Table Of ContentNARCISSISTIC
PERSONALITY
DISORDER
TOOLBOX
55 Practical Treatment Techniques for
Clients, Their Partners, & Their Children
DANIEL J. FOX
, PH.D.
Copyright © 2018 by Daniel J. Fox. Narcissistic Personality Disorder Toolbox
Published by:
PESI Publishing & Media
PESI, Inc.
3839 White Ave.
Eau Claire, WI 54703
Cover Design: Amy Rubenzer
Editing: Jenessa Jackson
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Printed in the United States of America
ISBN: 9781683731528
All rights reserved.
PESI
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& Media
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About the Author
Daniel J. Fox
, Ph.D., has been treating and specializing in the
treatment and assessment of individuals with personality disorders for over
15 years in the state and federal prison system, universities, and private
practice. He is a licensed psychologist in the state of Texas and author
of The Clinician’s Guide to The Diagnosis and Treatment of Personality
Disorders; the award winning Antisocial, Borderline, Narcissistic and
Histrionic Workbook: Treatment Strategies for Cluster B Personality
Disorders; and several articles on personality, ethics, and neurofeedback.
His specialty areas include personality disorders, ethics, burnout prevention, and emotional
intelligence. Dr. Fox has been teaching and supervising students for over 15 years at
various universities across the country, some of which include West Virginia University,
Texas A&M University, University of Houston, Sam Houston State University, and Florida
State University. He is currently a psychologist in the federal prison system, Adjunct
Assistant Professor at the University of Houston, and also maintains a private practice that
specializes in assessment and working with challenging clients.
Dr. Fox has given numerous workshops and seminars both domestically and internationally
on effective treatment of clients with personality disorders, ethics and personality disorders,
personality disorders and crime, emotional intelligence, burnout prevention, managing
mental health within the prison system, and others.
For more information on Dr. Fox go to his website: www.drdfox.com
iii
This book is dedicated to my three heartbeats:
My wife Lydia and my two children Alexandra and Sebastian
v
Table of Contents
Who this Workbook is for and How to Use it . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
SECTION 1
Treating The Client Along The Narcissistic Spectrum
Setting the Stage for Successful Treatment
• What are you doing here? Narcissists don’t seek treatment ............................ .1
• T o treat or not to treat: The distinction and overlap between narcissistic personality
disorder and antisocial personality disorder ........................................ .3
• Questionnaire to distinguish between entitlement and narcissistic personality disorder ...... .5
• Identifying mild to extreme factors of narcissistic personality disorder ................... .8
• The two faces of narcissism: overt and covert ......................................12
Addressing and Changing Maladaptive Patterns
• Identifying surface and core structures of narcissistic personality disorder ................ 19
• Identifying the motivators to give up maladaptive behaviors and beliefs .................. 22
• The intrinsic 4 and the veneer of perfectionism ..................................... 28
• Narcissistic reactions: from stress to rage .......................................... 32
• Building and breaking interpersonal connections ................ .................... 38
Digging Deeper into Motivations and Lessening Symptomatology
• Enhancing personal empowerment to lessen maladaptive narcissistic behaviors ............ 43
• Assertiveness over aggression ................................................... 49
• Lengthening the fuse to prevent explosions ........................................ 55
• Doing it differently ........................................................... 60
• Strengthening appropriate social potency .......................................... 64
Final Steps of Successful Treatment
• Conceptualizing successful treatment ................ ............................. 71
• Treatment planning for success .................................................. 74
SECTION 2
Treating The Partner of a Narcissist
Setting the Stage for Successful Treatment
• What is and what may never be and challenging foundational beliefs ............... ..... 83
• Identifying the narcissistic self-serving significant other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
• Should I stay or should I go? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
• How I (we) see it . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94
Addressing and Changing Maladaptive Patterns
• Breaking the cycle of glorifying, belittling, and abandoning . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
• Clarifying and maintaining boundaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
• Contending with gaslighting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
• Power to choose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Digging Deeper into Motivations and Lessening Symptomatology
• Becoming disconnected from the narcissist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
• 7 relationship hopes and realities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
• Want, deserve, must have . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
• No more rollercoaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
• Building on the foundational 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Final Steps
• Staying together or moving apart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
• Understanding myself and my relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
SECTION 3
Treating The Impact of Narcissistic Parents
Setting the Stage for Successful Treatment
• Narcissistic family characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
• Components of adult children of narcissists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
• The family of my dreams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Addressing and Changing Maladaptive Patterns
• Avoiding “the family crucible” trap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
• Self-definition beyond narcissistic parenting pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
• A duck in the rain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Digging Deeper into Motivations and Lessening Symptomatology
• Overcoming the 7 pains of narcissistic pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
• Overcoming the destructive inner narcissistic family member . . . . . . . . . . . . . . . . . . . . . . . . . 176
• Differentiation of child from parent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
• Parenting differently . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Final Steps
• The family dynamic influencers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
• Therapeutic milestones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Who this Workbook is
for and How to Use it
Narcissism is a treatable condition, whether in a client, as a part of a relationship, or as a family
dynamic. Many clinicians feel frustrated and overwhelmed when working with individuals along the
narcissistic spectrum, their partners, and with children of narcissistic parents. This workbook is designed
to help clinicians assist clients to grow out of the hurt and pain associated with narcissism. Many times
these issues feel irreversible, but the truth is that with the right treatments and interventions, changes
can be made that move the client, their partners, and their children away from the impact of narcissistic
pathology toward healthier and more adaptive functioning.
The worksheets, exercises, and activities in this workbook are specifically designed to help
clinicians successfully work with clients along the narcissistic spectrum, partners in a relationship
with an individual along the narcissistic spectrum, and/or children of a parent/caregiver along the
narcissistic spectrum. Within each client type section (individual, partner, or child) is a specific four-
part sequence that is influential when working with individuals with personality disorders – in this case,
narcissistic personality disorder or an individual along the narcissistic spectrum. The first part of each
section sets the stage for successful treatment, which involves identifying the issues and concerns that
are present.
The second section involves addressing and changing maladaptive behavior patterns that keep clients
stuck in narcissistic pathology or cause them to remain in a narcissistically influenced relationship with a
partner or parent. The third part of each section digs deeper into what motivates clients to continue their
narcissistic behavior or to remain in a relationship with an individual along the narcissistic spectrum
(this includes children with narcissistic parents). The fourth and final part of each section is composed
of steps to finalize successful treatment after reducing the impact of narcissistic pathology by helping
clients make better choices for themselves.
THE APPROACH TO THE NARCISSISTIC SPECTRUM AND NPD IN THIS WORKBOOK
In this workbook, the term “along the narcissistic spectrum” will be used to include individuals who
exhibit narcissistic traits in varying degrees, as well those who meet criteria for narcissistic personality
disorder (NPD).
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