by Sam Vaknin
By stroking the narcissist's grandiosity, they hope to modify or counter cognitive deficits, thinking errors, and the narcissist's victim-stance. They contract with the narcissist to alter his conduct. Some even go to the extent of medicalizing the disorder, attributing it to a hereditary or biochemical origin and thus 'absolving' the narcissist from guilt and responsibility and freeing his mental resources to concentrate on the therapy."
But is therapy worth the effort? What is the success rate of various treatment modalities in modifying the abuser's conduct, let alone in "healing" or "curing" him?
Your Abuser in Therapy
Your abuser "agrees" (is forced) to attend therapy. But are the sessions worth the effort? What is the success rate of various treatment modalities in modifying the abuser's conduct, let alone in "healing" or "curing" him? Is psychotherapy the panacea it is often made out to be – or a nostrum, as many victims of abuse claim? And why is it applied only after the fact – and not as a preventive measure?
Courts regularly send offenders to be treated as a condition for reducing their sentences. Yet, most of the programs are laughably short (between 6 to 32 weeks) and involve group therapy – which is useless with abusers who are also narcissists or psychopaths.
Rather than cure him, such workshops seek to "educate" and "reform" the culprit, often by introducing him to the victim's point of view. This is supposed to inculcate in the offender empathy and to rid the habitual batterer of the residues of patriarchal prejudice and control freakery. Abusers are encouraged to examine gender roles in modern society and, by implication, ask themselves if battering one's spouse was proof of virility.
Anger management – made famous by the eponymous film – is a relatively late newcomer, though currently it is all the rage. Offenders are taught to identify the hidden – and real – causes of their rage and learn techniques to control or channel it.
But batterers are not a homogeneous lot. Sending all of them to the same type of treatment is bound to end up in recidivism. Neither are judges qualified to decide whether a specific abuser requires treatment or can benefit from it. The variety is so great that it is safe to say that – although they share the same misbehavior patterns – no two abusers are alike.
In their article, "A Comparison of Impulsive and Instrumental Subgroups of Batterers", Roger Tweed and Donald Dutton of the Department of Psychology of the University of British Columbia, rely on the current typology of offenders which classifies them as:
"... Overcontrolled-dependent, impulsive-borderline (also called 'dysphoric-borderline' – SV) and instrumental-antisocial. The overcontrolled-dependent differ qualitatively from the other two expressive or 'undercontrolled' groups in that their violence is, by definition, less frequent and they exhibit less florid psychopathology. (Holtzworth-Munroe & Stuart 1994, Hamberger & hastings 1985) ... Hamberger & Hastings (1985,1986) factor analyzed the Millon Clinical Multiaxial Inventory for batterers, yielding three factors which they labeled 'schizoid/borderline' (cf. Impulsive), 'narcissistic/antisocial' (instrumental), and 'passive/dependent/compulsive' (overcontrolled)... Men, high only on the impulsive factor, were described as withdrawn, asocial, moody, hypersensitive to perceived slights, volatile and over-reactive, calm and controlled one moment and extremely angry and oppressive the next – a type of 'Jekyll and Hyde' personality. The associated DSM-III diagnosis was Borderline Personality. Men high only on the instrumental factor exhibited narcissistic entitlement and psychopathic manipulativeness. Hesitation by others to respond to their demands produced threats and aggression ..."
But there are other, equally enlightening, typologies (mentioned by the authors). Saunders suggested 13 dimensions of abuser psychology, clustered in three behavior patterns: Family Only, Emotionally Volatile, and Generally Violent. Consider these disparities: one quarter of his sample – those victimized in childhood – showed no signs of depression or anger! At the other end of the spectrum, one of every six abusers was violent only in the confines of the family and suffered from high levels of dysphoria and rage.
Impulsive batterers abuse only their family members. Their favorite forms of mistreatment are sexual and psychological. They are dysphoric, emotionally labile, asocial, and, usually, substance abusers. Instrumental abusers are violent both at home and outside it – but only when they want to get something done. They are goal-orientated, avoid intimacy, and treat people as objects or instruments of gratification.
Still, as Dutton pointed out in a series of acclaimed studies, the "abusive personality" is characterized by a low level of organization, abandonment anxiety (even when it is denied by the abuser), elevated levels of anger, and trauma symptoms.
It is clear that each abuser requires individual psychotherapy, tailored to his specific needs – on top of the usual group therapy and marital (or couple) therapy. At the very least, every offender should be required to undergo these tests to provide a complete picture of his personality and the roots of his unbridled aggression:
1. The Relationship Styles Questionnaire (RSQ)
2. Millon Clinical Multiaxial Inventory-III (MCMI-III)
3. Conflict Tactics Scale (CTS)
4. Multidimensional Anger Inventory (MAI)
5. Borderline Personality Organization Scale (BPO)
6. The Narcissistic Personality Inventory (NPI)
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The SYSTEM
Conning the System
Even a complete battery of tests, administered by experienced professionals sometimes fails to identify abusers and their personality disorders. Offenders are uncanny in their ability to deceive their evaluators. They often succeed in transforming therapists and diagnosticians into four types of collaborators: the adulators, the blissfully ignorant, the self-deceiving, and those deceived by the batterer's conduct or statements.
Abusers co-opt mental health and social welfare workers and compromise them – even when the diagnosis is unequivocal – by flattering them, by emphasizing common traits or a common background, by forming a joint front against the victim of abuse ("shared psychosis"), or by emotionally bribing them. Abusers are master manipulators and exploit the vulnerabilities, traumas, prejudices, and fears of the practitioners to "convert" them to the offender's cause.
I. The Adulators
The adulators are fully aware of the nefarious and damaging aspects of the abuser's behavior but believe that they are more than balanced by his positive traits. In a curious inversion of judgment, they cast the perpetrator as the victim of a smear campaign orchestrated by the abused or attribute the offender's predicament to bigotry.
They mobilize to help the abuser, promote his agenda, shield him from harm, connect him with like-minded people, do his chores for him and, in general, create the conditions and the environment for his ultimate success.
II. The Ignorant
As I wrote in "The Guilt of the Abused", it is telling that precious few psychology and psychopathology textbooks dedicate an entire chapter to abuse and violence. Even the most egregious manifestations – such as child sexual abuse – merit a fleeting mention, usually as a sub-chapter in a larger section dedicated to paraphilias or personality disorders.
Abusive behavior did not make it into the diagnostic criteria of mental health disorders, nor were its psychodynamic, cultural and social roots explored in depth. As a result of this deficient education and lacking awareness, most law enforcement officers, judges, counselors, guardians, and mediators are worryingly ignorant about the phenomenon.
Only 4% of hospital emergency room admissions of women in the United States are attributed by staff to domestic violence. The true figure, according to the FBI, is more like 50%. One in three murdered women was done in by her spouse, current or former.
The blissfully ignorant mental health professionals are simply unaware of the "bad sides" of the abuser – and make sure they remain oblivious to them. They look the other way, or pretend that the abuser's behavior is normative, or turn a blind eye to his egregi
ous conduct.
Even therapists sometimes deny a painful reality that contravenes their bias. Some of them maintain a generally rosy outlook premised on the alleged inbred benevolence of Mankind. Others simply cannot tolerate dissonance and discord. They prefer to live in a fantastic world where everything is harmonious and smooth and evil is banished. They react with discomfort or even rage to any information to the contrary and block it out instantly.
Once they form an opinion that the accusations against the abusers are overblown, malicious, and false - it becomes immutable. "I have made up my mind – they seem to be broadcasting – "Now don't confuse me with the facts."
III. The Self-Deceivers
The self-deceivers are fully aware of the abuser's transgressions and malice, his indifference, exploitativeness, lack of empathy, and rampant grandiosity – but they prefer to displace the causes, or the effects of such misconduct. They attribute it to externalities ("a rough patch"), or judge it to be temporary. They even go as far as accusing the victim for the offender's lapses, or for defending herself ("she provoked him").
In a feat of cognitive dissonance, they deny any connection between the acts of the abuser and their consequences ("his wife abandoned him because she was promiscuous, not because of anything he did to her"). They are swayed by the batterer's undeniable charm, intelligence, or attractiveness. But the abuser needs not invest resources in converting them to his cause – he does not deceive them. They are self-propelled.
IV. The Deceived
The deceived are deliberately taken for a premeditated ride by the abuser. He feeds them false information, manipulates their judgment, proffers plausible scenarios to account for his indiscretions, soils the opposition, charms them, appeals to their reason, or to their emotions, and promises the moon.
Again, the abuser's incontrovertible powers of persuasion and his impressive personality play a part in this predatory ritual. The deceived are especially hard to deprogram. They are often themselves encumbered with the abuser's traits and find it impossible to admit a mistake, or to atone.
From "The Guilt of the Abused":
Therapists, marriage counselors, mediators, court-appointed guardians, police officers, and judges are human. Some of them are social reactionaries, others are abusers, and a few are themselves spouse abusers. Many things work against the victim facing the justice system and the psychological profession.
Start with denial. Abuse is such a horrid phenomenon that society and its delegates often choose to ignore it or to convert it into a more benign manifestation, typically by pathologizing the situation or the victim – rather than the perpetrator.
A man's home is still his castle and the authorities are loath to intrude.
Most abusers are men and most victims are women. Even the most advanced communities in the world are largely patriarchal. Misogynistic gender stereotypes, superstitions, and prejudices are strong.
Therapists are not immune to these ubiquitous and age-old influences and biases.
They are amenable to the considerable charm, persuasiveness, and manipulativeness of the abuser and to his impressive thespian skills. The abuser offers a plausible rendition of the events and interprets them to his favor. The therapist rarely has a chance to witness an abusive exchange first hand and at close quarters. In contrast, the abused are often on the verge of a nervous breakdown: harassed, unkempt, irritable, impatient, abrasive, and hysterical.
Confronted with this contrast between a polished, self-controlled, and suave abuser and his harried casualties – it is easy to reach the conclusion that the real victim is the abuser, or that both parties abuse each other equally. The prey's acts of self-defense, assertiveness, or insistence on her rights are interpreted as aggression, lability, or a mental health problem.
The profession's propensity to pathologize extends to the wrongdoers as well. Alas, few therapists are equipped to do proper clinical work, including diagnosis.
Abusers are thought by practitioners of psychology to be emotionally disturbed, the twisted outcomes of a history of familial violence and childhood traumas. They are typically diagnosed as suffering from a personality disorder, an inordinately low self-esteem, or codependence coupled with an all-devouring fear of abandonment. Consummate abusers use the right vocabulary and feign the appropriate "emotions" and affect and, thus, sway the evaluator's judgment.
But while the victim's "pathology" works against her – especially in custody battles – the culprit's "illness" works for him, as a mitigating circumstance, especially in criminal proceedings.
In his seminal essay, "Understanding the Batterer in Visitation and Custody Disputes", Lundy Bancroft sums up the asymmetry in favor of the offender:
"Batterers ... adopt the role of a hurt, sensitive man who doesn't understand how things got so bad and just wants to work it all out 'for the good of the children'. He may cry ... and use language that demonstrates considerable insight into his own feelings. He is likely to be skilled at explaining how other people have turned the victim against him, and how she is denying him access to the children as a form of revenge ... He commonly accuses her of having mental health problems, and may state that her family and friends agree with him ... that she is hysterical and that she is promiscuous. The abuser tends to be comfortable lying, having years of practice, and so can sound believable when making baseless statements. The abuser benefits ... when professionals believe that they can "just tell" who is lying and who is telling the truth, and so fail to adequately investigate.
Because of the effects of trauma, the victim of battering will often seem hostile, disjointed, and agitated, while the abuser appears friendly, articulate, and calm. Evaluators are thus tempted to conclude that the victim is the source of the problems in the relationship."
There is little the victim can do to "educate" the therapist or "prove" to him who is the guilty party. Mental health professionals are as ego-centered as the next person. They are emotionally invested in opinions they form or in their interpretation of the abusive relationship. They perceive every disagreement as a challenge to their authority and are likely to pathologize such behavior, labeling it "resistance" (or worse).
In the process of mediation, marital therapy, or evaluation, counselors frequently propose various techniques to ameliorate the abuse or bring it under control. Woe betides the party that dares object or turn these "recommendations" down. Thus, an abuse victim who declines to have any further contact with her batterer – is bound to be chastised by her therapist for obstinately refusing to constructively communicate with her violent spouse.
Better to play ball and adopt the sleek mannerisms of your abuser. Sadly, sometimes the only way to convince your therapist that it is not all in your head and that you are a victim – is by being insincere and by staging a well-calibrated performance, replete with the correct vocabulary. Therapists have Pavlovian reactions to certain phrases and theories and to certain "presenting signs and symptoms" (behaviors during the first few sessions). Learn these – and use them to your advantage. It is your only chance.
Note - The Risks of Self-diagnosis and Labeling
Click HERE to Watch the Video
The Narcissistic Personality Disorder (NPD) is a disease. It is defined only by and in the Diagnostic and Statistical Manual (DSM). All other "definitions" and compilations of "criteria" are irrelevant and very misleading.
People go around putting together lists of traits and behaviors (usually based on their experience with one person who was never officially diagnosed as a narcissist) and deciding that these lists constitute the essence or definition of narcissism.
People are erroneously using the term "narcissist" to describe every type of abuser or obnoxious and uncouth person. That is wrong. Not all abusers are narcissists.
Only a qualified mental health diagnostician can determine whether someone suffers from Narcissistic Personality Disorder (NPD) and this, following lengthy tests and personal interviews.
It is tr
ue that narcissists can mislead even the most experienced professional (see the article above). But this does not mean that laymen possess the ability to diagnose mental health disorders. The same signs and symptoms apply to many psychological problems and differentiating between them takes years of learning and training.
Befriending the System
In the process of mediation, marital therapy, or evaluation, counselors frequently propose various techniques to ameliorate the abuse or bring it under control. Woe betides the party that dares object or turn these "recommendations" down. Thus, an abuse victim who declines to have any further contact with her batterer – is bound to be chastised by her therapist for obstinately refusing to constructively communicate with her violent spouse.
Better to play ball and adopt the sleek mannerisms of your abuser. Sadly, sometimes the only way to convince your therapist that it is not all in your head and that you are a victim – is by being insincere and by staging a well-calibrated performance, replete with the correct vocabulary. Therapists have Pavlovian reactions to certain phrases and theories and to certain "presenting signs and symptoms" (behaviors during the first few sessions). Learn these – and use them to your advantage. It is your only chance.
I described in "The Guilt of the Abused - Pathologizing the Victim" how the system is biased and titled against the victim.
Regrettably, mental health professionals and practitioners – marital and couple therapists, counselors – are conditioned, by years of indoctrinating and dogmatic education, to respond favorably to specific verbal cues.
The paradigm is that abuse is rarely one sided – in other words, that it is invariably "triggered" either by the victim or by the mental health problems of the abuser. Another common lie is that all mental health problems can be successfully treated one way (talk therapy) or another (medication).