APRESENTAÇÃO

DE APOIO

TRATAMENTO DOS
TRANSTORNOS DE
PERSONALIDADE
 Professores
WENDY BEHARY
Professora Convidada
Wendy é psicóloga especialista em tratar narcisistas e as
pessoas que convivem com eles. Ela faz clínica, treina profissionais e
supervisiona psicoterapeutas há décadas. Também é a fundadora e
diretora do Centro de Terapia Cognitiva de Nova Jersey e dos
Institutos de Terapia de Esquema de NJ-NYC-DC, nos Estados
Unidos. Bolsista-fundadora e supervisora-consultora da Academia de
Terapia Cognitiva (Instituto Aaron T. Beck), Wendy atuou como
presidente do Conselho Executivo da Sociedade Internacional de
Esquema Terapêutica (ISST) e também trabalhou como
coordenadora de treinamento e certificação do Conselho Executivo
do ISST. Atualmente, é presidente do Subcomitê de Programas de
Desenvolvimento de Esquemas Terapêuticos para o ISST. Wendy
ainda é autora do best-seller internacional, “Disarming the narcissist:
surviving and thriving with the self-absorbed”, que na sua 2ª edição já
foi traduzido para 12 idiomas. Também é coautora de vários capítulos
e artigos sobre Schema Therapy e Cognitive Therapy.
DANIELA DI GIORGIO SCHNEIDER
Professora PUCRS
Possui graduação em Psicologia pela Pontifícia Universidade
Católica do Rio Grande do Sul (2001), Mestrado em Psicologia
pela Universidade Federal do Rio Grande do Sul (2005) e
Doutorado em Psicologia pela Universidade Federal do Rio
Grande do Sul (2008), com Pós-doutorado em Psicologia pela
Universidade Estadual de Londrina (2016). Leciona em cursos de
especialização e formação em Terapia Cognitivo-Comportamental
e Terapia de Esquemas em diversas regiões do Brasil. Atualmente
ministra a disciplina de “Terapia Cognitivo-Comportamental para
os Transtornos da Personalidade” na Especialização em Terapia
Cognitivo-Comportamental da PUCRS e é uma das supervisoras
do atendimento em terapia cognitivo-comportamental na
Especialização em Terapia Cognitivo-Comportamental do INTCC.
Tem experiência na área de psicologia clínica e pesquisa, com
ênfase em Psicoterapia Cognitivo-Comportamental e Terapia de
Esquemas.
 Ementa da disciplina
Estudo de modelos cognitivo-comportamentais para o entendimento e
tratamento dos transtornos da personalidade, com ênfase no modelo da Terapia do
Esquema. Caracterização da avaliação, elaboração de plano de tratamento e principais
intervenções usadas com esta população.
Schema Therapy for Narcissism

Wendy T. Behary, Author/Expert

“Disarming the Narcissist”
Past President, International Society of Schema Therapy
(ISST, 2010-2014)
A Parallel Process
Scene from a Movie…
“Malice”
 When Triggered by the Narcissist

Permit Give In Avoid

Passive-
Compete Aggressively
Punish
 NPD: Early Maladaptive Schemas
➢ Abandonment
➢ Mistrust & Abuse
➢ Emotional Deprivation
➢ Dependence
➢ Vulnerability
➢ Enmeshment
➢ Defectiveness/Shame
➢ Social Isolation
➢ Approval-Seeking
➢ Failure
➢ Subjugation
➢ Self-Sacrifice
➢ Unrelenting Standards
➢ Negativity
➢ Entitlement-Grandiose
➢ Insufficient Self-Control
➢ Emotional Inhibition
➢ Punitiveness
 Narcissism and “Echoism”

Agentic traits pertain to self- Agentic/Communal Integration

assertion and independence,
(while Communal traits pertain to
concern for others and
interpersonal sensitivity)
Narcissism = exaggerated agentic
traits (can include achievement
for the good of others – healthy
narcissism)
Echoism = silencing of one’s
needs/voice; overfocus on the
needs of others to avoid guilt and
appearing narcissistic (Craig Malkin)
 Grandiosity
Grandiose Narcissism is
characterized by
extraversion, low
neuroticism, and overt
expressions of feelings
of superiority and
entitlement.
 Vulnerable (Covert)
Narcissist

Vulnerable narcissism reflects

introversive self-absorbedness,
high neuroticism,
hypersensitivity even to gentle
criticism, and a constant need
for reassurance
 Biology and Neurobiology Play a Role

Speculations:

Temperament Higher Impulsivity

and
Environment Higher Sensitivity

Lower Capacity for Frustration Tolerance

Diffusion Tensor Imaging
“One primary characteristic of narcissists is that they exude a sense of
confidence. However, the brain activity of these persons is inconsistent
with their appearance. At a neural level, narcissists appear needy and
insecure. Chester, et al. used a method of measuring brain activity called
diffusion tensor imaging that measures the amount of connected activity
between different brain areas. Such scans produce more accurate wiring
diagrams of the brain, in contrast to structural magnetic resonance
imaging (MRI) scans that show the brain’s gray matter, and functional MRI
scans (fMRI) that measure overall neural activity.
Higher narcissism scores were associated with lower connectivity between
certain brain areas. These areas are associated with the ability to think
positively about oneself and thus low activity in these areas may prompt
NPD individuals to repeatedly seek out affirmation from others. This is
consistent with theories that narcissists have difficulty understanding their
own self-concept and may have low implicit self-esteem underneath an
entitled, seemingly confident, and arrogant presentation.”

https://www.imedpub.com/articles/the-cognitive-neuroscience-of-narcissism.php?aid=22149
The Cognitive Neuroscience of Narcissism
George FR1,2* and Short D1,3
Need for A Highly Effective Approach
when Dealing with the Difficult Issues
of Narcissism in the Treatment Room!
Informed by
Schema Therapy
3rd
Edition,
Now Available!
 ➢ Insufficient Limits

➢ Used or Manipulated

➢ Conditional Approval & Hypercriticalness

Origins of
Narcissism ➢ Rejection & Social Exclusion

➢ Loneliness & Isolation

Unmet Childhood Needs
in Narcissism
➢ Unconditional Love & Attention

➢ Holding, Nurturance & Affection

➢ Acceptance & Praise

➢ Empathy & Understanding

➢ Realistic Limits

➢ Trust
 Innate Child

4 Types of Maladaptive Coping

(Schema)
Modes Internalized Caregiver

Healthy Adult/ “Good Parent”

 Specific Schema Modes in Narcissism

➢Lonely/Shamed Child Mode

➢Impulsive Child
➢Overcompensating Mode
➢Detached Self Stimulating Mode
➢Demanding Critic
➢Healthy Adult
 ➢Isolated, unloved, alone, rejected:
feels “average”, not special, empty,
socially unacceptable

Lonely/Shamed
Child Mode
➢Triggered by loss of validation and
special status, and by absence of
distraction or stimulation
 ➢Easily frustrated, impatient,
and inconsolable, prone to
outbursts and high
reactivity.

Impulsive ➢Triggered by absence of

Frustrated Child getting what they want
when they want it; having to
“wait”; hard-to-reach
challenges; lack of
stimulating satiation; lack of
immediate support and
gratification.
 ➢Superior, Entitled,
Arrogant, Show Off;
Overcompensates for
Lonely/Shamed Child
Overcompensating ➢Also shows up as:
Mode Competitive, Status-
Seeking, Self-Aggrandizing,
Bullying, Critical of others,
Non-empathic, Envious…
 ➢Cuts off access to painful
emotions and seeks to avoid
Detached Self- triggering the Lonely Child
Soother / Self- Mode.
➢Examples: Excessive Work,
Stimulator Mode Compulsive Sexual
Distractions, Spending,
Gambling … Solitary
Interests
Usually triggered when alone,
in the absence of immediate
sources of validation
 Internalized messages from a significant caregiver;
demands extraordinary performance,
high/unrelenting standards.

The
Demanding
Critic Mode “Your worth is your work”

“You have to prove/earn

your value”
 Under limited conditions:

➢Can (genuinely) Show

Vulnerability; Express
Empathy and Accountability;
The Healthy Adult Demonstrate Reciprocity.

➢Mostly shows up in high-

functioning work, academic,
and athletic performance
 Relationships are experienced primarily as
sources of approval and validation. Approval
becomes a substitute for nurturance

Narcissists in
Intimate Limited empathy
Relationships
(1)
Feels frequent envy because, when
someone else receives approval, narcissist
feels as if attention (“nurturance”) has been
taken away from him
Narcissists in
Intimate Relationships (2)
➢The love object is often
idealized initially because, by
gaining approval from a
perfect person or partner,
their value feels heightened
(compensation for
Defectiveness)
➢The partner is devalued
gradually during course of
relationship
 Not Enough LEVERAGE
Some
Obstacles In Many deny they have any internal
psychological problems
Treating
Narcissism (1) Rarely report painful emotions or
thoughts

Direct CBT attempts to challenge

entitlement usually fail
 Refusal to do homework or
exercises

Some
Obstacles In Desire to control treatment &
maintain one-up position relative
Treating to the therapist
Narcissism (2)
Therapist’s schemas are triggered
& usually impede progress
Meeting Core Needs

Correcting Biased
Emotional Experiences
The Therapy A Fundamental Strategy for
Adaptive Re-Parenting
Relationship
& Re-Scripting
 ESSENTIAL ELEMENT

Empathy
(The Golden Nugget)
“Stepping into the skin of another”
Disarming the Narcissist, Wendy Behary
EMPATHY Identification with or
vicarious experiencing
of the feelings,
thoughts, or attitudes
of another

Mirroring People: The Science of

Empathy
and How We Connect with Others,
Marco Iacoboni
Harnessing Realness

➢Anticipate Activating Events

➢Use of the PAUSE Strategy

 Working With
Detached and
Overcompensating Modes
Empathic Confrontation to address
Avoidance, Hold Accountable, and Set Limits
 ➢Therapist’s Posture: “Sensing the
Story” – Differentiating the Past
from the Present.
Empathic ➢Linking and Labeling Maladaptive
Confrontation Reactions and Self-Defeating
Patterns.
➢Understand and Hold Accountable