I Am Indispensable.
Both were fairly strong characters and their marital relationship had always been fraught with disagreements and compromises. But they were committed to each other and worked hard at their marriage. When little Angela arrived, it surfaced Jim and Sue’s deep differences in their styles of parenting, as their family backgrounds were varied. Their arguments over Angela’s upbringing went from bad to worse, and at Sue’s insistence, they presented themselves for therapy. Sue was a family physician with her own practice, while Jim, with two doctoral degrees, was a lecturer, apart from managing his own practice too. Having spent a few days analyzing their psychological profiles from the tests they did for me earlier, Jim’s results surfaced some concerns. However, these summaries formed the bases for further exploration of their individual cognitive and behavioural issues, as well as how they interacted as a couple.
Over several sessions, as they became more comfortable in counselling and their guards were much lower, it soon became clear that their ‘mode of compromise,’ was in fact, Sue giving in to her husband on most issues in order to keep the peace. Jim’s personality traits were a major contributory factor to their fights. He was an only child of doting parents, in-laws and grandparents, and nothing he did was ever amiss. Discipline in those early years was minimal. He grew up having most things his way, and as an adult, his self-importance took centre stage in the way he conducted himself. In conversation, he ensured that you knew his remarkable academic and professional achievements, including the various important people who made up his social circle; he made sure you knew that he only had friends who had status. There was no doubt that he was specially gifted in his chosen professional field, but his sense of entitlement and need for constant admiration made him somewhat insufferable as an acquaintance. Sue had learnt to pander to his sense of privilege. When they could not agree together, he would be derogative of her or her ideas, or her friends and relatives, until she relented. When we discussed their respective ideas of bringing up children, the exchange became loud, and Jim’s behaviour turned aggressive and haughty. On several occasions, Sue would initiate a compromise solution, but Jim would not listen to her. He kept badgering and belittling her, till she was close to tears. I intervened several times to cool their tempers. He made no apologies.
Men and women who have been diagnosed with narcissistic personality disorder tend to be resistant to treatment, and would invariably be in denial of their own symptomatology. In this case, the decision was taken to not disclose Jim’s diagnosis, but to pursue his treatment on the basis of others’ experience of him. Sue’s feedback of her experience as his wife and confidante, together with my contribution, formed the basis for the lengthy treatment strategy. As a doctor, Sue was not unfamiliar with the tact that I had cautiously taken, and counselling went along with her full cooperation, in order to help Jim be more self-aware as we progressed.