EMDR and The Metaphor of Transformation

What the butterfly knows is transformation and the metaphor they provide is one that survivors can use to see their own transforming recovery.

The beginning of the year is a liminal time and like the butterfly in a cocoon, you are out of one life experience but not yet in another.  You are betwixt and between not knowing what the new year will bring. This is a time of possibilities and can be, your time of transformation!

If you can identify with any experience described in The Institute’s newsletters or magazine, then you have been called to the adventure of recovery.  This year EMDR can help you release the burden of pain so you can embark on your own recovery.

Survivors are curious ‘what’ EMDR  ‘does,’ what is incorporated in a normal EMDR session, and why it claims to be able to help with trauma, intrusive thoughts, and other aftermath effects of Pathological Love Relationships. Let’s see what is involved in EMDR…

EMDR helps you through a process called Desensitization. The call to recovery is usually signaled by the appearance of enormous emotion and can be a mixture of sadness, hope and fascination or it can be grief, fear or anger about betrayal. Most certainly the Pathological Love Relationships has left its mark upon your emotions.  How these painful feelings and symptoms get processed is through what is called Desensitization.  The technique used in Desensitization is called BLS or Bi-Lateral Stimulation.

The process in Bilateral Stimulation (BLS) is that a therapist uses one or more of the following techniques. They have you

  • Follow a light with your eyes
  • Follow the therapist’s finger movements with your eyes
  • Feel the therapist tapping rhythms on your hands
  • Or by listening to auditory tones that the therapist plays on a headset

During these sessions, you are encouraged to let whatever imagery, feelings, sensations or memories rise to the surface without trying to repress them.

When these images, feelings, sensations or memories come up in session, you are asked to focus on three things:

  • The image of the incident
  • The negative belief that goes with it
  • And where you feel these emotions or sensations in your body

Focusing on those three elements coupled with which ever BLS technique that is being used, intensifies the level of response and stimulates the natural tendency of the brain’s information processing system to move toward mental health. In other words, it helps the mind ‘digest’ unprocessed information that was causing emotional (or physical) symptoms. EMDR removes the pain of the trauma that has been blocking your ability to move forward in life (or in Pathological Love Relationships, move forward with releasing the pathological).

At the end of each BLS set, the therapist asks, “What do you get now?”  You are encouraged to report any feelings, images or thoughts you are aware of at that point.  The therapist encourages you to continue to report whatever comes to you without discarding anything as ‘unimportant’.

Each target memory that is focused on is like the head of an octopus.  The tentacles are memory channels containing other related experiences.  Sets of BLS are applied to each new awareness or related experience until each channel is cleared out.

If there are new sensations, awarenesses or insights accessed, the therapist will usually say “Go with that” and will go through another BLS set.  In this way the clinician encourages further processing of the material until the S.U.D. (Subjective Unit of Disturbance) level is “0” or “1” (on a scale of 0-10 with 10 being the highest level of disturbance). This is continued until there are no new awarenesses.

At the end of each BLS set, the therapist says, “Let it go and take a deep breath.”  It is important that you are aware that whatever memories, thoughts or sensations come up during EMDR they are old stuff, it is not happening in the present moment. You are safe in the present

Information processing in EMDR is like getting on a train and watching the scenery of thoughts, images or emotions pass by the train window of your awareness.  Each stop of the train is a new plateau of information where dysfunctional material can link up with appropriate, useful and self-enhancing information.  Your view isn’t completely functional until the train reaches the “last stop” of fully adaptive information and there are no new awarenesses.

Unburdened and desensitized from the pain of the past, you can emerge from the cocoon with new beliefs and new awareness, empowered to take flight! You will have experienced the transforming power of EMDR!

So, this new year, what will it be ?  The pain of the past or the beginning of a new life?  The choice is yours. Contact The Institute for more information about our EMDR Retreat in 2011. Space is limited so reserve your healing time now.

For more information on EMDR

  • Go to emdr.com, click on “Find an EMDR Clinician,” put in your city and state.
  • Read the list and make an appointment with an EMDR trained psychotherapist today or make plans to attend the EMDR Retreat in 2011.

Managing Anxiety Through The Butterfly Method

Pathological Love Relationships leave an aftermath of problems of which the most bothersome are all the anxiety symptoms. These include racing heart, racing mind, intrusive thoughts. obsessional thinking, adrenaline rushes, and cognitive dissonance. Part of recovery is symptom management and finding tools that bring relief to the some distressing of symptoms.

The Butterfly Hug is a form of bilateral stimulation that I suggest my client use in between EMDR sessions or even during a therapy session to relax and calm them self when they need to do so.

The Butterfly Hug was originated and developed by Lucina Artigas, M.A., M.T., and Ignacio Jarero, Ed.D., Ph.D., M.T.  Ignacio graciously gave me permission to share this with you.  They used this process with survivors of hurricane Pauline in Mexico, in 1998.  Since then, it has been used with adults and children who have experienced various forms of trauma.

The process is simple and can be done anytime, anywhere you choose.  It can help you induce a sense of safety and calm and empower you to self-comfort and self-soothe.  It can also foster your resilience and to allay any disturbing feelings that come up.   Most importantly, it can help to ground your awareness in the present moment. Anxiety symptoms are always related to future worrying so any symptom management that helps to ground people to the present moment also helps to manage anxiety.

Here is how it’s done:

  • Sit with your back straight.  Do abdominal breathing. Imagine you have a little balloon in your stomach that you inflate and deflate, slowly, deeply, smoothly.
  • Observe what is happening in your mind, emotions and body as you would observe clouds in the sky.
  • Cross your hands over your chest so that the middle finger of each hand is placed below your collarbone.  The rest of your fingers will touch your upper chest.  Your hands and fingers are as vertical as possible (pointing more toward your neck than your arms.  You can interlock your thumbs.
  • Alternate the movement of your hands, right, left, simulating the flapping wings of a butterfly.
  • Continue to breathe slowly and deeply, observing whatever is going through your mind and body (thoughts, images, sounds, odors, emotions and physical sensations) without changing, avoiding or judging anything.  Observe it like clouds passing by.

The butterfly is an ancient symbol of transformation.  As you use this simple tool, you are facing, rather than avoiding conflict.  Whenever you stop avoiding, you raise your level of consciousness (awareness).  As you do this, you are strengthening your inner radar detector by becoming more of who you really are, empowering yourself and calming yourself all at the same time.

DSM 5 Personality and Personality Disorders Sneak Peek

The American Psychiatric Association has released a “sneak peek” of changes to the personality and personality disorder information.

You can view the info at this webpage:

What Happens In An EMDR Session?

Do you ever have present day experiences that trigger  old, extremely distressing memories as if they were stuck in your brain?  Do sights, sounds and smells that remind you of the original event leave you in an extreme state of anxiety, hypervigilance or panic?  When this happens, do you hear the abuser’s ideas in your head, putting you down, criticizing or ridiculing you in some way?  Do you sometimes think you are crazy?  This is a normal response to traumatic material that has not been fully processed.

Eye Movement Desensitization and Reprocessing is used to disconnect emotionally disruptive memories from current life experiences.  Its focus is the resolution of emotional distress arising from traumatic events.  No one knows for sure how EMDR works but through brain imaging techniques, we are seeing its effects. Dr. Daniel Amen M.D., in his book, ”Healing the Hardware of the Soul”, states that, “people who have been traumatized and develop Post Traumatic Stress Disorder symptoms (such as flashbacks, nightmares, worries, quick startle response, anxiety, depression and avoidance) are frequently overly concerned and worried (anterior cingulate section of the brain-get stuck), anxious and hyper alert (basal ganglia section of the brain), and filter everything through negativity (limbic-thalmus section).”  EMDR calms all of these areas of the brain according to the SPECT brain scans Dr. Amen has been doing for the last 20 years. These scans allow us to see the internal operations of different parts of the brain, allowing us to learn more about which parts do what.

When a person experiences an event that is extremely distressing and overwhelming, it is stored in the brain with all the sights, sounds, thoughts, feelings and body sensations that accompanied the event when it happened.  Think of your brain as a recorder that doesn’t miss a thing, storing all aspects of an experience, whether we consciously remember it or not.

When a scary or extremely painful event happens, the brain is sometimes not able to process the experience as it normally does.  The thoughts, feelings and sensations of the traumatic event can become frozen in the nervous system as if in a time warp.

EMDR helps to activate the brain’s natural processing abilities with efficiency, thereby helping to move the disturbing material through the nervous system, allowing the person to heal more completely.

In a typical EMDR session, a client focuses on a troubling memory.  With a trained psychotherapist, the client identifies the negative belief she has about herself connected to this memory.  The client then chooses a positive, more adaptive belief that she would like to believe about herself.  The emotions and body sensations associated with the memory are identified. The client then attends to the memory as a whole in brief, sequential doses while focusing on an external stimulus that creates bilateral (side to side) movement:  eye movements by watching the therapist’s moving finger or a light or tactile tapping or tones.  After each set of bilateral movements, the client is asked how she feels.  This segment is complete when the memory is no longer disturbing.  The chosen positive belief is then installed, via bilateral movement, to replace the negative one. The result of EMDR is the rapid processing of information about the negative experience and movement toward an adaptive resolution.  This means a reduction in the client’s anxiety, a change from a negative belief about self to a positive belief and more functional behavior in relationships and at work.

EMDR deals with past events that led to present symptoms, current circumstances that trigger distress and future events that can be targeted to help you in acquiring the skills you need for adaptive functioning in the present and in the future.

A typical EMDR session lasts 60 minutes.  The length of treatment depends on the nature and length of time of the problem, the degree of trauma, its complexity and the client’s age when it happened. However, with EMDR, in contrast to traditional talk therapies, treatment time is usually markedly reduced.

The first couple of sessions consist of taking a thorough client history. A Safe Place (a place to go in your imagination to get serenity and peace) is installed with bilateral movement.  A Resource or Skill, picked from a list by the client, is also installed to facilitate the EMDR work that can begin by the third or fourth session.

EMDR can evoke strong emotions and sensations.  This is normal since the method is used to process those uncomfortable feelings and sensations when they come into the clients’ awareness. Usually these unpleasant feelings are experienced briefly and soon fade as the treatment proceeds.

Two suggestions:

  1. Go to www.emdr.com to get more information about EMDR and the research studies.
  2. Go to www.emdr.com, click on Find A Clinician, put in your city and state, or a major city near you to find a trained clinician, make an appointment and go get some relief!


More on EMDR:  EMDR and the lessons from neuroscience research by Bessel A. van der Kolk, M.D., Professor of Psychiatry, Boston University School of Medicine

Vulnerability and Other Prey of Psychopaths

Help protect yourself from victimization by psychopaths.

by Marisa Mauro, Psy.D., is a clinical psychologist at the California Department of Corrections and Rehabilitation.

Certain personality traits may create better perpetrators and, unfortunately certain cues may create better victims. In a study by Wheeler, Book and Costello of Brock University, individuals who self reported more traits associated with psychopathy were more apt to correctly identify individuals with a history of victimization. In the study, male student participants examined video tapes of twelve individuals walking from behind and rated the ease at which each could be mugged.

Read more at Psychology Today…

Beginning at the Beginning: Personality Formation and Dysfunction

Dr. Thedore Millon, The Pioneer of Personality Science

If Freud was the ‘Father’ of Psychoanalysis, Dr. Theodore Millon is the ‘Grandfather of Personality Theory’. I couldn’t have been more thrilled to interview Freud than I did Dr. Millon (pronounced Milan, like the city)!

Dr. Millon’s biography reads like a clinical and scientific manifesto with his prolific writing of an unusually large number of books and journal articles. His career has not only spanned decades but has changed how the world has come to understand personality and the disorders of it. His contribution to the understanding of personality disorders has earned him the title of one of the ‘Pioneers of Personality Science.’

I wanted to launch the magazine with my talk with Dr. Millon because everything we do at The Institute is related to the issues of personality and personality disorders. So to begin the magazine’s focus on the right foot, it would seem fitting to begin with talking about personality, theory, development, and why this is so important to you–the survivor in a relationship with someone with a personality disorder. This discussion should also be of interest to therapists trying to help a survivor with the aftermath of the relationship. In either case, what has troubled someone enough to seek out The Institute is their relationship with someone else’s personality disorder, pathology, or psychopathy.

But first, a little trot down memory lane for me about Dr. Millon and his importance to me and you!

  • My theory books in graduate school for my course in Personality Development were Dr. Millon’s.
  • My theory books in graduate school in my psychopathology course included Dr. Millon’s and his work was peppered throughout the other course books and personality disordered trainings that I have taken in over 20 years.
  • As a young therapist in a mental health clinic working in only personality disorders, it was HIS testing instruments we used to diagnosis personality disorders.
  • It was his information I used to describe the personality formations that make up personality disorders to my interns.
  • His charts help us distinguish characteristics between the various 10 personality disorders.
  • His ideas on ‘challenges of life’ that personality disordered people face.
  • His references about violence associated with psychopathy that warned us.
  • And his clinical reference books that lined my book shelves and the pathology library associated with our mental health clinic/

For me, there could have been no one else I would rather talk to than the person who has contributed so much to the understanding of personality disorders and what I have devoted my coaching work to. He has helped you as well–any informational help you have received about narcissism, borderlines, anti-socials, and psychopaths has probably stemmed from the work of Dr. Millon.

At 83 years old, his life time of dedication to the exploration of personality disorders has brought it out of the closet of ‘mystery’ and ‘assumptions’ and under the microscope of diagnostics. So on a personal level I thank this man for his contribution to what we know so far.

So what is it that we should discuss about personality disorders? Why is the issue of personality important to you, your future, and your therapist? You can’t deal with what you don’t know—as a survivor or as a therapist and so the first step in this journey associated with personality disorders is the ‘knowing.’ The difficulty about ‘knowing’ personality disorders is that its theories are still being hashed and rehashed (as it should) and what we are left with are some differing views. While Dr. Millon has clearly helped us understand what he calls ‘personology’ and the developmental aspects of the disorders, we still have a long way to go in understanding things such as,

  • Why do these disorders form?
  • What can be done if anything?
  • Who will be affected or even harmed because of them?
  • What societal effect does personality disorders have?
  • What cultural and political effect does personality disorder have on others?
  • What relational damage is done to others?
  • What parenting damage is done through personality disorders?
  • What type of parent, partner or prodigy does a personality disordered person make?
  • What are personality disorders doing to our systems—legal system, social service system, criminal justice system, mental health system?
  • Why are some of the personality disorders more destructive than others?
  • What commonalities do personality disorders share at their core?
  • Is there a common ‘after math of symptoms’ seen in the survivors of the high destructive Cluster B personality disorders?
  • How do survivors heal? What do they need? What do the children need?
  • Who doesn’t understand this and how can we teach them—the general public, the court systems, the mental health systems, social service systems, and child welfare systems?

These are existential type questions that survivor’s live with every day. Now our world is starting to live with these questions and the problems of these unanswered questions as pathology and its tyranny rises in the world around us. As our societal systems are being challenged by pathology and hood-winked by the lack of education it’s the survivors and children who feel the most impact of our ‘not knowing enough’ about these existential questions related to these disorders. The bleed-over is a conned legal system, a blinded child welfare system, an untrained mental health system, a tapped-out social service system, and a burgeoning criminal justice system. Education about these disorders has never been more vital to our own existence than it is today.

Sandra: “Dr. Millon, where are we today in understanding this diverse diagnosis of personality disorders? What is on the horizon, for instance, in psychopathy?”

Dr. Millon: “We are still dealing with the changes that happened to the Diagnostic Statistical Manual III when they changed from a psychopathic personality to what they now call Anti-social personality disorder. There are some flaws there because Anti-social is based on illegal activities and criminality when many of these persons don’t get caught to get labeled criminal so diagnostically would be missed.”

Sandra: “So what is being discussed for the next DSM version that will be coming out?”

Dr. Millon: “From what I gather, they are still discussing expanding Anti-social to include combinations of other personality disorders. Many persons with Anti-social also have other personality disorders associated with it which can make their presentation very different from others.”

Sandra “Such as?”

Dr. Millon: “Combinations of Anti-social + Paranoid, Anti-social+ Avoidant, etc. There could be as many as 10 factors or combinations of the disorder if we look at them in these types of configurations.”

Sandra “How will that help?”

Dr. Millon “It’s a clearer picture of the overlap of the disorders combined together and shows some of the diversity that you can see in the disorder when it’s influenced by other personality disorders.”

Sandra “There is a lot of talk about the genetic transmission of some of these personality disorders. What are your thoughts?”

Dr. Millon: “I think we are still trying to understand this. There are some of the personality disorders that are more strongly genetically transmitted than others for instance psychopathy. But for some of the other personality disorders, it is more socially learned.

Sandra “You mean ‘the nurture’ portion?”

Dr. Millon “Yes, sometimes family influences, and sometimes other types of social influences. It was Koch in 1890 that discussed biological aspects of psychopathy. He called it ‘constitutionally psychopathic.’ Then Birnbaun in 1910 discussed it as a ‘sociopath’ because he felt there were more social influences that caused the disorder than biology.’

Sandra “I am sure you are aware of the brain imaging techniques that are being used now to look at some of the possible biological differences in the brains of psychopaths. Do you think there is something this can teach us?”

Dr. Millon “I think it is some years away from being able to help us. While we can look at some of the biology of it, it doesn’t help us ‘yet’ understand personality apart from biology. This is still in a very primitive stage. What we also need to look at are the cognitive processes and how the brain activity affects personality. We aren’t there yet. It’s a course tool but I do see that it holds promise.”

Sandra “What do you believe about the permanence of personality disorders. Your Institute offers treatment to various types of the disorder. What changes do you see in them?”

Dr. Millon “This is difficult now days with insurance companies giving limited amount of sessions. Personality disorders take a long time to effect some change in their behavior.”

Sandra “But how are they down the road? The partners get very frustrated with their inability to sustain positive changes.”

Dr. Million “Yes, that’s a very good way to describe that. Consistency is difficult for them. It would be most helpful if they could come back several times a year for ‘tune ups’ to remind them what they should be doing. This is where treatment effects are often lost. Of course, some of the lesser personality disorders can have more modest changes than some of the difficult Cluster B’s.”

Sandra “So what are we really doing then? It seems we are offering their partners false hope when they enter therapy and the partner believes that the change will be permanent. They are staying because they believe that.”

Dr. Millon “No doubt that their relationships are heavily impacted by their disorders. They don’t always have good outcomes in their relationships. I understand why their partners are concerned if their treatment will be effective over the long haul.”

Sandra “How do you know it IS effective over the long haul? Do you hear back from your client’s years down the road? Is success merely being able to hold a job? Or is there a quality of life issue, even for the partner that needs to be evaluated?”

Dr. Millon “Some do contact me from time to time. It’s not always easy to be able to tell what is happening in their lives by a quick contact. It would be optimal for them to come back several times a year so we can really gauge what is happening.”

Sandra “You aren’t referring to anti-social, psychopaths, etc. when you are discussing this type of treatment, per se?”

Dr. Million “More with the narcissists, histrionics and borderlines.’

Sandra “Are personality disorders, in essence, attachment disorders?

Dr. Millon “In some ways, many of them lack intimate attachments or the ability to have attachments as we know them. Some of the disorders have low emotionality and constitutionally or biologically experience a sort of a-social emotionality. They don’t connect on the same level which effects their attachments.”

Sandra “This seems to me to be what the partners complain about most—the essence of the attachment is marred. This could lead into a whole other conversation about Attachment Theory, couldn’t it?”

Dr. Millon “Yes, yes indeed. Personality and their disorders clearly affect a wide parameter in interpersonal relationships.”

Much of the rest of our conversation was more clinical in nature about theory and cognitive-behavioral approaches.

What I think we can take away from this conversation with Dr. Millon is how far we have come in understanding some of the disorders over the last few decades yet clearly, there is still much to understand when we consider the overlapping nature of the clustered disorders and how each personality disorder can create an almost layered effect when someone has more than one personality disorder. (According to research, 60% of people who have one personality disorder have more than one personality disorder.) Understanding how multiple types of disorders effect the overall personality presentation (and its effect on others and resulting relational health) is important for survivors and therapists to understand. There remains a lot of debate as to the ‘treatable-ness’ of personality disorder largely related to the complexity of these overlapping symptoms.

Our thanks to Dr. Millon for a life time dedicated to understanding personality and its disorders.

(All articles are copyrighted and cannot be reproduced, however feel free to put a link to this page.)


Theodore Millon, PhD, DSc, is a leading personality and developmental theorist. Dr. Millon was the founding editor of the Journal of Personality Disorders and is past president of the International Society for the Study of Personality Disorders. He has been a full professor at Harvard Medical School and the University of Miami. He is the principal author of many clinical inventories and testing instruments related to personality disorder testing. Dr. Millon has also written or edited more than 30 books and has contributed more than 200 chapters and articles to numerous books and journals in the field. Dr. Millon established the Institute for Advanced Studies in Personology and Psychopathology in Coral Gables, Florida, where he serves as dean. In 2008 he received the “Gold Medal Award for Life Achievement in the Application of Psychology” from the American Psychological Foundation. The award recognizes Dr. Millon’s distinguished career and his enduring contribution to psychology through research and the application of techniques to important practical problems in psychology. You may view Dr. Millon’s vita here:

All content does not necessarily reflect the opinions of The Institute.

Where Brain Biology Begins and Ends

Dr. Kent Kiehl, The Mind Research Lab

Survivors of psychopaths have waited a long time to find out ‘officially’ what they already suspected was true: that there are biological brain differences in psychopaths. The women we interviewed for ‘Women Who Love Psychopaths’ talked specifically about psychopath’s impulse control problems, an incomplete spectrum of emotions, unusual processing of emotional and factual information, surface attachments,  superficial (yet impassioned) relating, and poor response to punishment. Since pathology effects personality which is how a person thinks, feels, relates, and behaves, psychopathy results in exceptional negative effects on all of those pervasive aspects of personality.

These differences in brain function help partners (and us) understand beyond an assumed ‘willful behavior’ theory why biological brain differences drive psychopaths’ behaviors. We already know that brain regions affect and regulate emotions which regulate behavior such as violence. The NIH (National Institute for Health) in 2006 reported a study that an aggression-related gene weakens the brain’s impulse control circuits. In an NIH newsletter they state, “A version of a gene previously linked to impulsive violence appears to weaken brain circuits that regulate impulses, emotional memory and thinking in humans. Brain scans revealed that people with this version — especially males — tended to have relatively smaller emotion-related brain structures, a hyperactive alarm center and under-active impulse control circuitry. The study identifies neural mechanisms by which this gene likely contributes to risk for violent and impulsive behavior through effects on the developing brain…These new findings illustrate the breathtaking power of ‘imaging genomics’ to study the brain’s workings in a way that helps us to understand the circuitry underlying diversity in human temperament said NIH Director Elias A. Zerhouni, M.D… By itself, this gene is likely to contribute only a small amount of risk in interaction with other genetic and psychosocial influences; it won’t ‘make’ people violent explained Meyer-Lindenberg. But by studying its effects in a large sample of normal people, we were able to see how this gene variant biases the brain toward impulsive, aggressive behavior.”

How much more then for a psychopath who is the ultimate in impulsive and aggressive behavior? Whose lack of emotional memory and poor impulse control is likely to = relational harm to those in intimate relationships with them? The issue of biology as a contributing factor of psychopathy has been one of the single most important relational harm educational tools that The Institute has come across. Partners of psychopaths can relate to the obvious brain regulating differences in the psychopaths without having known the source of it. Understanding the degree that brain differences plays in the psychopaths thinking, feeling, relating, and behaving helps partners understand what they are up against in their decisions about their own safety in these relationships. Perhaps this very issue will eventually impact how we gauge lethality risks in domestic violence and help us make better decisions about Batterer Intervention programs.

Dr. Kent Kiehl of The Mind Research Lab is using similar MRI’s that NIH has used in their 2006 studies to specifically study the brain differences in psychopaths. In the audio interview with Dr. Kiehl he addresses what he hopes that MRI’s will provide in understanding psychopath’s behaviors and risks. We talk with him about the details of his MRI research and its relevance to the diagnosis of psychopathy and antisocial personality disorder using such tests as the Psychopathy Checklist and the DSM-IV. He also shares his thoughts on the possible use of MRI scans themselves as a diagnostic tool, and possible methods to screen out psychopaths from certain occupations. While Dr. Kiehl also hopes that MRIs will some day provide insight into ‘treatment options’ for psychopaths, The Institute is slightly less optimistic. However, we do share the optimism of deeper understanding of how pathology affects and increases behavioral harm that ultimately relates in relational harm.

Dr. Kiehl is also using MRI’s to better understand other brain responses in different mental illnesses like
schizophrenia and addictions. We asked him about the potential of one day using these MRI’s to
understand possible brain differences in other personality disorders, especially Cluster B’s in Borderlines
and Narcissists. The Institute believes one day those brain differences may be as evident as they have been
in psychopaths. As we step further into the understanding of brain function on the quality of relational health, we open doors for partner education and treatment approaches for those harmed by pathology.

We think you will find the interview with Dr. Kiehl to be enlightening and fascinating and the link for it is listed below. We also invite you to read the in depth interview with Dr. Kiehl in our Research Section done by The New Yorker. We graciously thank Dr. Kiehl for his interview, his education to the field of psychopathy, and for his profound work.

Listen to the interview with Dr. Kiehl.

You can read more about The Mind Research Network at www.mrn.org.

All content does not necessarily reflect the opinions of The Institute.

The Wizard of Oz and Other Narcissists

by: Eleanor Payson, ACSW

Interview with Eleanor Payson, Licensed Clinical Social Worker and
author of ‘The Wizard of Oz and other Narcissists.’

(Editor’s note: The Institute has continued to write about and support the idea that many of the people in relationships with narcissists are not necessarily ‘co-dependents.’  That is because we stick strickly to the addiction-based assessment of co-dependency which is the partner or an addict. In this article Eleanor uses the word ‘co-dependent’ we believe, in a slightly different idea to incorporate other emotional and behavioral aspects.)

Interview by Harrison Koehli

1.)    Why did you write your book?

In the eighties and nineties, I was dismayed by the lack of awareness and tools available for clients struggling in relationships with severely narcissistic individuals.  My goal was to create a framework of understanding that would help clients heal and empower themselves in a variety of contexts; as the partner of a narcissist, the adult child of a narcissist, the coworker or client, or the friend of a narcissist.

On a more personal level, I am an adult child survivor (and today I would say “thriver”) of a narcissistic personality disordered (NPD) stepparent.  My own healing work in therapy coincided with entering the field of social work as a chemical dependency treatment professional.  In the eighties I worked with cocaine addicted individuals who were frequently identified as having severe narcissistic traits or full NPD, and I was fortunate to attend seminars and training programs with the experts at that time on narcissism.  All of this eventually led to my passion to write an easy to understand book for codependents or individuals who find themselves in these painful and devastating relationships.

2.)  What is the premise of it?

I believe the premise of my book is the same as my mission for writing it, which is to educate and help individuals extricate themselves from the corrosive dynamics that occur with narcissistic individuals.  The solution to most problems begins with an elevation in consciousness first.  So, I believe that when we begin to recognize and understand the dynamics that occur in these relationships, we can prevent and heal more quickly from the serious repercussions that erode our well being whether it is psychological, emotional, physical, financial, or perhaps even the loss of freedom.  I also address the inevitable dynamics of codependency that develop or worsen when we become involved with a narcissistic individual.  As we become fully conscious, emotionally and intellectually, we can steer a different course through the powerful force field of the narcissist’s personality.

Finally, I attempt to educate the lay public about the continuum of narcissism that can exist and help people to realize that it can take time for the full picture to emerge.  As the codependent deals with her own issues and learns how to insist on more respectful and reciprocal exchange, the questions about the narcissistic individual’s capacity for change will eventually come to light.   Sadly, all too often, as the codependent recovers her authentic self, the narcissistic issues in the other person are revealed to be the full narcissistic personality disorder (or a closely related personality disorder.)  The good news is that the codependent can recover her authentic and whole self and choose a very different life.

3.)  What kind of relationship dynamics do narcissists have in their relationships?

The word “dynamics” that you mention is the key to understanding these confounding relationships.  In healthy relationships, there is a dynamic of mutuality – the shared consideration of giving and receiving.  For example, it might be the consideration of noticing who arrived at a store counter first, or respectfully listening when someone is speaking and waiting one’s turn to share, or having empathy for who might be in need of a little extra support in a given context.  The boundaries between self and other in healthy relationships simply unfold with an implicit understanding of a normal give-and-take.  And typically the average person operates from a foundation of “giving the benefit of the doubt” when dealing with others, meaning a readiness to extend support and empathy to another person.

Unfortunately, as we encounter the narcissistic individual or the NPD person we discover that the implicit boundaries of mutuality are not operating, or perhaps I should say, they are only superficially operating.  The personality presentation of the narcissist invariably has an intensity or potency that initially causes us to suspend our disbelief and turn off our critical faculties that allow us to notice distortions and inconsistencies.  Intensity of presentation (either overt or covert) taps directly into the vulnerability of the codependent’s unconscious need to idealize others as a way of compensating for feelings of inadequacy and low self-worth.  In short, the narcissist literally induces others into a trance and feeds on the stolen narcissistic supplies that inherently belong to both.  Eventually, we encounter a host of painful dynamics from the narcissist’s unconscious mindset that places self as superior to other, self in competition with other and in a nutshell – self against other.

Although this mindset is a defense against a more deeply held sense of inadequacy, the narcissist’s entitlement feelings have a mighty strength of will behind them.  This tenacious iron will is due to the identification with a grandiose self – some larger than life identity (even when covert as in the identity of a minister and, therefore, more difficult to observe.)  All of this sets the stage for the narcissist’s desperate need to dominate the mental and emotional resources (narcissistic supplies) of attention, empathy, consideration, admiration and support in his/her relationships.  The exploitation of the narcissistic supplies is one reason that the codependent becomes so depleted.  In addition to depriving others of affirming and empathic behaviors, the narcissist also plays out the defense of projection – seeing his/her unwanted negative traits in others and communicates subtly or openly an endless array of devaluing messages.  Finally, as the narcissist achieves greater degrees of dominance in a given relationship, he or she can “rewrite the program,” so to speak, over the identity of the other person.  In the end, the narcissist exploits others for the additional privileges of status, money, power, and even the ability to take away the freedom of others.

4.)  What kind of problems do your clients have in their relationships with narcissists?

To be on the receiving end of the dynamics just described is to slowly and continuously lose a sense of one’s core identity or core self.  As we discussed earlier, narcissistic individuals often are drawn to individuals whose vulnerabilities are typically described as codependent.  For those not familiar with the term, codependency is an overall tendency to compensate for low self-esteem by pleasing and gaining approval from others.  Individuals with codependency issues are typically overly attuned to the feelings and needs of others at the cost of knowing and asserting their own.  Problems with depression, anxiety, low self-esteem, and neuroses of all kinds are included in the array of issues that these clients might have.  There is also a tendency to idealize others and invest trust too easily.  Invariably the codependent individual suffers from abandonment fears, attachment hunger and a subsequent confusion and inability to recognize his or her inherent rights as a person.  The good news from my perspective is that codependents more commonly fall into the neurotic level of mental disturbances, and consequently have much greater capacity for insight and motivation for change.   Therefore, the picture is really very optimistic, and it is endlessly rewarding to work with codependents as they blossom and reclaim their lives.

5.)  What if any treatment do you see possible for personality disorders – do you encourage couples counseling or for partners to wait it out while the narcissist is in treatment?

I hope you will bear with me as I attempt to answer the various aspects of your question.
Part of the problem with recommending treatment options for individuals presenting with narcissistic issues is that it is often not clear initially what level of narcissistic disturbance exists in the person.  When the narcissistic person has already been assessed (by qualified and competent professionals) as having a personality disorder then the potential for change is extremely unlikely.  However, the NPD individual can (and not infrequently does) make use of therapy in the supportive sense and sometimes also is willing to be treated for co-existing issues that are often part of the picture such as depression, anxiety disorders, mood disorders, and attention deficit disorder.  The kind of change that an NPD person is capable of in this scenario is generally superficial, and therapy is used primarily to deal with some crisis that is stressful and threatening to his/her already fragile sense of self.  I do wish, however, that mental health professionals were more willing to recognize that character disordered individuals can benefit from treatment for these co-existing issues, and we are in a unique position to advocate for this treatment.  Despite the inability for deeper change, it can be an enormous relief, not only for the NPD individual but for family members also, when these co-existing conditions are to some degree alleviated.

Having said all this, the capacity for genuine change generally exists in those individuals who are in some type of relationship with the narcissist – provided, of course, that they are not personality disordered also.  As I mentioned earlier, the changes that the codependent individual must work on involve developing a healthier sense of self alongside learning skills for effective limit setting and the implementation of firm, consistent and explicit boundaries that demand more appropriate behavior from the narcissist.  Ultimately, there may be choices that involve ending the relationship with the narcissist or seriously limiting one’s exposure to him or her.  These choices are generally necessary when the narcissist proves to be incapable of developing more appropriate behavior.  Perhaps the most important imperative for family members, friends or their partners is to become educated about the problem so that so they do not stay stuck in the confounding and corrosive dynamics of these relationships.

I also encourage the codependent partner, family member, friend, etc. to enter into therapy and to attend codependency support group(s.)  I feel proud to report that the women and men in Michigan who have been through our program over the years have started the first CONA group – Codependents of Narcissistic Individuals Anonymous (now officially sanctioned as a twelve step program by the World Service Headquarters of Alcoholics Anonymous.)  For anyone reading this, I want to emphasize how necessary it is to reach out and get help and not stop until you feel you have found someone who can validate and understand what you are going through.  If the therapist is overly anxious to dismiss the possibility that you are involved with someone with severe narcissism or perhaps a full blown NPD then move on until you find a therapist who does recognize the realities of the problem and who can offer support, validation, and empowerment strategies.  I know that I am singing to the choir here, however, it is impossible to overstate the importance of getting help from experienced professionals familiar with these issues.

To return to the question of capacity for change on the part of the NPD person, I think sometimes when the NPD individual does show capacity for genuine change, then we have to acknowledge the possibility that the person may have been misdiagnosed in the first place.  The real mystery cases are those individuals who seem to hover in the area between a “high functioning” personality disordered person versus a neurotic individual with strong narcissistic issues.  Within this mystery group, the big question on the table has to do with the capacity for developing mature introspection and a sustained ability for change due to the development of empathy.  Once family members or spouses develop insight and begin to change the asymmetry in the relationship with the NPD person, it becomes possible to tease out the deeper picture and to make choices that are founded on an accurate assessment of the level of functioning within the narcissistic person.

Consequently, I often recommend a combination of individual therapy (for both parties, but primarily for the codependent person because this person generally has a greater capacity for change) and marital or family therapy for the relational problems.  I also recommend that separate therapists (working in co-ordination with each other) provide the different therapy requirements.  When there are limited resources, I generally encourage the codependent person to attend individual therapy to heal and strengthen her sense of self so that the exploration for change with the narcissist or possibly ending her relationship with the narcissist is something she has the strength to do.

6.)    How many years post treatment have you followed up to see how they are doing?

As a therapist in solo private practice, I do not have the resources to conduct follow-up surveys or research.  I know that this is one of the great contributions that Sandra L. Brown, M.A. and others with The Institute are offering as they devote themselves to this important work, and I know it will continue to advance awareness and the development of effective treatment.

7.)    What kind of parents do they make?  What kind of stories do they tell you?
8.)    What do the children say about their narcissistic parents?  (Harrison, I hope you don’t mind that I combined these questions, as they are more or less the same.)

The stories of clients with NPD parents are incredibly varied and unique and yet, they are just as remarkably similar in the underlying and universally shared experience of reality.  I will never forget a beautiful woman from a foreign country who had lived in America for only a few years.  Having grown up with an NPD mother, she described her loss of self in the most poetic terms.  She described her struggle to free herself as a process of erasing her mother’s initials that were carved into every cell in her mind.  She went on to affirm how she was learning to penetrate the veil of her mother’s wants, thoughts and feelings as she discovered the choices that were her own.

Somehow, this woman’s description has stayed with me as a powerful expression of the loss of self that results when the child is held hostage to the NPD parent’s conditional expectations.  Most important, however, is the reality that this potent mourning process brings the hope for healing and renewal.  It is an amazing moment to awaken to a deeper knowing of self and to realize that we can reclaim our freedom from the unhappy tyranny of the conditional or false self.  We need to realize that we can become victims of the conditional or false self in one of two ways – an inner or internalized false self, or conforming to the false self of someone else.

9.)    What is the most troubling aspect of the personality disorder?

I would have to say that the most troubling aspect of these disorders are not just that they are life long problems for the personality disordered individuals, but too often it is a “life sentence of misery” for those who are involved with these individuals.  This brings us full circle back to your first question that raised the question about the premise behind my book.  I truly believe that we can change this reality.  With enough education and effort to raise our collective consciousness about of the predatory nature of personality disorders, not only will there be fewer victims, but we may also discover more effective treatments for this population.  In any case, I am passionate about helping to prevent and alleviate the “life sentence” for the would-be victims of individuals suffering from these personality afflictions.

10.)  What relation, if any, have you found between depression, anxiety, etc. and interaction with people with personality disorders?  Does the latter cause or exacerbate the former?  (Harrison – This first question is a little fuzzy, but I think the second question clarifies it.  I hope my answer addresses what you are asking.)

I’m not sure that anyone knows the answers to the important questions of causality with respect to personality disorders.  We do know that there is a high incidence of co-morbid or co-existing conditions with respect to personality disorders and the array of other problems such as depression, mood disorders, anxiety, ADHD, addictions, anorexia, and the list goes on.  I also think that we have to be very careful about causality interpretations, because this can very quickly take us on unnecessary detours that distort our understanding and treatment of the differences between these problems.  The clinical term “co-morbid,” meaning co-existing, is an effective term because it reminds us that these are parallel, but not necessarily causative conditions.  Having said this, it is absolutely true that these “parallel” conditions do amplify and exacerbate each other.  As I mentioned earlier, when we successfully treat a co-morbid conditions (such as depression) it can be a significant achievement in lessening the overall destructive impact of the individual’s personality disorder.

11.) Have you found that a lucid explanation of personality disorders helps in the therapeutic process?

Yes, absolutely.  After my book was released, the women and men who attended my public talks demonstrated a powerful need for greater clarification and understanding of the narcissistic personality disorder and the whole continuum of healthy to unhealthy degrees of narcissism.  Eventually, these events grew almost organically into the development of our seminar program that came to be called Discovering the Healthy Self.  I am convinced that education of these issues plays a potent role in accelerating a person’s capacity to heal and grow.

12.)    Do you see a need for a more general understanding of personality disorders?  And how do you see that happening?

Again an emphatic yes, and I know we are in great agreement about this.  Since 2002 when my book was first published there were only a handful of books on this subject for the average reader.  Since that time, a few dozen books have been published on the subject as well as important information about other personality disorders.  Your wonderful web magazine and many blog sites also are getting the word out with important information about how to identify a potential personality disorder in a person and empowerment strategies for coping with these individuals.

13.)  Can accurate knowledge about personality disorders act as a preventative measure against the negative influences of interactions with narcissists, for example?

Yes, I do think so.  Perhaps the silver lining about the tragic consequences we are experiencing as a country is another reason that the subject is getting more attention.  We now have a powerful need to understand how our government officials and experts in the banking world could have conducted themselves with such careless selfishness.  The short answer is that so many of these individuals have personality disorders.  My greatest hope for our society is that we become self aware enough as individuals that collectively we can detect what makes a healthy person healthy and conversely what clues tell us about a deeper disturbance.  When we have developed a healthier consciousness about all this, I believe it will be less likely that we will elect such disturbed people to government office or allow them to gain prominent positions over our institutions.

As a conclusion, I would like to thank you Sandra for your wonderful work and dedication to furthering people’s awareness and understanding of these important issues.  I also want to thank you for the opportunity to participate in this interview.  My warmest regards to you and your staff.

Harrison, let me also thank you for your extremely patient and helpful support in the interview process.


Eleanor Payson, ACSW,  is a licensed marital and family therapist, practicing individual, marital, and family therapy for the past eighteen years. Graduating from the University of Michigan in 1983 with her Masters in Social Work, she has continued her education on issues ranging from; chemical dependency and codependency, adult children of alcoholics, narcissism and borderline personality disorders, relationship therapy, and attention deficit/hyperactivity disorder.

All content does not necessarily reflect the opinions of The Institute.

Experts Speak Out

The Institute will be interviewing some of the great influences in the field of pathology. Stay tuned for interviews with:

  • Dr. Susan Forward, author of ‘Men Who Hate Women & The Women Who Love Them’, ‘When Your Lover Is a Liar’, ‘Toxic Parents: Overcoming Their Hurtful Legacy & Reclaiming Your Life’, ‘Emotional Blackmail’, ‘Obsessive Love’, and more.
  • Dr. Kent Kiehl, Ph.D., Associate Profession of Psychology and Neuroscience, University of New Mexico and the Director, Mobile MRI Core and Clinical Cognitive NeuroScience, The Mind Research Network.
  • Eleanor Payson, M.S.W., A.S.C.W., author of ‘The Wizard of Oz and Other Narcissists.’
  • Amy JL Baker, Ph.D., author of ‘Adult Children of Parental Alienation Syndrome: Breaking the Ties That Bind’ and is the Director of Research at the Vincent J. Fontana Center for Child Protection.
  • Theodore Millon, Ph.D., D.SC Dean & Scientific Director of the Institute For Advanced Studies in Personology & Psychopathology, Retired Professor from Harvard Medical School (Psychiatry). He is the author of:
    • ‘Handbook of Psychology, Volume V: Personality and Social Psychology’ (2003). (Co-Editor). New York: Wiley-Interscience.
    • ‘Personality Disorders in Modern Life’ (2000). (Co-author). New York: John Wiley & Sons.
    • ‘Oxford Textbook of Psychopathology. (1999, Editor-in-chief). New York: Oxford University Press.
    • ‘Personality-Guided Therapy’ (1999, author). New York: Wiley-Interscience.
    • ‘Psychopathy: Antisocial, Criminal, and Violent Behavior’ (1998, Co-editor). New York: Guilford
    • (And scores and scores of chapters in other publications as well as many testing instruments, books, and professional articles. Dr. Millon’s writing is prolific and extensive in the area of personality disorders.)
  • Nancy L. Thomas, author of ‘When Love Is Not Enough: A Guide to Parenting Children with Reactive Attachment Disorder’ and Director of Attachment.org—parenting resources for unattached and unbonded children.
  • Bill Eddy, Esquire & L.C.S.W., author of ‘High Conflict People’, ‘Splitting: Protecting Yourself When Divorcing a Borderline or Narcissist’, and ‘Managing High Conflict People in Court.‘ He is the Director of the High Conflict Institute and is a Certified Family Law Specialist and a Licenses Clincial Social Worker.
  • James Dumesnil, MS, LPCMHC, CCFCClinical Director — Families By Design, Inc.
    President–CA Mental Health Counselors Assoc, Licensed Professional Clinical Counselor
    Clinically Certified Forensics Counselor, Clinically Certified Criminal Justice Specialist
    Attachment Therapy & Forensic Counseling
  • And more being lined up.