Attachment and the Narcissistic Spectrum

There are two types of narcissism that will be considered for the Viewpoint Worksheets 1 and 2, grandiose, or overt, and vulnerable, or covert, narcissism. These two types of narcissism share some components but can be distinguished by several factors (Wink, 1991), as shown in the following charts:

Individuals who meet criteria for the grandiose or overt type of narcissism tend to be classified as having a more dismissing attachment style, a stance of positive self-appraisal, and a denial of interpersonal distress. The vulnerable or covert narcissistic style tends to be represented by having a fearful or preoccupied attachment style, which indicates a negative self-appraisal that causes him or her not to say positive things about the self, experience interpersonal distress, and have a tendency to avoid relationships (Dickinson & Pincus, 2003).

Working with attachment issues with clients along the narcissistic spectrum brings about many complex issues and is one of the main reasons working with this population is so challenging. Bonding is exceptionally difficult for individuals along this spectrum because of their resistance to attach to the therapist and their utilization of ego-protective methods to get their needs met. The therapist must be aware that an asymmetrical relationship will exist in which the attachment figure (the therapist) supplies the environment for secure attachment to develop, rather than this security occurring in a more routine fashion over time. This imbalance will cause the therapist to feel that he or she is working harder trying to engage the client compared to other, non-narcissistic spectrum clients. It is not uncommon for narcissistic clients to seek constant adulation and praise through storytelling and fantasy, which can derail treatment if not controlled early in the process.

Next Steps

The following worksheets will help to address these core issues, but these are difficult areas for clients on the narcissistic spectrum. The further along the spectrum the client is, the more complicated the process becomes, because the focus of treatment shifts to the complex core issues of the client's attachment style (e.g., dismissing for the client with overt narcissism, preoccupied for the client with covert narcissism).

Two Viewpoint Worksheets are provided, one for the overt narcissism client (1) and one for the covert narcissism client (2). These worksheets are most effective when you have established a relationship that is honest with minimal ego resistance to growth and change. Ask your client to fill out the worksheet, and then discuss the answers in a very open and non-threatening manner. The client will be highly sensitive to feedback if he or has answered honestly. Remember, every answer is a valuable one. If your client gives an answer that you know is false, that still provides useful data in treatment. All information, even a lie, is fodder for treatment. In these cases, your client's answers can be seen as a projective.

Worksheet

Viewpoint ¹

Directions: Write your immediate thought after each sentence stem. Do not edit your thoughts. For example, the first sentence stem asks about how you judge people for a particular trait, and the second asks about what would help you change that immediate thought, if negative, or what would make it stronger, if positive.

People are trustworthy when:

___________________________________________________

People can show they are trustworthy by:

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The best way to connect with someone else is:

___________________________________________________

You know you have connected to someone by:

___________________________________________________

People care when:

___________________________________________________

You show someone you care by:

___________________________________________________

People show how they value themselves by:

___________________________________________________

You show how you value yourself when:

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Feedback is helpful when:

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You provide helpful feedback by:

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Being in the spotlight is important when:

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It is unimportant to be in the spotlight when:

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You defend yourself when:

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I do not feel I have to defend myself when:

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Worksheet

Viewpoint²

Directions: Write your immediate thought after each sentence stem. Do not edit your thoughts. For example, the first sentence stem asks about how you judge people for a particular trait, and the second asks about what would help you change that immediate thought, if negative, or what would make it stronger, if positive.

People are trustworthy when:

___________________________________________________

People can show they are trustworthy by:

___________________________________________________

You know you can connect with someone else when:

___________________________________________________

People show they are worthy of being connected to by:

___________________________________________________

People care when:

___________________________________________________

You show someone you care by:

___________________________________________________

You should protect yourself when:

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The best way to protect yourself is by:

___________________________________________________

Life hurts most when:

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You avoid pain in life by:

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