.  (I can't say never because I'm a human being and human beings sometimes judge each other and you may think a psychiatrist should never do that but do write me when you've examined the content's of someone's heart and you've found the perfect non-judgmental person; I would like to have coffee with them.)

If you're worried that you're psychiatrist thinks you're too self-involved because you talk about yourself in therapy, you might want to find something else to worry about.  ;- )  (Roy will be back soon to translate my emoticons). 

And just a quick fyi: the definition of narcissism per wikipedia:
Narcissism is a term with a wide range of meanings, depending on whether it is used to describe a central concept of psychoanalytic theory, a mental illness, a social or cultural problem, or simply a personality trait. Except in the sense of primary narcissism or healthy self-love, "narcissism" usually is used to describe some kind of problem in a person or group's relationships with self and others. In everyday speech, "narcissism" often means inflated self-importance, egotism, vanity, conceit, or simple selfishness. Applied to a social group, it is sometimes used to denote elitism or an indifference to the plight of others. In psychology, the term is used to describe both normal self-love and unhealthy self-absorption due to a disturbance in the sense of self.


Andrea said...

I really like this blog post. You seem like a great therapist. I think my therapist would describe her job in much the same way. I have had therapists in the past who didn't seem to enjoy providing therapy, but I have been lucky to have worked with a great therapist for the past five years.

Going to therapy is different from talking with friends and family, and I think that most people understand that when they are in therapy, they will be talking about themselves more. It may seem narcissistic, but the purpose is to learn to make better choices and decisions, and a true narcissist is not interested in self improvement.

Anonymous said...

Whew. So Dinah, please explain this:"That being said, it still can feel very uncomfortable on the shrink side of a couch when a boring patient asks if they are boring. What would you say?"
In one post you seem to say that yes, there are boring patients and now, there are no boring patients.

Anonymous said...

Well, what if your psychiatrist gets peeved with you because you keep bringing up a litany of complex medical problems and the shrink only wants to focus on mental ones? So you go down a list of symptoms and you say, "Oh, here's irritability! I have that one nonstop." And the shrink counters with, "That doesn't surprise me. Don't take this the wrong way, but you are a complainer." And then a week later you end up diagnosing yourself with a connective tissue disease that is going to show that those 4 years of complaints of severe headaches, blurred vision, etc. actually made sense? Is the patient owed an apology?

I am thinking that if I had not complained of those symptoms, to a friendly ear that I thought would listen, I'd still be in medical limbo. Internists tend to write off diarrhea, headache, nausea, tremor and dry mouth in a mentally ill patient as the patient just being a drama queen. At least I got what I wanted out of the therapy/med checks. If the shrink had a frustrating time of it while I was in the office, too bad for the shrink.

rob lindeman said...

I highly recommend The Last Psychiatrist,, who has made a blogging career out of narcissism, to wicked, snarky effect.

wv = thersa bright golden haze on the meadow

Dinah said...

Anon 1: Why would you want to take me to task over trivialities? It's a blog, I let my guard down a little. I used the boring patient who asks if they are boring example because it was the question a reader asked in the previous post's comment. I don't think anyone has ever asked me if they are boring me, and if I thought I had been asked this question and it was a real issue for me, I would not have used this example for fear that my own patient who had asked if they were boring had read it and feel hurt. I think our readers can imagine similar scenarios. Boredom is not really a problem for me.

Anon2:If the shrink had a frustrating time of it while I was in the office, too bad for the shrink. Yup, good attitude. You're not there to entertain the shrink, you're there to work on your stuff.

Anonymous said...

Trivial, shmivial. It is all grist for the mill. I forgot it was a blog. I mean I had a feeling that it was but then I wasn't sure. Now that you brought it to my attention, I am way less confused. Ping pong

Anonymous said...

Sometimes I am curious about what my shrink is thinking or how my shrink feels about me (or even other patients). But usually, not. My goal is not to pay her for me to entertain her. I am paying her for her experience and education to help me. A strange business transaction, indeed.

I just moved to a new city and am in the process of establishing relationships with a new psychiatrist and therapist. I really respected my "old team" members and believed they helped me great deal. I miss them already.

Of course, initially I will be speaking at great length about myself. I do not believe this is self-centered behavior in the least. The "new team" needs to get to know me!

Daniela said...

Beautiful post! Thanks for saying this, and better than I would have. Smiley face.

Marie Gronley MD said...

Very carefully I will say that often people who are suffering from mental disorders are very self-focused and with good cause. They are struggling and hurting and this concern and attention to "self" can be confused with narcissistic behavior when in reality they are hurting so much; all they can focus on is the distress and anguish in their lives. Many of us have been in a place where we have to deal with the problems within before we can be of any help to our friends and family; often this can be mistaken as narcissism.

I have also met people on the other end of the spectrum who seem to stay in therapy all their lives because they love talking about themselves; or so it seems. Some people remind me of the monkey who puts her hand in the coconut to grab all of the food and cannot remove her hand from the coconut because of her clinched fist(greed and self-centered)attitude.

Sometimes those who are ostensibly not suffering from any major mental illness, yet stay in counseling never get better because they cannot take the focus off of themselves and look to find interest in someone else's life. They miss the joy of helping others and putting someone else's needs first and end up like the monkey, never satisfying her appetite. This is the irony of narcissism in that the goal of the narcissist is usually self satisfaction; but the end result is never ending discontent. I began this comment with a "very carefully" because it is not always easy to discern between a narcissist and someone who is self-focused on some real problems and crises that demand most of their attention.

Jane said...

I thought I would post this comment from The Last Psychiatrist. I'm not sure what it says about narcissism or how narcissists behave, but I think it's good food for thought.

"As regular readers of TLP have mentioned before, the most interesting (and the most forgotten) part of the legend of Narcissus, is that while he fell for a reflection, he was completely unaware that the reflection was his own."

Anonymous said...

I have actually found that I pretty consistently dislike talking about myself in therapy. I do it because I'm committed to staying healthy and sane and functional, and it's infinitely easier with a good therapist. But overall, I really dislike it, and have found that many other people with serious mental health issues (ie not the worried well, or people seeking help for a specific event, like a breakup or a death) feel the same way.

I think it's relevant to realize that there are indeed many of us who really dislike this part of therapy, yet continue to try our best to do it because it is supposed to help us stay stabilized and sane.

Anonymous said...

In some ways, I think it depends how long you have been working with your therapist.

I am still working on that rapport with my psychiatrist and trying to get over the attitude that I am annoying them, or feeling like a burden etc.

However, with the psychotherapist, with almost a year working on some pretty heavy issues, I have come to understand when he is being blunt, adding humor, or adding some profound insight. Rather I understand where he is coming from and don't feel like so much of a narcissist. There is a team work involved. And like the first poster said, therapy is different than talking with family or friends. Friends/family are NOT trained and haven't dealt with hundreds of thousands of issues just like yours. Family and friends don't have the tools, they get burned out fast and tend to tell you if you are getting "selfish" or "ungrateful," or turning into a "Me Monster."

I have had some significant life changing moments ( too many) this past year. In return I have found some incredible opportunities - courtesy of the therapist to get down to business and work on changing myself, so I can become better in the long run.

I would think that more than anything, a therapist gets frustrated when you haven't at least made some small attempt to work on those things that they have asked you to do between visits. And perhaps guilt on the side of the patient from not making progress fast enough.

And once again I would have to agree with the first poster. I don't see a narcissist in therapy. They already see themselves as perfection and not needing to change. Too much work.

Anonymous said...

Do narcissists ever seek treatment? Seems to me they would never conclude they were in need of help.

Can narcissism be cured? If so, I know some perfect candidates!

Anonymous said...

Isn't the point of therapy to talk about your problems, so that you can let go of them and move on.

C.J. Brenner said...

Narcissism is actually in my personal experiences a very easily noticable trait in sharing conversation with another person.
Narcissism is an affliction of self need and self preferential actualization that one can detect by visiting the other person in a conversation in which you may introduce information that conflicts with that other person's ego. If you are guessing at this, it might be a likilihood that you are responding to the patients disagreement with your professional touch rather than the patient demanding that the situation be focused on his or her own ego and self needs.
Be careful not to aggressively dictate that another person follow your lead as you may not be responding to his true dilemmas. In that sense, one may miss the true patient care issues and focus on ones own personal priorities in the course of a session of revelation and insight about the workings of another person's mind and personality.

Ways to beat depression said...

Hello Dinah,

I have a wonderful therapist that treats me very well. He also works from a psycho-analytic vision.
I've been in counselling for sic years, and I'm still learning new things about myself. Maty this therapy isn't as popular as it was before, but if you invest your time and energy in it works well.

Kind regards,
Tasha Smith
Ways to beat depression reviewer