Childhood Narcissism Therapy: A Story Of One Presence

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

The mother of 6-year-old Sasha S. turned to me with a request to diagnose intellectual development. The results of diagnostics in kindergarten were a cause for concern.

Mom was recommended to send the girl to a special school.

While I was talking to my mother, this diagnosis raised my doubts. Mom and daughter, both interesting, well-dressed and with the tension of despair in their entire appearance, created an amazing feeling of being well-groomed and abandoned at the same time. The whole appearance of the girl betrayed her disinhibition. capriciousness, some alarming confusion, but not mental retardation. However, in the very first minutes of my interaction with her (or rather, attempts to establish it), I experienced a strong temptation to join the opinion of my colleagues.

The child caused not only confusion, but horror and a feeling of complete hopelessness. The impression was that the girl did not hear, did not understand what they wanted from her and simply was not able to concentrate for more than 5 seconds. At the same time, she made it clear that she was noticing my presence, since she acted with exactly the material that was offered to her (a sheet of paper with a pen, cubes). Moreover, she acted constantly, chaotically and not in the way I asked her.

So we "talked" for the first ten minutes. I was kept at this time solely by curiosity and excitement: what is happening and what can I do about it?

Somehow, gradually, Sasha began to focus on instructions and showed her complete intellectual integrity, although the level of development of her cognitive abilities turned out to be rather low.

She did all this, remaining in a constant chaotic movement, balancing on the same line between complete ignorance and passive resistance.

What was surprising for me was that after working with her I did not feel tired at all (it took us more than an hour). Sasha, on the other hand, looked tired and exhausted (I must say, fatigue was very good for her - she somehow stopped constantly moving and became like a child with whom you can just talk or play).

Of course, I agreed to work with her. At first, my mother was interested exclusively in developing activities, which was understandable, since only the ghost of the inexorably approaching school forced her to somehow take care of the girl: “I saw before that not everything is normal, but just I couldn't do it, but before school I still need to …”.

At least, I was pleased with some adequacy of the mother in assessing the situation. However, further work showed that my presence in the room where Sasha was brought was for her the only significant factor: unusual, threatening and attractive at the same time. Without a doubt, I was the only figure for her who collected all her attention and energy, and intellectual tasks remained only a dim distant background. Realizing that further work in this direction without proper therapeutic sessions would be extremely ineffective, I offered my mother these sessions for Sasha. The first session was conducted with my mother. Neither mom nor girl was happy about this, but I was interested in it.

By this time, I had already managed to get to know my mother better, and I knew that she was perfectly aware of the huge distance between herself and her daughter, but was not ready to approach (“if she grows up like me, she will feel like a fool”). It was important for me to understand how this destroys their interaction and whether it is worth working with it now or postponing until better times.

I had the feeling that I had invited two people, barely known to each other, who now feel rather strained and awkward. Sasha had a strong anxiety, a need for safety and support, which her mother skillfully ignored, which was not surprising, since her mother's need for support was almost higher than Sasha's.

They turned exclusively to me. An agreement was concluded with my mother on therapeutic work with Sasha, while maintaining developmental classes with an intensity of 2 times a week.

Mum was offered individual therapy. I will make a reservation right away that I offered the first joint lesson after this only a year later, which caused my mother to have a fit of horror.

Actually 1 session with Sasha was actually our acquaintance. Before this lesson, I structured, and I kept the girl in this structure. Here all my attempts to appeal to her inner world of feelings and desires met with strong resistance. Although this could be called resistance only theoretically, because in fact it was a continuous aimless movement, flow, flight. She slid constantly, stopping at nothing. Her desires were unformed and unclear, she practically did not contact me, she did not answer my questions and replies. The only thing that somehow kept her was the offered sheet of paper. She drew, and I was present. My presence and "empathic listening" were (and have remained for many sessions) my only technique. The first was a mobile home. It was not just a car, but a "house on wheels". Then a man and a woman appeared, and with them hostility, sadness, loneliness (Sasha's parents divorced several years ago). She was not in this picture. She fiddled with them for a long time: she washed something, corrected, painted on. As a result, their figures and especially their faces turned into something worn out and shapeless. After she "finished" with her parents, the queen appeared (already on another sheet).

Here, in my opinion, for the first time, Sasha noticed my presence and asked me to turn away. The girl reacted quite definitely to my attempts to invite her to take care of her boundaries, and the meaning boiled down to the following: “I have absolutely no idea what you are talking about! I want to draw a queen, not learn to hide. I was glad that she realized at least some need for me and turned her into a request. Now I turned away when she drew, and turned when she considered some object to be perfected. I was also asked to guess what she had drawn, but it was boring for me, and she had to explain it herself. The essence of her drawing boiled down to the fact that the queen needs comfort and wants to keep warm.

The result of my questions, how this relates to her life and how the queen could warm herself, was the sun in the picture. With that, I decided that it was enough for the first time, and we were done.

My clearest feeling after the session was anxiety for Sasha. All her behavior: constant slipping, painful feelings and tension of needs, bodily fracture, some kind of inconvenience, "inversion" of movements caused a strong desire to hold and calm her. Explicit psychotic tendencies were alarming. At the same time, her deflection, reluctance to get in touch with her experiences, ignorance of my support caused some confusion in me as a therapist. I didn’t understand well how I could work with her if the only thing the client was ready to accept from me was my presence. My anxiety drove me to do as much as possible and as soon as possible, but Sasha has her own pace and meaning, and I have no choice but to adjust to her, just following her into her country of loneliness and sadness.

Sasha came to the next session in a state of extreme fatigue: red eyes, constant yawning, unfocused gaze. The nanny wanted to take the girl home, but she resisted, and we agreed that we would work as long as Sasha wanted it. The first two-thirds of the session Sasha was nesting, talking about something (not to me, but just out loud), crying (“I'm not crying, just tears are flowing”).

And I, in my opinion, was just by her side, periodically, of course, referring to her needs: what do you want? How would you be more comfortable? Sasha gradually became more and more calm.

Then I fell asleep and slept for about 20 minutes. When I woke up, the posture and movements were calm, measured, relaxed. Sasha got up and left in silence.

In the evening of that day, Sasha developed a high fever and lasted for three days without other symptoms. The alarmed mother examined the girl by a neurologist (Sasha is registered with increased intracranial pressure) and it turned out that the pressure had dropped significantly. I still don't know if this is related to our work, but the last lesson seemed very important to me, and sleepiness was not accidental. The first time I saw how Sasha took care of herself: she hid her face, pulled up a chair, brought a jacket, looked for a pose. The first time I saw her calm. I would say - reassured. Perhaps my presence and support created that safe space for her, in Cahors she was able to turn to herself. I fully admit that her meeting with herself could be a shock for her.

And my anxiety transformed into a feeling of lack of comfort. It was when I was working with Sasha that it seemed to me that my office was small, uncomfortable, uncomfortable, there were few toys in it, etc.

Now I think that my concern for her and the desire to take care was much more than she was willing to accept. Then it was at the level of experiences, quite strong and unclear, quickly replacing each other. (Apparently, the need to comprehend them gave rise to my notes after each session, thanks to which I can now recreate our entire path in sufficient detail).

The next two sessions are a trip to her country. A girl on bare ground ("This is land. There is nothing on it. And this is a girl.") Then a figure of desires appeared. Not as a specific desire, but as a desire for the fulfillment of desires. A flower has grown on the bare ground - a seven-flower. Then the car in which she lives appeared. This time it was a car, not a motor home. The car with her was on the left of the sheet, and mom and dad were on the right. Then they disappeared (Sasha erased them), and my mother ended up with her daughter in the car (here I had to take her word for it, because neither the girl nor the mother was visible, and Sasha insisted on this). I had the feeling that Sasha was telling me his story. Tries the ground under our feet in our relationship. At the end of the session, I made a piece of land for the flower of desires where it could take root. By the next session, it sprouted. The theme of death appeared: first - the black sun - "cold, dark". Then the girl who wants to die.

Then - the river and drowned people. Now it seems to me that it was a symbolic murder of those who left her. There was a sense of her directed energy. As if a spring had spilled out of the ground, out through the stones. The first time she accepted my support, drawing, she sat down on my knees. Immediately after this, real aggression appeared in our space - like a senseless occupation: attempts to seize my things, paint on paper. I was pleased with this movement that appeared, because it was directed towards me.

Before that, Sasha had rarely spoken to me. She sometimes answered my questions, suggestions, remarks and actions with changes in behavior, in drawing, almost never with words.

There was practically no interaction. Apparently, my presence and support were the necessary condition that allowed the girl to get closer to her feelings and desires.

Most likely, such a supportive presence was a completely new experience for Sasha, and she simply did not know how to handle it. On the other hand, I was a little worried about the affectivity and vagueness of her aspirations. I assumed that I would need a lot of art to defend my territory in contact with it and at the same time provide much-needed support to it.

I was surprised that despite the anxiety for her and a very strong personal response, I felt very natural with Sasha. Sometimes it seemed to me that I was doing or allowing some strange things that it is not clear whether it can be called therapy. But at the same time, the calm confidence in the fidelity of what I was doing did not leave me. I felt her well, her nervous deflexing style no longer confused and annoyed me, I stopped thinking about what techniques I could use, I was guided more by my own desires-unwillingness in our contact.

Sasha started the next session with plasticine. I was gladdened by her growing activity in taking care of herself. She began to better understand what she wants and from whom. A house appeared from plasticine.

In the house lived a girl named Zhenya (a purely symbolic character) with her dad. Zhenya is an outcast child with a black face. She was very bad, and therefore Sasha and dad drove her away.

Zhenya simply disappeared, then reappeared, and Sasha again and again returned to the situation of rejection. It seemed to me important that open, aggressive rejection, which at this session first appeared as a figure of relations between real people: Sasha and his dad, albeit in a symbolic field. At the end of the session, Sasha somehow calmed down, stopped, thought, and said: "We need to blind mom."

I am no longer making a reservation that none of my attempts to translate the action into a layer of real relationships and similar "therapeutic" moves have not been crowned with success.

Sasha did it herself when she was ready and did not accept any violence against herself, even in the form of offers.

Throughout the next session, we sculpted a house for the family: sofas, armchairs. The family was whole. I was pleased with this resurrection of the desire to be together. Sasha often did not succeed, she was generally deprived then of that leisurely accuracy of movements, which was required by her planned work. I wanted to help her, but she did not ask, and then I myself offered her help.

She accepted it very willingly, and then we sculpted the house together. Immediately after the session, it seemed to me again that I had too few toys, so Sasha could not play something, and instead tried to do what she needed to play. But after some time, it became clear that it was our first experience of joint action and my activity in this that turned out to be extremely important for Sasha, since compatibility was for her the next step beyond her experience. And yet, it seems that in our sessions Sasha learned not only how to use the people around him for his own good, but also some elementary instrumental and social skills. The next session began with the same plasticine.

But Sasha somehow very quickly lost interest in this, and began ordering me what to do. I said that it was unpleasant for me - she began to ask. I didn't want to sculpt anything - Sasha was not turned on. I understood that the main thing now is what is happening between us. I suspected that her movement towards me could take the form of suppression or capture, and now Sasha was clearly demonstrating those familiar patterns that she "learned" in family interaction. My task was to frustrate this process, but to do it in such a way that it was bearable for Sasha. I was very unsure of her resources, I just said that I didn’t want to do it alone, and I didn’t. She burst into tears, wanted to leave.

But she did not leave, but began to nest. She wanted to make herself a comfortable rookery where she could hide, a rookery - a burrow. Having built it, at first she really hid, but this did not last long. With my complete passivity, Sasha had to look for ways of addressing herself, and the voice became this way. She called herself not Sasha, but the invisible, the "golden invisibility", which showed a very clear, clear, melodic voice, which I had never heard from Sasha (now, after three years, Sasha is studying music at school, sings beautifully and dancing). This was a new stage in our relationship. The precontact phase was finally passed. This path required 7 therapy sessions and 10 developmental meetings!

My assumption after this session was that during the interaction Sasha got too close to me, and, apparently, such a distance was very disturbing and unsafe for her, Sasha felt too defenseless. But she didn’t know any other way to take care of her boundaries, besides orders or physical leaving. In the next session, there was a need for tactile contact, which Sasha tried to formalize and implement as a game manipulation (let's play masseuse). Perhaps the massage, which she recently started going to, turned out to be the first pleasant form of body contact.

Testing for admission to our school took place next week. According to the results, Sasha was admitted to the 1st grade. After that, the last session before the holidays took place.

On it, Sasha mastered and acted out her anxieties associated with a new role: fear of failure, insecurity, the need for trust from her mother.

The result and the testing process, during which Sasha demonstrated not only a higher level of development of cognitive abilities, but also, most importantly, the ability to work together in business communication and the ability to accept a cognitive task, as well as the final session, at which it became clear that Sasha had started to worry about the problems associated with her social, and not only her inner life, the fact that she was able to find out and realize very specific actual needs in our contact was for me confirmation that the first stage of our work was completed. At this stage, 10 therapeutic and 15 developmental sessions were carried out over 4 months. Our work was renewed in the fall. Sasha still preferred to move exclusively on her own, accepting (and now demanding!) Escort from me. The only thing that I managed to achieve was the words "No, I don't want to!" instead of the usual default ignore, although this was rare. It became possible to use some techniques, but only those that she proposed (a technique I call a certain agreement in relation to actions: let me do this, and you do so). For example, she invented the technique of a kind of "mirror" in drawing and modeling. The bottom line is that first I repeat after her what she does, and then she repeats after me. As a result, two very similar and still different jobs appear, in which all the advantages and safety of a healthy fusion are manifested: community while maintaining and individuality. We have used this technique over several sessions. In fact, it was a whole stage of work associated with self-acceptance. The experience of repetition after her was completely new for Sasha. She experienced great difficulty in building any lasting relationships with people - no matter how big or small. And of course, she simply did not have the experience of imitation. Mom was annoyed and frightened if she noticed in Sasha something that resembled herself, and for children Sasha was not so popular that someone would like to be like her. At some point I again had to defend my dignity and space because Sasha's rapprochement was swift and aggressive, but this time she did not burst into tears, but thought and left - for the second and last time she left herself, without me being sent off at the end of the session. After that, she began to notice and recognize me as a living equal partner and stopped so stoically defending herself against my activity.

The drawing process itself has acquired meaning and slowness. Her drawings have changed, they have become much neater and clearer. At first, it was the moment of similarity that was extremely important for Sasha. She tried to achieve it literally in every little detail (and tried to get it from me!), And was terribly angry and upset when, for example, the width of the trunk of a tree did not match. Over time, she not only resigned herself to the inevitability of differences, but also began to enjoy this game of simultaneous similarity - dissimilarity of works ("they are like sisters").

After that, she decided to work through such a painful experience as rejection of herself. This was perhaps the most intense and affectively charged session of ours.

Only at the very end, I exhaled with relief when Sasha went up to the tortured, beaten and discarded cat and stroked it goodbye. After this session, the teacher began to notice Sasha's uncharacteristic manifestations of warmth and affection for other people.

For several more sessions I drew after Sasha, and she tried to come to terms with the existence of my needs for our merging, gradually allowing me to do what she did, without repeating - we drew princesses, each one of our own. When she decided to erase her "for imperfection", I felt sorry for her, and I left her. At the first moment, Sasha was simply outraged by such a betrayal on my part, but in the next session, starting at some point in the habitually-angrily erasing the princess's face, she stopped, thought a little, carefully drew her eyes and mouth and asked to leave her drawing until our next meeting. (we drew on the blackboard in my office). After that, at the next session, Sasha herself first started talking about her desire to be friends with the guys, and she was even ready to take the first conscious step towards them (of course, so far in her aggressively mocking manner). This was the next stage of our work, at which she was able to speak out and play out her feeling of uselessness in a relationship, the constant fear that she would be forgotten, abandoned, "left without her." At this stage, she had her first real friend: a girl from the class.

At the same time, Sasha somehow changed very quickly and noticeably - she grew up, became prettier, her movements became more confident and flexible, her vzglzd became conscious and open.

We worked with Sasha for a total of almost two years. During this time, not only Sasha has changed, but also her mother's attitude towards her. We worked with my mother sporadically, for 5-6 sessions, she was afraid to turn on more, fearing a "breakdown" (several years ago she had a period when she could not work for six months and spent a month in a neurosis clinic - now she was afraid of repetition and called me only in moments of complete despair and hopelessness).

Now Sasha is finishing the third grade of the school of developmental education, according to her academic performance and at the end of the list she got almost to the middle, she sings and dances with pleasure, she has two bosom friends and she is quite happy with life. Sometimes she finds me at school and asks me to study, we meet several times and she disappears for a couple of months.

Mom stopped worrying that Sasha was becoming more and more like her and, like all ordinary mothers, she was worried about the top three in mathematics. Everyone forgot that Sasha was supposed to go to an auxiliary school. This was the first time a child of 6-7 years old had such vivid narcissistic tendencies, which showed me how the very presence of another person (in this case, a therapist) can be unbearable. for a child accustomed to episodic and frightening figures. It took Sasha 3 and a half months and a total of 17 (!) Meetings to move from precontact to actual interaction, and almost another year of therapy for me and the relationship with me to cease to be the main figure in our contact, to survive the fear of their own disappearance, when another appears, in order not only to withstand the simultaneous existence of two people, but also to receive support and joy in this contact, and to use, finally, other people for their own good, not instrumentally, but humanly.

In my impression, the main factor frustrating pathological tendencies was my presence. I made every effort not to join any of its parts: neither to the strong nor to the weak, but simply to be present with some integrity of my own (I will say right away, this was very difficult, since Sasha still does not leave attempts to subdue or obey).

On the one hand, it is a little offensive that all my art as a therapist was reduced to the maximum replacement of an absent mother, and on the other hand, this was one of the most interesting cases in my practice.