Heal NPD

In this weekly insight, Dr. Ettensohn addresses the common misconception that individuals with Narcissistic Personality Disorder (NPD) never seek therapy—and the even more misleading idea that simply wondering whether you have NPD means that you don’t.

This episode explores the origins of these myths, explaining how they stem from a misunderstanding of personality disorders and the role of insight. While NPD often involves rigid, maladaptive patterns of thinking and an egosyntonic sense of grandiosity, it also frequently includes periodic self-esteem collapses, during which individuals experience deep distress, depression, and anxiety. It is in these moments that many people with NPD seek therapy—contrary to the popular belief that they never do.

Dr. Ettensohn discusses how online narratives about NPD have distorted public understanding of the disorder, reinforcing harmful stereotypes that discourage those who need help from reaching out. Drawing from clinical experience and current research, he provides a more nuanced and accurate view of why individuals with NPD do, in fact, pursue treatment.

The "Weekly Insights" series is for paid members of Dr. Ettensohn's Heal NPD Youtube channel. In the short-term, Dr. Ettensohn is posting all even-numbered episodes free of charge. If you would like access to the full series, please follow this link:  https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join

In this weekly insight, Dr. Ettensohn explores how cycles of narcissistic wounding and dehumanization develop and perpetuate across relationships and even generations. He discusses the origins of pathological narcissism, the defenses formed in response to early emotional injuries, and how these patterns manifest in adult relationships as narcissistic abuse.

The discussion also highlights how those impacted by these dynamics may unknowingly adopt similar patterns of anger, projection, and polarized thinking, perpetuating the cycle. Breaking free from these patterns requires leaning into complexity, embracing nuance, and recognizing the shared humanity in all involved.

The "Weekly Insights" series is for paid members of Dr. Ettensohn's Heal NPD Youtube channel. In the short-term, Dr. Ettensohn is posting all even-numbered episodes free of charge. If you would like access to the full series, please follow this link:  https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join

In this weekly insight, Dr. Ettensohn discusses the limitations of polarized or dichotomous thinking, particularly when it comes to self-experience.

Inspired by viewer responses to a previous episode on the false self, Dr. Ettensohn discusses why concepts like “true” and “false” self can be misleading when taken too literally.

Our internal experiences are complex, layered, and dynamic—identity, thought, feeling, and behavior are not static or easily divided into “good” and “bad” categories. Psychological health involves learning to tolerate and even appreciate this ambiguity rather than striving for certainty.

The "Weekly Insights" series is for paid members of Dr. Ettensohn's Heal NPD Youtube channel. In the short-term, Dr. Ettensohn is posting all even-numbered episodes free of charge. If you would like access to the full series, please follow this link:  https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join

What’s the difference between healthy self-love and pathological narcissism?

In this week's episode of Weekly insights, Dr. Ettensohn discusses key differences, with recommendations for healing.

The "Weekly Insights" series is for paid members of Dr. Ettensohn's Heal NPD Youtube channel. In the short-term, Dr. Ettensohn is posting all even-numbered episodes free of charge. If you would like access to the full series, please follow this link:  https://www.youtube.com/channel/UCHeT5kujD1JqHRAi-x8xD-w/join

In this episode of the members-only "Weekly Insights" series, Dr. Ettensohn reflects on the positives and negatives of gratitude as a therapy intervention, noting the potential for unintended enactments of invalidation or 'pressure to perform' in the therapy relationship. Things like gratitude journals invite us to reflect on the things that are good in our lives. But they can also reinforce inauthenticity when someone has been raised in an emotionally invalidating environment.

In this episode, Dr. Ettensohn explores the insights of Alice Miller regarding  emotional abandonment and narcissistic use of the child, focusing on how these early dynamics shape pathological narcissism and Narcissistic Personality Disorder (NPD).

Drawing from Miller’s groundbreaking work, Dr. Ettensohn examines how a child growing up in a narcissogenic environment learns to adapt by creating a false self—a facade designed to secure love and avoid rejection in a world where their authentic self is not welcome.

The episode explores the function of grandiosity as a defense mechanism—an unconscious strategy to deny the pain of unmet emotional needs—and its counterpart, depression (narcissistic vulnerability), which turns the pain inward. Both defenses serve to protect the individual from confronting a devastating loss: the realization that the love and support they needed was not available.

The episode offers a compassionate exploration of how this tragic loss gives rise to the false self, a defense that becomes both a survival strategy and a prison. Through relatable metaphors and clinical insight, Dr. Ettensohn describes the psychological toll of living behind this mask and the challenges of reconnecting with the buried authentic self.

Though the loss cannot be undone, healing is possible. By grieving the past and clearing away the defenses, it is possible to rediscover the vibrant, authentic self that has always been there, waiting to emerge.

References:

Miller, A. (1979) Depression and Grandiosity as Related Forms of Narcissistic Disturbances. International Review of Psychoanalysis 6:61-76

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum

VISIT THE WEBSITE: https://www.healnpd.org

In this episode, Dr. Ettensohn draws on psychodynamic dimensional models of personality development to describe narcissism and NPD at the borderline level.

Characterized by identity diffusion, blurred boundaries, and disrupted internal experience, borderline personality organization represents an "in between" level where the perceptions of the self and others float in and out of clear focus.

This episode reviews the important concepts of personality style vs. organization, helping the viewer to understand what a personality disorder actually is and why all personality disorders share common features. It discusses the developmental arrests thought to underlie borderline organization and describes common defense mechanisms that characterize this level of object relations. Borderline-level NPD is then discussed using these concepts.

The episode concludes with a discussion of treatment.

References:

Berney, S., de Roten, Y., Beretta, V., Kramer, U., & Despland, J.-N. (2014). Identifying psychotic defenses in a clinical interview. Journal of Clinical Psychology, 70(5), 428–439.

Clarkin, J. F., Cain, N. M., & Lenzenweger, M. F. (2018). Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: Clinical insights with a focus mechanism. Current Opinion in Psychology, 21, 80-85. http://dx.doi.org/10.1016/j.copsyc.2017.09.008

Di Giuseppe, M., & Perry, J. C. (2021). The hierarchy of defense mechanisms: Assessing defensive functioning with the Defense Mechanisms Rating Scales Q-Sort. Frontiers in Psychology, 12:718440 https://doi.org/10.3389/fpsyg.2021.718440

Kernberg, O. F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association, 18, 51- 85.

Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. New Haven: Yale University Press.

Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual: PDM-2 (2nd ed.). New York: Guilford Press.

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press. Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum

LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca

LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8

VISIT THE WEBSITE: https://www.healnpd.org

*A note about the title: The title is a partial quote from BPD specialist Marsha Linehan, describing borderline personality disorder. I am aware of her original intent to describe that specific patient population. I also use the quote in the video to describe the emotional vulnerabilities that necessitate splitting. Although she was describing BPD specifically, I feel the quote also works for borderline organization in general. The intense emotional vulnerabilities and exposure to unprocessed experience reflect the absence of moderating internal capacities - "skin" so to speak.

Dr. Mark Ettensohn answers questions and responds to viewer comments in a livestream broadcast from 7-25-24. 

In this episode, Dr. Ettensohn draws on psychodynamic dimensional models of personality development to describe narcissism and NPD at the psychotic level.

Characterized by compromised reality testing, symbiotic object relations, low integration between parts of the self, and the use of reality-distorting defense mechanisms, psychotic-level NPD represents both the least developmentally mature and most severe form of the disorder.

This episode explains the spectrum of personality development, from psychotic to healthy. It then explains the psychotic personality organization in detail, providing descriptions of specific defense mechanisms utilized at this level. Finally, psychotic-level NPD is described.

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum

VISIT THE WEBSITE: https://www.healnpd.org

Cited References:

Berney, S., de Roten, Y., Beretta, V., Kramer, U., & Despland, J.-N. (2014). Identifying psychotic defenses in a clinical interview. Journal of Clinical Psychology, 70(5), 428–439.

Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. New Haven: Yale University Press.

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.