• Ashley Rivard

Dr. Kate Balestreiri : Narcissism. Ep 2 Transcribed

This transcript was exported on Dec 10, 2020 - listen to the podcast here



Dr. Kate Balestreiri:

Someone who's organized very narcissistically, has an overwhelming amount of shame. That shame is so dysregulating that they either own it and go into that more sort of covert, "I'm awful," or they disavow it completely. "I'm great. See, look at all these people who love me, who are great. Look at all these organizations that I belong to that are great. Look at these shoes that I have that are great. I'm great."


Ashley Rivard:

Hey guys. I'm Ashley Dawn Rivard and you are now Into the Dawn, a provocative podcast that looks at all things taboo, such as suicide, grief, sex, addictions, and more. Each week I talk with experts who successfully investigate their areas of interest. If you like what you hear, please remember to subscribe.


Ashley Rivard:

Dr. Kate Balestrieri is a licensed psychologist, certified sex therapist, pat couples therapist, and certified sex addiction therapist. She is the co-founder of Triune Therapy Group here in Los Angeles and has been practicing clinically and forensically for over 13 years. This episode is all about narcissism, and I know you're an expert in narcissism, so I really want to unpack this with you. Okay? Let's just start with defining narcissism.


Dr. Kate Balestreiri:

Great. Yeah, it's a great question because I think a lot of people have a lot of misconceptions about what narcissism is and traditionally, most people understand narcissism to include a really sort of grandiose, highfalutin sense of self, someone who is very charming, doesn't demonstrate a lot of empathy. They tend to be very full of themselves and align themselves with only the best people, organizations, positions, achievements, so on and so forth. When we think about narcissism, that's typically what we think about someone who thinks they're great, wants everyone else to think they're great and is very obsessed with appearances. Sometimes that can mean physical vanity, but oftentimes, it really ends up looking like impression management and image as a whole. All of those things about narcissistically organized people tend to be true, but there are other variations of narcissism that are a bit more subtle and that don't get as much airtime.

Ashley Rivard:

What are those?


Dr. Kate Balestreiri:

We tend to think about narcissism as I just described it, more along the lines of overt narcissism, but someone who is more of a covert narcissist has a lot of similar features. If you think about self impression on a continuum, so I think I'm really great on one side of the continuum, or I think I'm really terrible on the other side of the continuum, someone who oscillates toward more covert demonstration of narcissism, tends to see, tends to focus on themselves in the same sort of myopic way. Instead of thinking they're great, they think they're kind of, I don't know how to say this without swearing.


Ashley Rivard:

Swear.


Dr. Kate Balestreiri:

Oh. If someone on one side of the continuum thinks I'm the shit, someone on the other side of the continuum thinks I'm a piece of shit, but I'm the biggest piece of in the world that everyone revolves around. A lot of sort of similar characteristics are there, but they have that kind of negative shame-based connotation as opposed to the grandiose presentation.


Ashley Rivard:

Would you say their motive is the same and maybe I'm saying this wrong, but...


Dr. Kate Balestreiri:

Well, I feel like I don't know that the motive is similar or different because I don't think about narcissism as being more motive directed in that way. At least not consciously, but I would say unconsciously people who demonstrate a lot of narcissistic features tend to have a really fragile sense of themselves. Whether or not they are on the grandiose or the overt side of that spectrum or, malignant narcissist, it's often referred to and then the covert side, that focuses on themselves and really feeling kind of fragile in how they organize an intact ego or an intact impression of themselves. They tend to either under value or overvalue as a means of staying protected psychologically and emotionally.


Ashley Rivard:

It's all at the end of the day kind of based on protection of self?


Dr. Kate Balestreiri:

Yeah. Self protection. Usually because someone who's organized very narcissistically has an overwhelming amount of shame. That shame is so dysregulating that they either own it and go into that more sort of covert, "I'm awful," or they disavow it completely. "I'm great. See, look at all these people who love me, who are great. look at all these organizations that I belong to that are great. Look at these shoes that I have that are great. I'm great." It's a construction that they build to really organize themselves in a way so as to stay protected against that really fragile, tender, wounded part of them.


Ashley Rivard:

What is it that a narcissist really wants?


Dr. Kate Balestreiri:

They want to be seen and valued.


Ashley Rivard:

Okay. They just do it in different ways or they express themselves, or would you say they can't just ask for that? They can't ask if it's too vulnerable for them.


Dr. Kate Balestreiri:

Well, I think that you hit it on the head. There was a lot of vulnerability for anybody when they're asking to be seen, witnessed, heard. If we feel like our sense of self is really fragile and at any point in time, someone might see through the charade of what we're putting out there. Then we become really protective of that gooey little center. We don't want people to see it because the underlying fear is, if you see it, you're not actually going to love me and you won't be with me and I won't have a place and I won't have a value.


Ashley Rivard:

Do the signs of male narcissists versus a female narcissist, are they similar or are they overtly different?


Dr. Kate Balestreiri:

There are a lot of similarities. It's interesting because clinicians in the field will often talk about the overlapping characteristics between people who have a narcissistically organized personality versus someone with a borderline organization in their personality. Women are often ascribed to the diagnosis of having a borderline personality. Men are more often seen as having a narcissistic personality, but there's a lot of characteristics that are similar between the two diagnoses. Certainly, there can be men with borderline diagnosis and women with a narcissistic diagnosis. Some of the overlapping traits tend to be around needing to be idealized or idealizing other people and then a quick devaluation when something doesn't align with the fantasy that someone has of themself or of someone else.


Dr. Kate Balestreiri:

Very charming, very manipulative, very cunning, able to navigate the social hemispheres with grace and adoration when necessary and quickly discarding anything that doesn't fit for them and what they need in the moment. Those are just some of the characteristics that are overlapping, but I would say that there are a lot of traits that are similar between men and women when we're thinking explicitly around narcissism. Really it's about that myopic sense of, I have to just sort of stay focused on me because if I don't, my world falls apart.


Ashley Rivard:

Okay. Would you say more women overt narcissists?


Dr. Kate Balestreiri:

I would have to look at the research on that, actually. I don't know. It would be a good study to conduct.


Ashley Rivard:

Okay. Yeah. That's really interesting to me.


Dr. Kate Balestreiri:

Excuse me, men do tend to externalize. Women tend to internalize. It would make sense that men would be traditionally more of the externalized, the overt or the malignant narcissistic type. Women might tend to have more of an internalized shame-based narcissism.


Ashley Rivard:

I guess I still, I'm not fully clear. If you have shame as a woman or as a male and you just feel this shame about something, how are you narcissistic, because aren't you like, you just don't feel good about yourself?


Dr. Kate Balestreiri:

That's different than having a narcissistic organization. Someone who has shame can recognize, "Wow, I feel a lot of shame right now, but the world doesn't start in stock with my shame." Someone who is more narcissistically organized in a shame spiral might feel like, "Wow, everything that is going on is because I'm such a piece of shit." They focus so much on everyone being impacted by them and everything happening around them because of their shame or who they are, or aren't in their sense of self and construction of themselves. When someone has shame without a narcissistic organization, it can feel scary to be down that rabbit hole for a little while, but there's a little bit more tether to the reality of the situation and acknowledgement that, "This may be related to whatever I said did, or didn't say didn't do in this situation," but also, an acknowledgement that life will go on. The world is not going to end. I don't need to pull in a lot of players to help me alleviate this.


Ashley Rivard:

I think I might have that covert narcissism. I was like, as you're talking, I'm like, "Oh." I'm very much more conscious of like, "Oh my gosh, this is what I do," but yeah. Oh boy. Okay. Working on that one.


Dr. Kate Balestreiri:

Hang on for a second. I just want to touch on that. Most people have threads of narcissistic tendencies. What we're talking about is when someone has so many characteristics and features that they qualify for a full-blown diagnosis. A lot of people would probably resonate with what I just said and be like, "Oh boy, who's my therapist? Where's my therapist? I need to call right now." What is, I think, important to remember is that a little bit of narcissism is inherent in who we are as creatures and socially necessary because that's how we learn.


Ashley Rivard:

It's healthy to have a little bit of narcissism.


Dr. Kate Balestreiri:

We all need to have a little bit of pride. We all need to have a little bit of like, "Hey, I'm awesome. I can do stuff and I am worthy and lovable and that's great." Then we all need to have a little bit of like, "Okay, I got a little big for my britches and touched on that and now I can reel it back in a little bit." When we're talking about these extremes, it's when people don't have those balancing and containing elements to their personality to help them understand when they've gone too far in either direction.


Ashley Rivard:

Self-awareness.


Dr. Kate Balestreiri:

Yes.


Ashley Rivard:

Okay. I was pondering this, talking to somebody about this and I feel like when somebody said something to me and I said something, this is a while ago about being a narcissist. They said, "No, I'm confident." I thought, "I think sometimes confidence can mass narcissism." We can say, "No, I'm just being confident." What is the fine line between confidence and narcissism?


Dr. Kate Balestreiri:

That's a great question. I think it's a really subjective answer because all of us have different value systems. We may put more weight on different characteristics as being healthy and adaptive and professional and successful. Other people might look at those same characteristics and say, "Well, that's uncomfortable. I think that person is full of themselves." In either scenario, they may meet criteria for a full-blown diagnosis and they may not. It's really more of a constellation of issues. If there's a lot of confidence, I think things to look at, to factor into whether or not someone really is more organized in a narcissistic way would be, do they lack empathy for other people, because people can be very confident and wildly empathic. If there's confidence without empathy, that's something to pay attention to. Not necessarily a full-blown diagnosis, but something to look at. Are they really charming and cunning and manipulative?


Dr. Kate Balestreiri:

Do they own a room without care for what's going on? Are the people around them in a lot of pain, but they seem to be okay? Because one of the things that we look at when we're looking at a diagnosis of narcissism is, are the symptoms ego-syntonic or ego-dystonic. What that means is that when someone has symptoms that are ego-dystonic like symptoms of anxiety, depression, PTSD, those symptoms feel uncomfortable for them and they generally want them to go away. When the symptoms go away, they feel so much better, it's dystonic. They don't want to feel it. Something that is ego-syntonic usually benefits the person. They feel pretty great about it. It works for them. They don't feel a lot of distress directly as a result of the symptoms, but the people around them do.


Dr. Kate Balestreiri:

If there's a lot of confidence in the people around them across context and scenario, there tends to be awake of people with hurt feelings or broken relationships, volatile relationships. Then it might be an indicator that this is kind of ego-syntonic and a problem. If it's ego-syntonic and the people around her are like, "Hey, cool. We love this person. They're awesome. It works and we don't feel hurt at all." All of that, then it's probably not a problem. Does that make sense?


Ashley Rivard:

Yeah, absolutely. It makes sense. It's really great insight to that. There's a few questions I have around this. If you're dating a narcissist, is there a way to navigate that or when somebody is a full fledged narcissist, and let's say you're dating them, you might want to reconsider?


Dr. Kate Balestreiri:

It depends on what kind of relationship you're looking for and how amenable the partner is to working with you to curate that. People who are narcissistically organized can be very motivated to make their relationships work and be reciprocal. Sometimes they're not. It really depends on how much self-examination, they're willing to tolerate and what's in it for them. If it behooves them to make the relationship work, they're going to, and if they feel like it doesn't, then they won't.


Ashley Rivard:

Narcissists, at the end of the day, it's what serves them?


Dr. Kate Balestreiri:

In varying degrees. Sure.


Ashley Rivard:

Okay. Okay. What causes somebody to become a narcissist? Is this genetic? Is it trauma from childhood?


Dr. Kate Balestreiri:

I tend to think about all mental health organizations as being epigenetic. What that means, is that we have a genetic possibility for a lot of different things. What gets expressed in our genetic outcome is based largely on the different experiences that we have from our environment. That can include the kind of nutritional input we have, the kind of environmental stressors we have, the kind of relational dynamics we have with early caregivers, how we are imprinted and our resulting attachment styles and how they develop. When we have children who have a genetic predisposition for narcissistic personality traits or organizations, I think it's important to look at how did their environment help those different genes get expressed, because so much of what we do is based on what we see and how we learn.


Dr. Kate Balestreiri:

It's not necessarily like someone's parents sat them down and said, "Okay, kiddo. Here's how you're going to be a narcissist." Usually when there is a dearth of validation, a dearth of acknowledgement, a dearth of love and attunement, we experience a lot of scarcity around that. If children are raised in a very shame-based environment, that can often exacerbate any kind of genetic predisposition, because then they grow up thinking, "Oh God, I'm terrible. I'm not worth anything. Nobody loves me." They construct this false self, the grandiosity and the look at me, I'm awesomeness. That's to protect against all of that lack of attunement, validation and witnessing that didn't happen.


Ashley Rivard:

Makes sense completely. If somebody is diagnosed a narcissist or they think they could be one, is this reversible?


Dr. Kate Balestreiri:

That's a great question. The general consensus around personality disorders is that they tend to be pretty static over the course of the lifespan and across contexts in people's lives. If it's happening here, it's going to be happening at work. It's probably happening with family. It's probably happening with the romantic partners. What I've seen be very effective is, really looking at working with people who are more acute in their personality disorder to help them recognize how making changes benefits them, again, addressing that ego-syntonic component. How do my symptoms work for me? How did the treatments work for me? Why should I be motivated? If they can find a purpose and a reason for making it make sense, I've seen people make great changes and significant strides. I don't like to use the terms curable or not curable because I think all human behavior exists on a continuum, but I definitely have seen people go on to lead far more reciprocal lives and be happy with that.


Ashley Rivard:

Awesome. That's great. That's great to know. If you're involved with a narcissist, whether it be romantically or platonically, they're in your life. Do you suggest certain communication that you find can empower both parties or setting boundaries or what's the best way to deal with people?


Dr. Kate Balestreiri:

Boundaries are really important. Boundaries are important, no matter who your partner is, who your family is and the nature of that relationship. Oftentimes, when someone is in a relationship with someone who has more of an acute personality disorder, narcissistic borderline, antisocial, or otherwise having really solid boundaries is the key to making that relationship work and learning how to stay on your own side of the street. A lot of people that I've worked with have turned their lives upside down, trying to get their partner to change. Sometimes that's just not in the cards and they take it really personally, when they get sucked back into the relational pattern that is often in play when dating a narcissist or having a different kind of relationship with someone who meets that criteria. It can be emotionally draining. They can feel depleted.


Dr. Kate Balestreiri:

They often feel exhausted and it's because their own boundaries are not intact. Now, oftentimes when people put in place those boundaries, they tend to reevaluate the relationship altogether and it may not serve them anymore. If that happens, they go on and have these better boundaries for different relationships moving forward. Sometimes, when you're co-parenting with a divorced parent and that parent is more narcissistically organized, or if there's someone in your family of origin, a mother or father sibling, you may not want to cut with them altogether. It's really important to practice a ton of self-care and be in constant conversation with yourself about what are my limits? How am I getting triggered? Where am I taking bait? How can I practice more love and compassion with more distance and detachment?


Ashley Rivard:

Does it even behoove the person who is dealing with the narcissist to share their feelings on their behavior and how it affects them? Can the narcissist hear that and take it in?


Dr. Kate Balestreiri:

Some can and others may take it and use it as something to be weaponized in future roller coasters. It's really, I think, up to each person to decide how vulnerable and willing they would like to be. That's when the help of a therapist can be really great, because if both people are willing to go into the therapist, then it can be more of a collaborative endeavor. Frequently, what I hear and what I see in the rooms, is that it can be very challenging to get someone who's more narcissistically organized into treatment. Then when they're there, they're usually playing a bit of a power match with the therapist, trying to outsmart everyone in the room. Sometimes they use what the other partner says against them later when they go home.


Dr. Kate Balestreiri:

That's all part of the investigation about what exists in this relationship and what do I want to hold on to and what am I willing to tolerate? If I adhere to certain boundaries that keep me safer, is this relationship still meaningful for me? If so, great. Then usually they can find some kind of collaborative work around, but if that's not the case, sometimes people choose to leave.


Ashley Rivard:

Yeah, absolutely. I want to go back real quick to when you mentioned, if you have a parent who's narcissistic. If you have a parent, you were raised with a parent who is a narcissist, does that mean you have a higher tendency of becoming one yourself?


Dr. Kate Balestreiri:

Potentially, yes, because there might be some genetic passing along of that predisposition that happens. Also, when you have a parent who's more myopic and more self-focused, often it leaves the child with the acknowledgement that they're either not good enough to please their parent or they're not seen. They might, again, overcompensate by developing the same kind of traits that they saw their parent use, and that helps them both guarantee that they are seen and witnessed and taken seriously and valued, but also, psychologically it puts them in a position of being on the other side of the perpetrator/victim spectrum. A lot of people become what hurt, because that gives their flailing mind a sense of comfort. Like, "Oh, I'm on the other side of this equation now," psychologically. It's not something consciously that people do necessarily, but our brains often try to do what was done to us as a way to make sense of it.


Ashley Rivard:

Right. I would assume this could be wrong. You can let me know, that if you were raised with a parent who was narcissistic, if you don't take that on, you might be attracted or drawn to people who have those tendencies.


Dr. Kate Balestreiri:

Yeah. Everyone grows up and tends to partner up with people who are familiar, either in physical characteristics or personality, characteristics, or interpersonal dynamic characteristics, with people that they had early relationships with. Those are our parents. If we grew up with functional, secure, adoring parents who gave us what we needed most of the time, not all the time, not perfectly, but most of the time, then we seek that out in a partner. If we had a parent who was really preoccupied with their own self-worth and demanded nothing but the best from us or berated and devalued us, then we lived with more extremes and we might either tend to be self punitive and willing to tolerate that behavior. Because again, it feels familiar on a neuro-biological level or we might tend to become more like them.


Ashley Rivard:

What is your opinion then on social media and how that has played into narcissism. Do you feel that this has fueled it or do you think it's always been there just as prevalent, but social media has brought it up?


Dr. Kate Balestreiri:

Good question. I think it's really hard to know if the rates of narcissism existed with this same degree. Now, we're just knowing about it more because we're more connected through social media. I do think that social media has given us an interesting platform to become far more self-conscious than we ever were before. I don't necessarily think we have, and I could be wrong, I'd have to look at the studies if they're even are any studies about any increased prevalence of narcissism since social media has become a thing, but at least in terms of people meeting full diagnostic criteria. I do think that as a culture, we've become far more myopic and self-focused because technology gives us an illusion of being connected, but we're spending less time with people in the same rooms, more time connected to people tangentially through social media and technology. We're a little bit more inwardly focused to begin with. I don't know if it's necessarily narcissistic, but definitely more inward.


Ashley Rivard:

Of course. What then does a narcissist consider self-love?


Dr. Kate Balestreiri:

Anything that suits their fancy, I would imagine.


Ashley Rivard:

Okay. Would you say then it's ego based, it's not from your heart?


Dr. Kate Balestreiri:

I think it's difficult to speak in absolutes, because for different people, their ego needs, or their fragile sense of self, need repletion from different sources. For some people, it is about collecting as much adoration from the people that they're attracted to as they can. They esteem themselves based on how many partners can I attract or have doing for me. For other people, it might be how many professional achievements can I collect? I'm only good enough if I get XYZ accolades. For others, it might look like having the most money, or it might look like being the most attractive. Their self care needs might really... Are likely most aligned with whatever is driving their illusory construction of the self.


Ashley Rivard:

If you have the desire or you need to have the accolades of work, or how many partners, would you say then that you can almost put them in quadrants of like, not an overall narcissist, there might be just, somebody might be a full blown narcissist, but in this area of my life, I'm narcissistic. I have to be the best in everything I do. Let's say I don't need all the partners, or does it just all filter, like you've seen it, just it all molds to one?


Dr. Kate Balestreiri:

Hmm. That's a great question. My experience is that people who are more acute in their narcissism and have higher degrees of alignment with the diagnostic criteria for the disorder, tend to be pretty much static across the context in their life. Now, there's always variation, but it's difficult for, I think, somebody who's more narcissistically organized to just be that way at work and then go home and not be. Think about the wizard of Oz. That's a great metaphor for narcissism because his whole persona was wrapped up around being big and powerful. The minute anyone saw his real person, he kind of crumbled and was fumbly. It's important for people who are more acute in this diagnosis to be as all encompassing in every domain of life.


Ashley Rivard:

Yeah. I can see that. What I really have gotten from this conversation is that, it's almost that we should have the most compassion for narcissists because they are so scared. They're just so scared of their vulnerability of being hurt and they are covering so much. They don't feel safe, a safe space to express their feelings.


Dr. Kate Balestreiri:

Yeah. They don't feel safe to really be themselves. They don't really know who they are outside of all of these sort of arbitrary alignments. I think it is appropriate to have a lot of compassion for the wounded child in them, that is directing everything that we see on the other side of the curtain. It also doesn't mean that you have to remain without boundaries or enabling or condoning behavior that doesn't work for you. I think a lot of people struggle with that when they're in relationship with someone who has this diagnosis or evidences a lot of the traits and behaviors that we've been talking about because, it's pretty easy to see the wounded child inside somebody who's doing this. It's also really easy to get eaten alive by their protective and defense mechanisms.


Dr. Kate Balestreiri:

I've worked with a lot of people who have been taken out at the knees by their love and compassion. Again, I would encourage anyone to really evaluate what are you willing to tolerate and work with and to create boundaries that keep you safe and you can be compassionate and loving from a distance if safety in the relationship. I don't necessarily mean physical safety, although that's an element. Really emotional and relational safety is not able to be secured.


Ashley Rivard:

Yeah. That's great. I love that. Thank you for sharing how people can work with it. I think probably more women struggle with the nurturing element of if they're in relation with somebody like that. Yeah. You see the good, and then you're negotiating with yourself and then you're like, "Shit. What am I doing?" Yeah. This has been so insightful for me.


Dr. Kate Balestreiri:

I'm so glad.


Ashley Rivard:

I'm sure everyone, and I love talking to you about this and I definitely want to have you back.


Dr. Kate Balestreiri:

Absolutely.


Ashley Rivard:

We can talk longer and I mean, you have so many areas of expertise, so we can dive in there.


Dr. Kate Balestreiri:

Yeah. I would love to be back. This is great. I love what you're doing with your show because people, in my opinion, need as many safe places to talk about everything that we're going through. As we are continuing to evolve as a culture, there's a lot of great information that we have, and it's still kind of hard to be a human sometimes. I love what you're doing. Keep it up.


Ashley Rivard:

Thank you so much. Where can people find you?


Dr. Kate Balestreiri:

For anyone who would like more information about any of the programs that we have to offer, I actually have a 12 week program that I've created for people who are healing from toxic or abusive relationships, which often can be the case when you are involved with someone who is more narcissistically organized, not always, but often, so they can jump on my website to learn more about that. It's triunetherapy.com, T-R-I-U-N-E-T-H-E-R-A-P-Y.com. Or check me out on Instagram, on Dr. Kate Balestrieri, B-A-L-E-S-T-R-I-E-R-I.


Ashley Rivard:

Perfect. Well, thank you so much for taking the time and I look forward to the next.


Dr. Kate Balestreiri:

Thank you. Likewise.



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