Elinor Greenberg, Ph.D., Defining and Identifying Narcissism

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2024/11/05

Elinor Greenberg, Ph.D. (website) is the author of the book Borderline, Narcissistic, and Schizoid Adaptations: The Pursuit of Love, Admiration, and Safety. She is a globally recognized Gestalt therapy trainer specializing in the diagnosis and treatment of Borderline, Narcissistic, and Schizoid adaptations in a lively and practical way. She has trained psychotherapists in her approach in the England, Mexico, Norway, Russia, Sweden, US, Wales. She is an Associate Editor of the Gestalt Review, a faculty member of the New York Institute for Gestalt Therapy, and a faculty member of the Gestalt Center for Psychotherapy and Training, where she designed and taught a post-graduate program on the diagnosis and treatment of Borderline, Narcissistic, and Schizoid Adaptations. She is also a graduate of and former faculty member of “The Masterson Institute,” which is a post-graduate training institute teaching psychoanalytically oriented developmental, self, and object relations approach to the theory and treatment of personality disorders. She is a certified Ericksonian hypnotherapist and is in the National Registry for Certified Group Psychotherapists. Dr. Greenberg was honoured by Quora.com as a Top Writer for 2017 and 2018.

Greenberg explains the complexities of diagnosing narcissistic personality disorder. She emphasizes that narcissism involves rigid, maladaptive coping mechanisms rooted in childhood. Greenberg distinguishes between emotional and cognitive empathy, highlights the concept of “object constancy,” and describes her approach to therapy, including identifying splitting behaviours and listening for exaggeration and performative self-presentation in clients.

Scott Douglas Jacobsen: Today, we’re here with Elinor Greenberg, an expert in narcissism and other personality disorders. We’ll be focusing on narcissism today. I’d like to ask you about your unique approach to the treatment modalities of narcissism, which I was unaware of before being informed and educated by you. So, a two-part question:

First, how are we defining narcissism, and how do we use that definition to separate treatable from untreatable cases?

Elinor Greenberg: We don’t use that definition to separate treatable from untreatable. The definition helps to identify people who meet the full criteria for narcissistic personality disorder—what’s commonly called ‘the pattern.’ It’s the name of a pattern, not a label for the person. The pattern of coping that is termed narcissistic personality disorder is distinct from individuals who have narcissistic traits. These individuals may appear narcissistic on the surface, but at a deeper level, they are not.

In my definition of narcissistic personality disorder, the first criterion is that the individual must have a personality disorder. A personality disorder is generally defined as a rigid, maladaptive set of coping mechanisms, thought processes, behaviours, and interpretations that trace back to early childhood. These mechanisms likely developed, theoretically speaking (though we cannot prove it), in response to a home environment where the individual sought to maximize love and support while minimizing rejection and punishment. I reframe disorders as adaptations because I believe they begin as adaptations. However, the field defines them as maladaptive, persistent, and rigid responses that are often inappropriate. Nevertheless, the individual pays a price for these responses.

You can think of a personality disorder as a suit of armour—protection. Narcissistic personality disorder shields a person from humiliation, feelings of shame, and feelings of inadequacy. However, when you wear a suit of armour, you lose flexibility. So, you sacrifice flexibility in exchange for a specific kind of safety—feeling special, in the case of narcissism.

The first step is determining whether the person has a personality disorder, meaning they exhibit a rigid, maladaptive pattern that isn’t serving them and is interfering with their coping skills and functioning in important areas of daily life. On top of that, they would need to meet the criteria for narcissism.

Different criteria depend on the theoretical approach to narcissism. It’s like the story of the blind man and the elephant. Are you familiar with that?

Jacobsen: Yes.

Greenberg: For those who aren’t familiar with it. Briefly, five blind men are asked to describe an elephant. Each one touches a different part of the elephant. One touches the tail and says an elephant is like a string. Another touches the trunk and says an elephant is like a snake. One touches the side and says the elephant is like a wall, but you can feel it breathing. Narcissistic personality disorder is similar. Each theoretical school focuses on a different aspect of the same phenomenon, and all are more or less true.

In my first year, I had two clients like that. They initially seemed to view the therapy and me as adequate, even good. They praised me. Then, one day—maybe around six sessions in—I said something, and they suddenly hated me. It wasn’t just dislike. They didn’t calmly say, “Elinor” or “Dr. Greenberg”—whatever they preferred to call me—”I’m upset that you said that.” No, it wasn’t that kind of response.

It was pure hatred. The kind of reaction where they quit therapy, start yelling at me, and storm out of the room, accusing me of lacking professionalism or depth. They might even stop paying back the session when clients still paid me by check.

I couldn’t understand it. How could someone go from loving me to hating me, swinging from one extreme to the other, without any intermediary reaction that I could see? I must have said or done something that didn’t sit well with them. That’s when I began studying this phenomenon. I learned that object relations theory had the answer, explaining what I was witnessing—though I would not say I like the jargon.

I saw a lack of whole-object relations and object constancy. Now, why is this important? Why should I care? Well, nobody wants to be abused. Do you want to be abused?

Jacobsen: No, of course not.

Greenberg: Exactly. Few people enter a relationship wanting to be abused. However, a lack of object constancy is one of the greatest predictors of abuse in relationships during conflicts—whether it’s the abuse of a child, a partner, or even an employee. So, what does this mean? What does object constancy refer to?

It ties into whole object relations. If I have object constancy and like you, I will still like you even if you say something that annoys me. I may be upset by what you said, but it won’t destroy our relationship. I can process that.

I say things that annoy people, too. But if I’m disappointed in you, it doesn’t ruin our entire relationship. Let’s say we’ve had a ten-year friendship. Now, I’ve lost two narcissistic friends. I knew they were narcissists. I knew they often behaved like narcissists, idealizing me at first, but that wasn’t why I spent time with them. I liked them because they were interesting people. Then, one day, something happened; they were triggered and ghosted me. They stopped talking to me completely. I reached out, but I got no response.

This is typical. That’s the need for more object constancy. Someone gets hurt by me or is disappointed in what I said or did, or something someone else said affected our relationship, or even physical distance played a role. Many people cheat on their partners because, with physical distance, they cannot maintain their sense of a positive connection to the other person. So, if someone goes on a business trip and feels abandoned, or if they need and want their partner but don’t feel that connection, they might do something against their marriage vows—something they wouldn’t have done if they were still physically close to their partner.

A number of unpleasant outcomes occur when you don’t have whole object relations, which can lead to splitting in the middle of a fight. Why is this dangerous? A lack of object constancy means that in the middle of a fight, I go from seeing you as my loved one, my dear friend, to my enemy—someone I must protect myself against at all costs. This response is disproportionate and not based on reality.

It could be a baby I shake because it won’t quiet down, and I’m desperate for sleep, taking it personally. Or it could be my partner, whom I slap or throw the remote at during a fight because, if I’m the narcissist, I feel humiliated and attacked by them. There are many opportunities for this kind of reaction, which needs to be clarified.

In these moments, someone may do something abusive that they would never do if they had whole object relations. Their actions go against how they feel after the split. You hear about cases in the news—someone kills their wife, the police arrive, and they’re crying over her body, holding her and saying, “I love you, I love you, I never meant to do this.” I believe them. I believe that what happened to many of these people was that they lacked whole-object relations. They fought with their wife and lost sight of everything else in the heat of the moment.

Their love for this person, the entire history of good times, loving moments, even great sex—it all fades into the background. What remains is the desperate need to win the fight, to battle. If they’re prone to hitting, their partner will get hit. They won’t calm down until their partner is begging for forgiveness. If they’re not the violent type, they might stop talking to their partner altogether.

People who live with narcissists may endure someone refusing to speak to them for days as a form of punishment. The narcissist was triggered but didn’t become violent, so they withdrew instead. These are important concepts, and that’s why people find living with narcissists so difficult. Narcissists have an additional issue—they struggle to tune into others and feel genuine warmth. People with narcissistic personality disorder have little to no ability to feel this warmth for others.

Emotional empathy is different from cognitive empathy. Emotional empathy is when you see someone slam their finger with a hammer by accident, or maybe they’re on the screen, and you wince. That’s emotional empathy.

For most people, it’s difficult to watch someone else get hurt in a way they can imagine being hurt themselves or to see a child or animal suffer and remain calm about it. Their heart might race, or they might feel discomfort. Conversely, seeing someone embarrassed can trigger emotional empathy. I’ve had to leave movies because I would not say I liked watching a character’s embarrassment. It wasn’t funny to me at all, though others were laughing.

If you have emotional empathy, you connect to that person’s emotions. When you do this, your gut response mirrors what you imagine they’re feeling. Of course, you could be wrong. Maybe the person has a condition that dulls pain, and when they hit their finger, they don’t feel it. But the average person isn’t analyzing it that deeply; they’re reacting instinctively.

Emotional empathy is that gut feeling of joy when someone you love succeeds. For example, if your child calls you with good news, you feel warmth in your chest—what in Yiddish is called “naches”—and you’re genuinely happy for them. That’s emotional empathy. Or, when someone you care about is hurt, you feel bad for them and offer kindness, even if it’s inconvenient for you. Narcissists can’t do this. In the middle of a fight, a narcissist can hurt you without feeling any emotional pain.

Now, cognitive empathy is different. We all have it to some degree unless we’re neurodiverse in a way that limits it. Cognitive empathy is the ability to imagine what someone else might feel and respond appropriately based on that understanding. An example of this would be attending a friend’s wedding. You know you’re supposed to say everything is wonderful, even if you’re unhappy with the food or seating arrangements. Cognitive empathy tells you not to mention that the wrong entrée was brought or that the person sitting next to you made an inappropriate comment. You hold back because you wouldn’t want to hear those things if it were your wedding.

Cognitive empathy means doing the socially appropriate thing because it’s the right thing or benefits you somehow. For narcissist, they can display cognitive empathy even if they don’t feel it emotionally. For instance, at a funeral, a narcissist might not care that your father died unless his death affects them—maybe if he was financially supporting them. But if the narcissist is high-functioning, they will act as if they care because they know it’s the right thing to do.

So, that’s the difference between emotional and cognitive empathy. It’s important because, in the middle of a fight, no one usually stops to think, “Let me consider how the other person feels,” or “Maybe my first reaction to insult them will hurt our friendship in the long run.” For a narcissist, especially if they’ve lost whole object relations during the conflict, that thought isn’t available. And I say “average” because some narcissists can keep in mind that they have a use for you after the fight is over, especially if they see you as someone with higher status or importance. Others, however, won’t keep that in mind.

Jacobsen: Be mindful of time—seven and a half minutes. When you apply these concepts in a therapeutic setting, what are the first steps for treatment?

Greenberg: The first step is to make a differential diagnosis.

I’m looking for signs of splitting. If I’m approaching it from an object relations perspective, I’m looking for current and historical splitting. I pay attention to how they describe themselves and others. Now, everyone exaggerates sometimes—it’s part of modern conversation: “Oh, it’s so hot out,” or something similar. But narcissistic exaggeration is more extreme—they see themselves as the best and others as the worst. If I ask the average person about someone else, they might need more information or give a measured response. “On a scale of 1 to 10, how bad are they?” they’ll respond thoughtfully.

However, when you ask a narcissist, the person they dislike is always a ten on that scale. And if you ask them about themselves, “How special are you on a scale of 0 to 10?”—even when comparing themselves to someone they greatly admire—they might go as low as a 9, but they always see themselves as the best. I could give examples, but I don’t want to take up too much of your time. The point is, I listen to the language and challenge it: “Well, scale it for me.”

That’s what I’m paying attention to. I’m also listening for signs of empathy or a lack thereof and observing their self-presentation. I watch how they present themselves and how much effort they put into that presentation. For example, one man spent an entire session trying to present himself as someone who deeply cares whether I’m addressed as “Doctor” or “Ma’am” or something respectful, even though I repeatedly told him, “Call me Elinor, and let’s focus on why you’re here.” His wife had sent him to treatment for narcissism, but we spent the whole session with him, trying to show how respectful he was toward me. Something was off.

Jacobsen: It’s performative.

Greenberg: Exactly, it’s performative. Narcissists often perform one of two sides of a false self. Their authentic self was left behind in childhood to the extent that it wasn’t rewarded by their parents—or at least, they believed it wasn’t. Now, it’s not always the parents’ fault. There can be other situations or circumstances involved, and I’ve seen many of these. It’s not always about blaming the mother or the father. There are other contributing factors.

So, I’m listening to how they describe themselves. I’m also listening for balance. When they say, “My wife wanted me to come to therapy,” I ask, “Tell me about your wife and the issues she wants addressed.”

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