Clinical focus on the distress, confusion, anxiety, and long-term impacts on clients of relationships with people who have antagonistic personalities, and the behaviors consistently expressed in these relationships continues to expand. This workshop will focus on working with clients experiencing narcissistic relationships using case examples, as well as employing a simulation technique that allows us to explore what works (and what always doesn’t) with clients experiencing these relationships. We will re-orient to what antagonism and narcissism are, how they show up in relationships, what happens to people in these relationships and then primarily focus on what to do, as well as the contextual, legal and ethical issues raised by these clients.
Objectives
- Identify the diagnostic implications of narcissism and antagonism as personality presentations.
- Summarize the key issues in managing clients experiencing narcissistic abuse/antagonistic relational stress (NA/ARS).
- Examine how the concepts of DARVO, blindness, trauma bonding, and cognitive dissonance drive self-blame in narcissistic/antagonistic relationships.
- Distinguish the role of attachment in establishing and maintaining narcissistic/antagonistic relational dynamics.
- Differentiate between how a client may be vulnerable to entering a narcissistic/antagonistic relationship versus keeping them stuck in the cycles of these relationships.
- Identify the behavioral, emotional, cognitive, physical/somatic, sequelae and responses to antagonistic behavior and patterns observed in narcissistic/antagonistic relationships.
- Contrast the overlaps between the fallout of NA/ARS and other major psychiatric disorders as well as the how these patterns may co-occur with NA/ARS.
- Summarize the key tenets of what it means to be “antagonism informed.”
- Select key elements of assessment when working with clients experiencing NA/ARS.
- Evaluate the risks of treating the fallout of NA/ARS as merely “co-dependency.”
- Analyze the concepts of radical acceptance, grief, guilt, shame, and pity in the therapeutic process with a client experiencing NA/ARS.
- Develop a treatment plan for a client experiencing NA/ARS.
- Identify legal and ethical issues that may have greater salience in working with clients experiencing narcissistic relationships.
- Examine the importance of cultural competency, structural awareness, contextualization, and intersectionality when working with clients experiencing antagonistic/narcissistic relationships.
Outline
DAY ONE
Morning:
- PRESENTATION OF A CASE
- An overview of narcissism beyond just DSM
- Understanding antagonism as a more comprehensive higher order trait
- The dangers of the NPD diagnosis
- How does narcissism develop?
- Relational motivations for narcissistic people
- Sub-types of narcissism
- Assessing narcissism
- Comorbidities and overlaps – how narcissism can magnify other clinical conditions
- Learning to Identify Narcissism by its Common Patterns
- Behaviors, thoughts, and emotions in narcissism
- Shame and vulnerability in narcissism
- Protective defenses and behaviors in narcissism
- Narcissistic behaviors and tactics in relationships (narcissistic abuse)
- Neurodivergence vs. other mental health issues vs. antagonism: A brief overview
- Why this knowledge is essential to being antagonism-informed
- Revisit the case and questions
Afternoon:
- PRESENTATION OF A CASE
- The dynamics of narcissistic/antagonistic relationships
- Intermittent reinforcement and inconsistency
- How the world views narcissistic people
- Cognitive dissonance and getting stuck
- The concept of “trauma bonding”
- The narcissistic relationship cycle
- The role of attachment, connection, and safety in narcissistic relationships
- DARVO
- The concept of betrayal blindness
- The responses of people in relationships with narcissistic people
- What do our clients have to do to stay safe and stay attached
- How diminished social power magnifies these responses
- Self-abandonment and related responses by clients in narcissistic relationships (disconnecting to connect)
- The fallout of narcissistic abuse
- REVISIT THE CASE and questions
DAY TWO
Morning:
- PRESENTATION OF A CASE
- An antagonism-informed approach to working with clients
- The key phases of NA/ARS treatment
- What does trauma-informed really mean?
- Creating the treatment map
- What other treatments miss when working with NA/ARS
- A multifaceted working model for treating NA/ARS
- Do I stay or do I go?: What to do when your client is stuck/ambivalent
- Best Practices for working with NA/ARS
- The fundamentals framework
- Fostering safety
- Primary areas of assessment
- Managing severe symptomology
- Preparing the client for psychoeducation (and avoiding the dark corners)
- Fostering radical acceptance
- Guiding our clients to agency, individuation, and autonomy
- Revisiting the case and questions
Afternoon:
- Case Simulation
- Experiencing the NA/ARS treatment framework in action
- Key principles to effective treatment
- Enhancing strengths and protective factors
- How to facilitate post-traumatic growth and resilience
- Distribution of cases, working in small groups and discussing the cases
- Building treatment plans, highlighting challenges and questions
- Using the cases to continue to practice implementing antagonism-informed approaches to working with clients experiencing relationships characterized by antagonistic and narcissistic behaviors and dynamics
- Questions
DAY THREE
- PRESENTATION OF A CASE
- The vital role of cultural, intersectional, and systematic awareness in treating NA/ARS
- A Social ecological model
- Structural issues in NA/ARS: Looking beyond the individual model
- The realities of mental health access
- The many contexts of client experiences
- Cultural competency
- Fostering humility and flexibility
- Accounting for power: Navigating the asymmetric therapeutic relationships
- Why therapy approaches cannot be easily moved between cultural groups
- The culturally competent counselor
- What is positionality?
- Navigating the legal and ethical challenges of working with NA/ARS
- Documentation and accessing records
- Working with collateral contacts: other clinicians, evaluators and more
- Navigating confidentiality and privilege
- Consultation: Getting support and protecting your client’s identity
- Tips for working with attorneys and the courts
- Malpractice insurance and how to best protect yourself
- Navigating mandated reporting using an ethical decision-making model
- Multicultural dynamics: understanding cultural diversity within the law
- Recognizing different types of coercive control and what to do to best support your clients
- Guidance from APA ethical codes: Competency, scope of practice, supervision and more
- The impact on therapists: Avoiding burnout, helplessness, and secondary trauma
- Navigating the ups and downs of your client’s readiness for change
- Guidance for providing testimony and treatment summaries
- Revisiting the case and questions
Target Audience
- Social Workers
- Counselors
- Psychologists
- Physicians
- Marriage and Family Therapists
- Addiction Counselors
- Psychotherapists
- Case Managers
- Nurses
- Mental Health Professionals
- Therapists