The Narcissistic Dilemma Seminar with Dr Ruth Birkebaek (Jan. 2020)

Dr Ruth Birkebaek’s seminar on the Narcissistic Dilemma offered us some fascinating insights into working with this group of clients from the perspective of relational integrative psychology.  She began her career as a plastic surgeon in Brazil and after becoming interested in the impact of the mind on the development of physical illness, undertook many years of extensive training across a broad range of psychotherapeutic approaches.

Ruth uses a relational approach, looking at what lies deep inside the narcissist, namely the lonely hurt child, drawing on Richard Erskine’s developmental approach that people suffer from ‘relationship disruptions not psychopathology’.  As such she highlighted the importance of understanding the attachment patterns of these clients and their unconscious relational patterns of self in relationship to others.

She spent some time explaining the sense of inner emptiness and meaningless that exists as the phenomenological experience of narcissistic people and that that requires recurrent external validation of his or her value and importance.  When they get this validation they are left feeling so good that nobody else matters.

However, when this validation of their inflated sense of self-worth is absent they may feel shame or depressed.

Ruth spent some time looking at the possible origins of narcissistic behaviour, drawing on the work of Kohut, the self-psychologist, who believed it was important for children of  3-4 years old to idealise their parents in order to develop an internalized sense of purpose and self-esteem.  Without this, the child may turn inwards for an idealizing object.

She explained that, as a result of predictable emotional mis-attunement, a child grows up believing that they cannot rely on their parents and therefore cannot rely on anyone.  The script belief ‘I don’t need anyone’ becomes internalized and develops as a protective mechanism.  There develops an endless search for perfection in all that they do, and to find others who will mirror and admire their grandiosity. 

She spoke to of the psychological functions of parents, naming them as relational stabilization, relational regulation, relational reparation and relational enhancement.  When a child experiences parental mis-attunement in these areas, he finds a way of self-regulation and self-stabilisation, looking internally for the validation that is missing from his external experiences.

Having looked at the developmental theory, Ruth went on to look at the spectrum of narcissistic behaviour, ranging from the severe Narcissistic Disorder, through the moderate Narcissistic Pattern to the mild Narcissistic Style.

She invited us to consider our own Narcissistic Moments, for example the flashes of entitlement we might feel in a traffic jam, in order to understand that these moments exist for all of us, which proved to be an enlightening exercise for some of us!

Ruth then went on to talk about working with narcissistic clients.   She focused on their relational needs, highlighting that we cannot satisfy their archaic unmet needs today, but we can respond to the client’s current relational needs, ie being the idealized parent for them now, rather than changing history.

She highlighted that this is long, slow work, providing a dependable, consistent and reliable therapeutic relationship.  She explained the Self in Relationship Model, developed by Richard Erskine, which is helpful with narcissistic clients.  This involves a triangular approach, accessing the client through their physiology, their cognition and their affect, and slowly finding ways to integrate the 3 in order to facilitate change in behaviour in the here and now, rather than reverting to archaic patterns.

The afternoon session involved a practical demonstration of how Ruth works.  One of the delegates courageously volunteered to be her ‘client’ and Ruth’s gently empathic connection with her showed us beautifully how she utilizes the Self in Relationship Model. 

Following this, was an open Supervision session, when delegates asked Ruth for suggestions and support with their client work.

The whole day was enormously helpful in offering an insight into working with the challenge of narcissistic clients.  Ruth was an engaging, knowledgeable speaker, who shared her expertise with us with eloquence, compassion and a wonderfully light touch.

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Average feedback scores from our event:

Organisation of event: 4.84 out of 5

Speaker: 4.96 out of 5

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Feedback from our event:

“Great emphatic speaker. Sensitive and very attuned” – Diana Burr

“I will certainly look for more workshops with Ruth. Please will you ask her back?  Ruth has a gift for attuning to a large group with such attentiveness and sensitivity” – Carol Bennett

“Engaging information / theory; clearly presented; good collective atmosphere”

“Ruth had a very engaging manner and huge confidence / knowledge of her subject”

“Very engaging speaker who conveyed her ideas empathically and beautifully” – Mel

“One of the best events I have been to! Good parking and easy to find”

“Very good speaker, good pace, very informative”

“Excellent organisation, venue, facilities and speaker”

“Really interesting, beautifully presented”