“But my poor Saul, there’s no help for you, you’re heading straight for it. What about all those marvelous people we know, aged about fifty or sixty? Well, there are a few of them…marvelous, mature, wise people. Real people, the phrase is, radiating serenity. And how did they get to be that way? Well, we know, don’t we? Every bloody one of them’s got a history of emotional crime, oh the sad bleeding corpses that litter the road to maturity of the wise, serene man or woman of fifty-odd! You simply don’t get to be wise, mature, etc., unless you’ve been a raving cannibal for thirty years or so.”

“Oh, I understand it, but it doesn’t make it less depressing, the way the victims are always so willing to contribute their flesh and blood…Nonsense–The people who are oh so willing to be victims are those who’ve given up being cannibals themselves, they’re not tough or ruthless enough for the golden road to maturity and the ever-so-wise shrug. They know they’ve given up. What they are really saying is: I’ve given up, but I’ll be happy to contribute my flesh and blood to you.” (The Golden Notebook by Doris Lessing, 1973, pp. 626-627)

Here I have quoted an exchange between two characters in Doris Lessing’s novel, The Golden Notebook. It obviously overstates the case—we’re not talking here about actual cannibalism. The nugget of truth here, however, is that so many psychotherapy patients grew up in families with parents who, for a variety of reasons, were not emotionally attuned to them. Perhaps the parents were narcissistic, or alcoholic, or ill. To survive childhood, often these children develop what Alice Miller, in The Drama of the Gifted Child, has called “antennae” for other people’s needs or feelings, at the expense of their own. In the cannibal metaphor, they let themselves get “eaten” by demanding or controlling partners or parents or bosses.

I use the term “narcissistic families” to describe the environment that these children grew up in. As the authors of the book The Narcissistic Family state, “We identified a pattern of interaction that we labeled the narcissistic family…we found one pervasive trait present in all of these families: the needs of the parent system took precedence over the needs of the children…the child must be reactive to the needs of the parent, rather than the converse. In fact, the narcissistic family is consumed with dealing with the emotional needs of the parent system.” (pp. 4-5)

My former supervisor Dr. Volney Gay would describe this type of family, in psychodynamic terms, as an “inverted self-object” system. Rather than the parents being available to assist their children in building a healthy sense of self, the children are unconsciously recruited to continually boost the parent’s faltering sense of self. Alice Miller, in her book referenced above, describes why most psychotherapists come from such a background:

“…these children…eventually develop a special sensitivity to unconscious signals manifesting the needs of others. No wonder they often choose to become psychotherapists later on. Who else, without this previous history, would muster sufficient interest to spend the whole day trying to discover what is happening in other people’s unconscious?” (p. 8)

When most people describe a narcissistic individual, they are typically referring to the grandiose narcissist, who has an inflated sense of self and a lack of empathy for others. At the other end of the narcissistic spectrum is the “shadow narcissist,” which better describes the pattern that typifies the background of most patients. Thirty years ago, Dr. Jordan Lee and I wrote a description of the shadow narcissist for the flyer for our women’s group for adult children of narcissistic families:

“…this child become an adult with such personality traits as a lack of self-confidence, a chronic need to please, difficulty being assertive, a vulnerability of depression, and she has great difficulty identifying and acting upon her own feelings, wants, and needs.”

Sometimes a patient will ask me, “Am I narcissistic?” I might explain to him or her that all of us who grew up in narcissistic families have characteristics of both grandiose and shadow narcissism, and that each of us lies at a different place on the continuum that stretches from grandiose to shadow narcissism. Thinking in percentage terms, for example, one might be 80% shadow narcissist and 20% grandiose narcissist, or vice-versa.

Grandiose narcissist ———- Narcissist ———- Shadow narcissist

Sitting with a patient, I might draw a line across a piece of notebook paper, and label one end of the line as “selfless” and the other end of the line as “selfish.” To a shadow narcissistic patient, I might suggest that when she takes a few steps away from the “selfless” position, she then feels guilty and imagines she is all the way over at the “selfish” or grandiose position. Actually, she is getting closer to what I call “healthy self-interest.” As Dr. Lee and I wrote in our group flyer: “…when the adult child struggles to birth a self, she may feel guilty and worry that she needs too much and has become self-focused, like her narcissistic parent.”

Selfish ———- Healthy Self-interest ———– Selfless

This guilt is one of several dilemmas that we encounter in the treatment of individuals with narcissistic wounds. Thus, I often say to such patients, who are attempting to pay better attention to their feelings and needs, that “guilt is part of the territory.” I suggest to them that the guilt in this case doesn’t mean they are doing something wrong, but that they are doing something different—elevating their wants and needs, relative to other’s perceived needs, higher than they have in the past.

Nancy McWilliams, Ph.D., in her brilliant chapter on “Narcissistic Personalities”, in her book Psychoanalytic Diagnosis, writes, “What narcissistic people of all appearances have in common is an inner sense of, and/or terror of, insufficiency, shame, weakness, and inferiority.” (p. 171)
In assisting patients in the healing of their shame, I tend to turn to Buddhist teachers and Buddhist principles of non-judgment. One Buddhist teacher, who is also a psychologist, who focuses her teaching particularly on the ravages of shame, is Tara Brach, Ph.D. In her book, Radical Acceptance, she writes about “the trance of unworthiness” that many of us and our patients are seeking to recover from:

“As a friend of mine put it, ‘Feeling that something is wrong with me is the invisible and toxic gas I am always breathing.’ When we experience our lives through this lens of personal insufficiency, we are imprisoned in what I call the trance of unworthiness…what a waste of our precious lives it is to carry the belief that something is wrong with us…Inherent in the trance is the belief that no matter how hard we try, we are always, in some way, falling short.” (pp. 5-6)

Sometimes I will say to such patients, “You were brainwashed in childhood into believing that something is wrong with you. Part of our work is to undo the brainwashing.”

Codependent and shadow narcissistic patients often end up in relationships with controlling partners. Ann Jones and Susan Schechter write about this in their book When Love Goes Wrong: What To Do When You Can’t Do Anything Right. They write, “Because the controller builds himself up at the expense of others, no one can remain in a relationship with him without giving up important parts of the self…First you may give up certain activities or interests; then you find that you’re giving up your opinions, your wishes, your ambitions, your anger, your voice, your pride, your happiness.”

“Nevertheless, there is a difference between supporting a partner who also supports you and losing yourself to a partner who inflates himself at your expense…Ask yourself: Am I the whole person I used to be? Am I as expansive as the person I wanted to become? Or have I lost bits and pieces of myself without meaning to? Am I withering away? In this relationship, who takes up the emotional and physical space? Does he make himself bigger by making me smaller? Do I make him feel bigger by making myself smaller? If you feel yourself shrinking, you’re probably in a relationship with a controller.” (p. 16)

In working with codependent patients, I often say, “The two most important questions in life are ‘What do I feel?’ and ‘What do I want.’” Psychotherapy with such individuals includes a big focus on recognizing one’s feelings and needs, and learning to take a stand for these. A key concept in working with these patients in “differentiation.” One definition of differentiation is “resistance to the interpersonal contagion of anxiety or anger.” While “individuation” refers to the idea of becoming one’s own person, differentiation is the ability to hold onto one’s self in the midst of complicated relationships.

One psychologist who writes about differentiation is Harriet Lerner, Ph.D. In her book Marriage Rules: A Manual for the Married and the Coupled up, she describes the process of holding onto one’s needs while in relationship. Most people resist the idea of “ultimatums.” A better concept is what Lerner describes as “your bottom-line position.” She writes:

“A bottom-line position evolves from a focus on the self, from a deeply felt awareness of what one is entitled to, how much one can do and give, and the limits of one’s tolerance. One clarifies a bottom line not to change or control one’s partner (although the wish, of course, is there) but rather to preserve the dignity, integrity, and well-being of the self. A bottom line is about the ‘I’: ‘This is what I think.’ ‘This is what I feel.’ ‘These are the things I can and cannot do.’”

“Everyone has a different bottom line, even though we may not know what it is until we’re put to the test. There is no ‘correct’ bottom line that fits us all. While there’s no shortage of advice out there, neither your best friend not your therapist can know the ‘right’ amount of giving, doing, or putting-up-with in your relationship, and what new position you are ready to take on your own behalf.”

“The rules in this chapter cover a range of ‘bottom lines,’ from those that come up in the dailiness of coupledom (‘You have to clean the kitchen’), to voicing the ultimate (‘If these things don’t change, I don’t think I can stay in this relationship’). Consider each rule carefully, as you work to define a strong ‘I’ within the ‘we’ of your marriage. This challenge is at the very heart of having both a relationship and a self.” (p. 182)

When talking with patients about their primary relationship, I will suggest that most of the time we try to go along with and please our partners. However, every once in a while, an issue arises that is “a hill I’m prepared to die on,” in reference to something that I realize is of utmost importance to me. In summary, recovering from codependency is usually a long therapeutic journey of better identifying my needs and feelings, and being willing and able to take a stand in my relationships for what is important to me.