Diagnosing NPD (Question)

[bearwithme]

Hello!!

I have read several times in posts here where one may reference the other person's "N" and ask the other poster if their "N" had actually been "diagnosed" with Nism.   I can't remember for the life of me what anyone's response was to that question. 

I guess my question right now is this:  How is the N "diagnosed"?  When I was going to therapy (which was the best thing I ever did for myself) my therapist informed me that my mother has NPD and was an N.  That's how I found out.  Not her, though. Was this her diagnosis?  How can a therapist diagnose the N when the N isn't capable of going to see a mental health specialist in the first place?  Just by information that we feed them?

This is my problem today:  I've been NC for 14, months and counting, since kicking my Nmom out my door and out of my life.  I demanded she get help if she wanted to be involved with her granddaughter's life.  Since then and now, Nmom says (to other people) she's going to therapy and getting all sorts of help and psychological treatment, etc.  I know for a fact that she went twice to someone (God knows who) and now she just "talks" to a pastor or church person here and there.  She has been spreading the word that her treatment has lead her to "confirm" that it is "me" with all the problems and that I just need to "forgive and forget" and "find peace within myself " and "learn to love" and give of myself", etc, etc.  She has stated that her therapist has "given her nothing but support and admonishes my behavior."

Can an N go into therapy and "fool" the let's say, doctor?  Can my Nmom go into therapy as she would, crying, blubbering, hysterical and wailing about me and how bad I am and demonstrate how her life is ruined because of me?  I could imagine the stories she unfolded from her baggage right in front of him/her and I must look like the one with NPD!??!!!

How can the therapist diagnose her?  Or me?  What happens at the moment the therapist realizes they are dealing with an N?  How can they keep them there and have them come back for more sessions?  I ask this latter question because in know my Nmom tried therapy before, it was during her divorce with my father but she quit after 2 sessions because she felt,  "the Doctor is only on your father's side!"  She has also said many times "I don't need therapy!"  But I do know she has gone recently to someone but fear that the "real" doctor tried to counsel her as would any doctor and she flew the coop.  Yes?  No?

I know my question is a bit convoluted but I hope I make some sense to some here that know me and what I'm trying so hard to say.

Thanks for any input!

Bear

[sKePTiKal]

Hi Bear...

I understand your question, I think, so I'll give an answer a go.

When I was trying to pin a diagnosis on my mom, my T told me that she couldn't possibly determine what was wrong with my mom without seeing her... and that this one piece of information was totally irrelevant to me and the work I was doing. That said, I think she had a professional "guess" about it anyway. Certain symptoms in me can point back (not always conclusively) to specific kinds of parenting "mistakes"... but it really isn't enough info to base a firm diagnosis on.

If the therapist is experienced, I rather doubt your mom could walk in... projecting all her attributes onto you, blaming you for everything, and spinning her own role as victim-martyr... without completely giving herself away. However, the T can't call her bluff, now can s/he, without scaring your mom off. Step 1 in any T relationship is to establish a mutual trust - which if an N is attempting to enter therapy - could be the dicest, trickiest moment of all, I venture to guess.

And of course, your mom can't lose at this charade: she was a  'good girl' - she went to the T... but of course, s/he couldn't help her at all which only confirms her death-grip on the idea that she doesn't need therapy in the first place... so OF COURSE it's all your fault.

I'm not sure I got down to the question inside your question, Bear. Someone else will be along to give it shot soon, I'm sure. But that's a start anyway!

(((((Bear))))))

Nice to see you again! How've you been doing otherwise?

[BonesMS]

You're question makes a LOT of sense, Bear!

I'm also wondering if during one of her prior sessions, she accidentally "tipped her hand" and the therapist recognized her for exactly what she is....an N!  The reason I say this is based on an experience way back when, before the DSM was around in its current form.

My school referred my family to the county mental health center because I was having serious struggles.  At the age of 13, I was suicidal, tried to starve myself to death, and would hide behind furniture and file cabinets.  (I realize now that a lot of my behaviors were on the autism spectrum.  Connect neurological struggles with an NWomb-Donor, who was also sexually and physically abusive, and the result is a NIGHTMARE!)  At the therapist office, she would proclaim herself and her NGC son as the poor innocents and that I needed to be locked up in a mental institution because I was the ONLY one with the problem.  This went on until one day she dragged me into the therapist's office while in the midst of a Narcissistic Rage!  The therapist spoke with me alone and I described what led up to this latest explosion from her.  Then he spoke with the NGC alone and got a similar story.  Finally, he spoke to the NWomb-Donor alone and also got a similar story albeit from HER stance that SHE was the victim and that I needed to be removed from HER house IMMEDIATELY!  Then the therapist called all three of us together.

Imagine NWomb-Donor's shock and horror when the therapist told her straight to her face...."This child is finally starting to think, feel and behave like a NORMAL 14-year-old!  GET OFF HER BACK!"  NWomb-Donor grabbed NGC by the hand and stormed out of the office, leaving me there.  She refused to go back for any more sessions and also convinced NGC he didn't need therapy either because there was nothing wrong with him!  As far as they were both concerned, the only problem they had was me and the sooner they got rid of me, the sooner their problem would be solved!  Sick?  Yes!

I was so grateful that the therapist recognized the sick game for what it was and called her on it.  Unfortunately, back then, NPD had not been recognized yet so it didn't have a name at that time.  (This was in 1966 and family therapy hadn't been formalized yet either.)

Bones

[Guest]

Bear

this may not be your question, or it may be? You say

I demanded she get help if she wanted to be involved with her granddaughter's life. 

are you concerned that she may soon ask for contact, because of her reported therapy?

[Dr. Richard Grossman]

Hi Bear,

I’ll take a crack at it, too.

1)   Therapists have varying abilities to see narcissism and NPD.  Some therapists do not have narcissism/NPD on their radar screen.  (Some therapists are narcissistic or have NPD--and they are unable to see it in themselves.  But that’s a different story.) 
2)   Most therapists want to like their patients, and they often unconsciously see them in the best light possible.  Therefore some therapists miss the signs that their patient is narcissistic/has NPD.
3)   When stories/incidents are presented about other people (family members, friends, bosses, co-workers), some therapists are very capable of correctly identifying NPD while others are not.  Depending upon the stories, a good therapist can be 99% sure that the person being discussed is diagnosable, or at least highly narcissistic.
4)   But not always.  For example, sometimes people with personality disorders see therapists and their depictions of others are so inaccurate it is really hard to tell.  A good therapist tries to factor that in and see through it.
5)   If you tell patients that they are narcissistic or have NPD, there is a very good chance that person will be so injured they will diminish the therapist and not come back.  In other words, they will only continue if you see them in a particularly positive light—and the people around them in a particularly negative light.  In these cases, therapists struggle with what to do/say.  Build trust to break the news later?  Use denial?  Hope it goes away?  The vast majority of the time, the therapist, no matter how good or bad, will ultimately fail with these patients.  But (in my experience) every now and again, with years and years of work, one has a success.  Patients and therapists can and should be very proud of these rare occurrences—because it is, indeed, a life, a relationship(s), and a family rescued. 

I hope this helps…

Richard
 

[bearwithme]

Thanks for responding.

Thank you Dr. G for your response(s).  I am enlightened.  I hold that my therapist was more like your item #3 as that he was "capable of correctly identifying NPD."  It is my opinion that he was very good and came highly recommended by a forensic psychologist with an esteemed reputation and whom I trusted.  Going to him changed my life.  For the better.  Albeit, he took my arm and leg but that's another story.  Another thing I think about is that my older brother has/had been through extensive therapy throughout his life, much more so than me, and more than a few of his therapists mentioned that our mother had NPD.  My brother never mentioned this to me until I discussed my therapy with him.  Boy, was I floored!

Dr. G, I feel bittersweet on your statement:   

But (in my experience) every now and again, with years and years of work, one has a success.  Patients and therapists can and should be very proud of these rare occurrences—because it is, indeed, a life, a relationship(s), and a family rescued

  I just wished that is wasn't so "rare."  Why should this success be so rare? Yes, I know the answer but can't help feel entirely frustrated about it.  To those families and relationships that can be saved by this rare success: kudos to them!  I'm not so lucky.

Guest,

Bear

this may not be your question, or it may be? You say

I demanded she get help if she wanted to be involved with her granddaughter's life. 

are you concerned that she may soon ask for contact, because of her reported therapy?

  Yes and yes!  I think she is spreading the word that she is going to therapy so that she can see her granddaughter, etc.  So maddening to know that she is driven to therapy for the sake of her granddaughter (Nmom says, "MYYYY granddaughter! MYYYY granddaughter!!!") and no thought whatsoever to redeem the relationship with her own daughter.

Bones,  the picture you painted of your Nmom storming out the office is so great!  What goes through these people's minds?  I get so baffled just thinking about it that is actually causes my head to ache. 

Phoenix wrote:

If the therapist is experienced, I rather doubt your mom could walk in... projecting all her attributes onto you, blaming you for everything, and spinning her own role as victim-martyr... without completely giving herself away. However, the T can't call her bluff, now can s/he, without scaring your mom off. Step 1 in any T relationship is to establish a mutual trust - which if an N is attempting to enter therapy - could be the dicest, trickiest moment of all, I venture to guess.

And of course, your mom can't lose at this charade: she was a  'good girl' - she went to the T... but of course, s/he couldn't help her at all which only confirms her death-grip on the idea that she doesn't need therapy in the first place... so OF COURSE it's all your fault.

I so see what you are saying.  I think my Nmom gives herself away as the victim and martyr, etc.  So tricky for any therapist to tip toe around them or even try to help them.  I can't imagine the job at hand for any of them who know what they are dealing with.  And yes, she is no doubt in that office (or maybe in someone's car) right now doing what you said--blaming me and projecting all her attributes onto me, etc., when I went to therapy and told the therapist right off the bat, "I need help, there's something wrong with me, I cry a lot, it's me, I have problems, I'm a loser and bad daughter, please tell me what I'm doing wrong..."  (Literally!!)  Such a dichotomy.

Thanks for listening and answering.

Bear.

 

[BonesMS]

((((((((((((((((((((((((Bear)))))))))))))))))))))))))))))))

[Hopalong]

Another ((((((((((Bear))))))))))))) hug.

You
are
NOT
crazy

and

You
will
be
happy


xxoo
Hops

[Guest]

Bear

is she driven to therapy for the sake of her granddaughter, or for herself?
when do you think she had a relationship with her own daughter?

Ditto what Hops said. Take care of yourself.

[cat]

Bear - I do feel your pain.  My sister struggled with this - and not injuring the relationship my Nmom had with her daughter.  Eventually the grand-daughter came to see the issues on her own and pulled back from the Nmom.

A wise woman old me once that my Nmom's consequences were that her own children had pulled away from her and no longer talked to her.  And yes, my Nmom would badmouth us to everyone she knew. . . and for awhile people would believe her.  Until they were put into the same type of situation.  I agree with Dr. G.  There were many times I went back to my Nmom to try and sort things out - only to be betrayed once again.  Eventually, I came to understand that no matter what I wanted, it could never happen.  By lowering my expectations of my Nmom it was easier to deal with.  She did once go to a therapist - and didn't like what she heard. She never went back because it was the therapist's fault.

The really sad part of the entire situation is that I think she was never really happy - and no one could live up to her expectations.

[teartracks]

Dr. G,

But (in my experience) every now and again, with years and years of work, one has a success.  Patients and therapists can and should be very proud of these rare occurrences—because it is, indeed, a life, a relationship(s), and a family rescued.

How did you know when the tipping point came?

How wonderful the experience must be.

tt

[Dr. Richard Grossman]

Hi tt,

I’m not sure there’s a tipping point per se, but in my experience the following things happen:

1)   the person’s behavior towards other people begins to become less self-centered/controlling—and just as importantly there is a new found awareness of the “old” way of interacting when it happens.
2)   For the first time, people begin to offer genuine, non self-centered apologies for their behavior/way of being in the past.  This does not happen because the therapist suggests/tells the patient to do it—it happens because the patient feels it is important and necessary, and he or she realizes the damage done.  And they feel whole and secure enough to admit wrongdoing. 
3)   The relationship in the therapy office changes/evolves.  (This actually happens before 1 and 2).  Because the person feels safe, and, for the first time has a place in the world, he or she no longer feels the constant need to self-inflate.  So, a genuine closeness develops. 

And, yes, it is a wonderful experience when the two people succeed.

   
Richard

[SilverLining]

This is my problem today:  I've been NC for 14, months and counting, since kicking my Nmom out my door and out of my life.  I demanded she get help if she wanted to be involved with her granddaughter's life.  Since then and now, Nmom says (to other people) she's going to therapy and getting all sorts of help and psychological treatment, etc.  I know for a fact that she went twice to someone (God knows who) and now she just "talks" to a pastor or church person here and there.  She has been spreading the word that her treatment has lead her to "confirm" that it is "me" with all the problems and that I just need to "forgive and forget" and "find peace within myself " and "learn to love" and give of myself", etc, etc.  She has stated that her therapist has "given her nothing but support and admonishes my behavior."

Hi Bear.  I've been struggling with similar questions, and this thread has been helpful.  Last summer my mother had a few sessions of therapy.  She abruptly stopped, claiming the therapist gave her a "clean bill of mental health" and confirmed that her problems were all the fault of others.  I've been pondering what really happened,  wondering if the T figured out he was dealing with a hopeless N case and just gave up.  One method I've learned for seeing through my mothers stuff is to just let her ramble on until she contradicts herself.  And it became obvious after awhile her story about ending therapy was a lie.  It's not really a surprise that she diagnosed herself as not needing the therapy and just quit, without the agreement of the therapist.   Now she uses these few sessions of therapy as additional proof that her problems are not her fault.  After all, she was willing to go to therapy and the others who have caused all her issues haven't had therapy (she claims), so this makes her better than them..     

It's a tangled and confusing mess dealing with this stuff.