Neurology of Shame in the Narcissistic ClientExcerpted from: “Constitutionally Incapable of Being Honest”

The Narcissistically defended client in Substance Abuse Treatment Workshop by Mary Crocker Cook.

Mary Crocker Cook, D.Min., LMFT, LAADC, CADCII

www.marycrockercook.com(408) 448-0333

NPD CountertransferenceO Clinicians can frequently feel frustrated,

devalued, controlled, and even hostile toward NPD client. Most often, they will feel dread and a desire to avoid these clients, and may ultimately wonder about their own competence and “suitability” for the counseling field if there is more than one NPD on their caseload! The dismissiveness of the narcissist can feel painful, and if the counselor has their own early attachment damage, even narcissistic injury, this client will trigger profound feelings of discouragement.

O For some recovering counselors, there may even be an urge to return to mood altering behaviors or substances in response to being “invisible” in the presence of a narcissistically defended client. Ironically, the shame that gets triggered for the counselor is a mirror of the shame core of the narcissist.

O In my clinical experience the primary differentiating trait for the narcissistically defended client vs NPD client is the presence of, or capacity for, empathy. However, it’s hard for them to access their empathy even when capable because they are unable to identify their own emotions so have trouble accurately recognizing the emotions of others. The narcissistic client most likely developed their defenses in response to a narcissistic parent. This is a parent incapable of providing consistent emotional responses, and is unable to tolerate any expression of competing needs and wants that might interfere with the narcissistic parent’s agenda and self-image. Disappointing the narcissistic parent with opposing needs meant emotional abandonment if not abuse.

O Narcissistic clients have grown up meeting parental needs, so do not have an inability self-soothe. They are disconnected from their internal world as a result of receiving very little accurate feedback or recognition of their developing self. They are forced to “guess” at who they are, and eventually manufacture an image of a self they deem “acceptable” to the narcissistic parent, an image that cannot be questioned or challenged. The narcissistically defended client is not capable to trusting others and their intentions, ever vigilant for threats to the image they have carefully constructed

O “Looking at attachment through the lens of narcissistic vulnerability stimulates making a distinction between appropriate security needs and narcissistic use of the partner to manage self and avoid being hurt. In anxious attachment, the defensive strategy is to merge with an idealized other who bolsters feelings of worth. In avoidant attachment, the partner is distanced to maintain self through a behavioral or phenomenological response that strictly avoids closeness and any ensuing intense or negative feelings. One avoidant strategy keeps the self-contained, closed, passive, and nonassertive; the other strategy protects through idealizing the self and discounting the importance of the attachment system.” (8)

Narcissist Injury and Shame

O According to Schore (14), “shame is the reaction to an important other’s unexpected refusal to co-create an attachment bond that allows for the dyadic regulation of emotion.”. At it’s core, it is a loss of attunement with one’s caregiver (15) and is the “visceral experience of being shunned and expelled from social connectedness.” (16).

Shame has the physiological impact of a rapid transition from sympathetic to parasympathetic dominance of the autonomic nervous system, and from a positive to negative affective state in the person who experiences it (17). It is associated with such outward physical responses as facial expressions and behavior consistent with feelings of distress, accelerated respiration rates, sweating, and increased blood flow to the skin (18). This experience of blushing represents the physiological discharge of an experience of shame and is the outward signal to the watchful other that expresses a desire to be accepted back into society. (19)  

Neurobiology of Attachment

O Neurobiologically, Seigel(20) states, that when we are “feeling felt” in early childhood, our dopamine system expands, which results in allowing or wanting to “be seen.” Conversely, he defines shame as simply the absence of attunement. Siegel goes on to purport that shame contracts the dopamine system and leads the child to attempt to be “unseen.”

O Schore’s (21) research has shown that in the attuned moment between child and caregiver, both have that biological experience of the opiate system firing. These systems serve to reinforce the attachment and bond within the relationship. When people have healthy relationships both the dopamine and opiate systems are sustained.

O The body, limbic region, and cortex are involved in the physiological, emotional, and intentional states as one person resonates within another who is paying attention to other’s facial expressions (22) As an attentive primary caregiver tunes into the needs of an infant, gazes into the infants eye, and meets it’s needs for affection, safety and sustenance; the infants brain is developing neural pathways for relational survival. (23)

O The temporal poles have been shown to be involved in mentalizing - attending to your own mental state as well as the mental health of others. The amygdala, which we have talked about in terms of being part of the fear center, is also important in social-emotional processing. Mentalizing is the ability to attend to your own mental states as well as those of others. If you think about a mother mentalizing her infant, it is the mother’s ability to keep the mind of the infant in her own mind.

 

O Bradshaw (24) claims, “Prolonged shame states early in life can result in permanently dysregulated autonomic functioning and a heightened sense of vulnerability to others. Their lives are marked by a chronic anxiety, exhaustion, depression, and a losing struggle to achieve perfection.”

Neurobiology of shame

O Neuro-Physiological Integration requires integration of the Parasympathetic (PNS) and in a lesser role, the sympathetic (SNS) branches of the Autonomic Nervous System (ANS)(25). When integration is not going well, the mind moves toward rigidity (a state that may result from too much differentiation of neural circuits without the balance of integration (26)

O Shame begins in the right-hemisphere limbic processes, especially the meaning making amygdala. The amygdala houses implicit memory – the only memory available in the first 2 years of life. These memories contain behavioral impulses, affective experience, perceptions, etc. that, with repeated experience, cluster into mental models. (27) Thus, “the amygdala develops a generalizes, nonverbal conclusions about the way the world works. (28)

O Shunning, rejecting, and/or neglectful signals send a “neuroception” (29) genetic wiring for the neurobiological detection of safety, danger, or threat to life – that there is danger. The amygdala understand relationship to be unsafe and sends a message to the hypothalamus.

O The hypothalamus, with the pituitary, sends neurotransmitters though the body-brain translating social interactions into bodily processes. The fear/danger response triggers the autonomic nervous system. The SNS is activated stimulating the physical fight or flight response, and the child “up-regulates” to maintain hypervigilance to find a way to restore a safe connection. Without the relational repair the PNS over functions to create a withdrawn response. Alan Schore states, “the word used for the latter experience is shame.” (30)

O The Orbital Media Prefrontal Cortex is active in the role of affect regulation, serving as a center for appraisal and influences arousal. As such it is primary in the creation of attachment styles. It facilitates the regulation of bodily arousal by pushing down the SNS and activating the PNS (31) An unmodulated PNS pulls the child into painful and isolating stillness (32), and can trigger dissociation which is a PNS function. They child “down-regulates” to feel stable again.

O Part of the ANS, the Adrenal glands releases glucocorticoids (GCs), stress hormones, to respond to the distress. However, prolonged, high levels of GCs cause inhibited hippocampal functioning – cells basically get tired, collapse, and die. The hippocampus is vital in the role of explicit memory and conceptualization of new episodic learning –so in a distressing circumstance one may not know why he or she is reacting in a shamed/ing manner. (33)

O This last point is important to keep in mind, because someone in an acute shame attack has a flooded limbic system, and access to frontal lobe logic and problem solving are limited. They may have trouble finding their words, or their words may be designed to create distance so may be hurtful and aggressive. The distance will allow them to access their PNS system and calm down. Unfortunately, they may injure others in the process. Over time this is damaging to all of their primary relationships.

EducateO Emotional dysregulation means

they’re on an emotional roller coaster. They feel like they have no control over their emotions - actually they feel controlled by their emotions. That can lead to a number of difficulties like substance abuse; people feel so overwhelmed by their emotions that they often turn to alcohol or street drugs in an attempt to regulate their emotions.

O People who have early life trauma can move back and forth between states of hyper-arousal and hypo-arousal; they don’t necessarily get locked into one mode or the other. This creates an inner experience of a person who is being hijacked back and forth between those two modes - that would be very destabilizing and distressful for them.

In the first weeks of treatment (stabilization), you focus on enhancing emotional awareness and enhancing capacity for emotion regulation by: Introducing psychoeducation about the neurobiology of shame, offer regulation methods such as mindfulness, yoga, breathing techniques, EFT, use of music or relaxation tapes, or even aromatherapy.

O It will be important to educate these clients on the neurobiology of shame as you help them become aware of the physiological response connected to their reactivity. As they become aware that their defensiveness is a process, they can begin to develop skills to pay better attention to their physical reactions and learn skills to manage it. They need to see the link between their physical reactivity and their self-medication to cope.

O We can present the presence of the wounding as a fact, with some tie to not being seen and heard accurately, and then move toward managing the responses when triggered. It is important that they see the perception of being dismissed, being unseen and unheard as a potential cognitive distortion given their hyper-reactivity to those issues. They will need to practice reframing incidents to consider other explanations for communication conflicts than the dismissive filter through which they interpret their world.

8. http://www.thepresentparticiple.blogspot.com14. Schore. A. Early shame experiences and infant brain development. (1998) In Shame: Interpersonal Behaviour, Psychopathology and Culture, P. Gilbert & B. Andrews (eds.). Oxford University Press, pp. 57-77.15. Schore. A. Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development Erlbaum, 1994.; and Cozolino, Louis J. The Neuroscience of Human Relationships: Attachment and the Developing Social Brain (2006) WW Norton.16. Cozolino, Louis J. The Neuroscience of Human Relationships: Attachment and the Developing Social Brain (2006) WW Norton. Pg. 23417. Schore. A. Early shame experiences and infant brain development. (1998) In Shame: Interpersonal Behaviour, Psychopathology and Culture, P. Gilbert & B. Andrews (eds.). Oxford University Press, pp. 57-77.; and Schore. A. Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development.Erlbaum, 1994.; and Cozolino, Louis J. The Neuroscience of Human Relationships: Attachment and the Developing Social Brain (2006) WW Norton. 18. Broucek, F.J. (1982). Shame and its Relationship to Early Narcissistic Developments. Int. J. Psycho-Anal., 63:369-37819. Wingfield, Carolyn. Sharing Space The Role of Shame in Infant Development. Journal of Prenatal and Perinatal Psychology and Health 26(2), Winter 201120. Seigel, Danial. J. The Developing Mind: Toward a Neurobiology of Interpersonal Experience (1999) New York: Guilford Press

Resources

21. Schore, Allan. Affect Dysregulation and Disorders of the Self. (2003) W.W. Norton 22. Seigel, Danial. J. The Developing Mind: Toward a Neurobiology of Interpersonal Experience (1999) New York: Guilford Press23. Banenoch, Bonnie. Being a Brain-Wise Therapist: A Practical Guide to Interpersonal Neurobiology(2008) Norton Series on Interpersonal Neurobiology. 24. Bradshaw, John. Bradshaw On: The Family: A New Way of Creating Solid Self-Esteem (1990). HCI. 25. Neurobiology of shame. http://www.slideshare.net/lisasequeira/interpersonal-neurobiology-of-shame26. Seigel, Danial. J. The Developing Mind: Toward a Neurobiology of Interpersonal Experience (1999) New York: Guilford Press pg. 5027. Cozolino, Louis J. The Neuroscience of Human Relationships: Attachment and the Developing Social Brain (2006) Norton; Seigel, Danial. J. The Developing Mind: Toward a Neurobiology of Interpersonal Experience (1999) New York: Guilford Press28. Banenoch, Bonnie. Being a Brain-Wise Therapist: A Practical Guide to Interpersonal Neurobiology(2008) Norton Series on Interpersonal Neurobiology) pg 2429. Ibid pg 6030. Ibid. pg 2131. Seigel, Danial. J. The Developing Mind: Toward a Neurobiology of Interpersonal Experience (1999) New York: Guilford Press32. Banenoch, Bonnie. Being a Brain-Wise Therapist: A Practical Guide to Interpersonal Neurobiology(2008) Norton Series on Interpersonal Neurobiology) pg 10733. Cozolino, Louis J. The Neuroscience of Human Relationships: Attachment and the Developing Social Brain (2006) WW Norton