City Research Online City, University of London Institutional Repository Citation: Camm, E.M (2009). Narcissistic Vulnerabilities Experienced within the Processes of Change and Development. (Unpublished Doctoral thesis, City, University of London) This is the accepted version of the paper. This version of the publication may differ from the final published version. Permanent repository link: https://openaccess.city.ac.uk/id/eprint/17550/ Link to published version: Copyright: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. Reuse: Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. City Research Online: http://openaccess.city.ac.uk/ [email protected] Narcissistic Vulnerabilities Experienced within the Processes of Change and Development. OUROBOROS Author: Elizabeth Meg Camm Thesis submitted in partial fulfilment of the requirements for the award of Doctorate in Counselling Psychology At City University Department of Psychology (School of Social Sciences) Date of submission: October 2009 1 TABLE OF CONTENTS 2 - 8 Acknowledgements 9 Declaration of powers of discretion 10 Foreword 11 SECTION A: PREFACE 14 REFERENCES 21 SECTION B: CASE STUDY 23 Title: Narcissistic Defenses within the Therapeutic Relationship List of abbreviations 23 1. INTRODUCTION 24 1.1 Theoretical Orientation 24 1.2 Context for the work 28 1.3 Referral 28 1.4 Convening the first session 28 1.5 Assessment & formulation 32 1.6 In Summary: Motivation for using the DSM-1V-RT 34 1.7 Contract & Treatment Issues 36 2. DEVELOPMENT OF SESSIONS 36 2.1 Engagement 40 2.2 Making use of Supervision 40 2.3 Integrative Work 42 3. CONCLUSIONS 45 3.1 Learning about myself during Phil‘s therapy 45 4. REFERENCES 47 5. APPENDICES 50 B1: CBT assessment 50 B2: CAT information 52 B3: Genogram 53 B4: Provisional Psychoanalytic formulation 54 2 B5: DSM-1V-RT Diagnostic criteria for Narcissistic Personality Disorder 56 B6: CAT diagram 57 SECTION C: CRITICAL LITERATURE REVIEW 58 Title: Counter-transference: Narcissistic Vulnerabilities in the Therapeutic Milieu List of abbreviations 59 1. INTRODUCTION: 60 1.1 Trainee and Therapists‘ Emotions 60 1.2 Aims of Critical Literature Review 61 2. CRITIQUE OF LITERATURE 62 2.1. Historical developments and problems in defining CT 63 2.2. Integrative Model of CT 64 2.3. CT as a Prototype 66 2.4. Organizational Anxieties 67 2.5. Group Work and Facilitator Narcissism 70 2.6. Trainee Status and the Wounded Healer 71 2.7. Supervision and Personal Therapy 73 3. SUMMARY 74 4. CONCLUSION 75 4.1. Recommendations 76 5. REFERENCES 79 79 6. APPENDICES C1 University Programme Standards & Student Competencies 84 3 SECTION D: RESEARCH STUDY 87 Title: Behind The Mask: Women’s Mid-life Experiences of Facial Ageing Followed by Facial Rejuvenation Cosmetic Surgery. An Interpretative Phenomenological Analysis. List of abbreviations 88 Abstract 89 Reflexivity 93 CHAPTER 1: 94 1. 1 BACKGROUND 94 1.1 .1 Development of Consecutive Generation Studies 97 1.1.2 First Generation: 1950‘s – 1960‘s 97 1.1.3 Second Generation: 1970‘s – 1990‘s 98 1.1.4 Where We Are Now: 2000 and Onwards 100 1.1.5 Summary 103 1.2 WOMEN AND FACIAL AGEING 104 1.2.1 The Ageing Face 104 1.2.2 Socio-cultural Aspects 105 1.2.3 Ambiguities towards Facial Ageing and Rejuvenation 106 1.3 MOTHERS AND DAUGHTERS 109 1.3.1 1950‘s Mother 109 1.3.2 Growing up with Mother 110 1.3.3 Adult Mothers and Daughters 112 1.4 SELF, IDENTITY & THE REFLECTING MIRROR OF SOCIETY 113 1.4.1 Metaphors of the Mirror 115 1.5 SELF-CONSCIOUS EMOTIONS 117 1.5.1 Different Attributions of Narcissism 118 1.5.2 Research into the Area of Self-conscious Emotions 119 4 1.5.3 Origins of Appearance Related Shame-anxiety 121 1.5.4 Anxiety as a Basic Emotion and Interaction with Specific Self-conscious Emotions 121 1.6 SHAME 123 1.6.1 Shame, Pride and Shame Cycle 125 1.7 SUMMARY 127 1.8. REFLEXIVITY: Where it all started 129 CHAPTER 2: METHODOLOGY 131 2.1 RESEARCH PURPOSE AND DESIGN 131 2.1.1 Research objectives 131 2.2 REFLEXIVITY ON RESEARCH QUESTIONS 131 2.3 RATIONALE FOR A QUALITATIVE STUDY 132 2.4 EPISTEMOLOGICAL CONSIDERATIONS UNDERPINNING QUALITATIVE RESEARCH 132 2.5 COMPARISONS BETWEEN METHODOLOGICAL APPROACHES 134 2.6 OVERVIEW OF IPA 135 2.7 PARTICIPANTS 136 2.7.1 Recruitment 138 2.7.2 Table: Demographics of Participants 139 2.8 ETHICAL CONSIDERATIONS 140 2.9 PROCEDURES 141 2.9.1 Interviewing strategies and techniques 141 2.9.2 Transcribing and Analysis 144 2.9.3 Summary table of integrated themes of all Participants (5th stage) 146 2.10 REFLEXIVITY 149 CHAPTER 3: ANALYSIS 150 3. INTRODUCTION 150 3.1. TEMPORAL EXPERIENCES OF FACIAL AGEING FOLLOWED BY FRCS AND/OR NON-INVASIVE PROCEDURES 150 5 3.1.1 Contemplation 151 3.1.2 Peri-operative period 155 3.1.3 Euphoric and proud 159 3.1.4 Repeats and reflections 161 3.2 MOTHER, SELF AND FACIAL APPEARANCE 163 3.2.1 1950‘s Mother and her Facial Grooming 164 3.2.2 Intergenerational Appearance Concern Messages 166 3.2.3 Developmental Influences and Appearance Concerns 168 3.2.4 Ambivalent Relationship with Mother Regarding Perceptions of their own Facial Appearance 172 3.2 THE CYCLICAL NATURE OF SHAME, PRIDE (VANITY) AND SHAME 177 3.3.1 The double-edged sword of pride (vanity) and shame 178 3.3.2 Hiding shame for pride‘s (vanity‘s) sake 179 3.3.3 Roots of shame 181 3.3.4 Narcissism: Self-absorbing or Self-individualizing 183 3.4 SUMMARY 188 3.5 REFLEXIVITY 189 CHAPTER 4: DISCUSSION 190 4. INTRODUCTION 190 4.1 Brief Overview 190 4.1.1 Diagram of the Relationships between Super-ordinate themes 192 4.1.2 Temporal experiences of facial ageing; FRCS; and non-invasive procedures 193 4.1.3 Self, mother and facial appearance 193 4.1.4 The cyclical nature of shame, pride (vanity) and shame 193 4.1.5 6 4.2 TEMPORAL EXPERIENCES OF FACIAL AGEING FOLLOWED BY FRCS AND/OR NON-INVASIVE PROCEDURES 194 4.2.1 Coping with age related transitions 194 4.2.2 Role of anxiety and denial: peri- and post-operatively and, or, Procedures 197 4.2.3 Results, repeats and ambiguity 200 4.3 SELF, MOTHER AND FACIAL APPEARANCE 204 4.3.1 Growing up with mother 204 4.3.2 Developmental influences and appearance 206 4.3.3 Ambivalent relationship with mother 208 4.4 THE CYCLICAL NATURE OF SHAME, PRIDE (VANITY) AND SHAME 212 4.4.1 The double edged sword of vanity and shame 212 4.4.2 Hiding pride and shame 214 4.4.3 Roots of shame 217 4.4.4 Narcissism: self-absorbing and Self-individualizing 219 4.5 CONCLUSION 222 4.6 REFLEXIVITY 225 CHAPTER 5: VALIDITY, LIMITATIONS, BUILDING-ON THIS RESEARCH AND RELEVANCE TO COUNSELLING PSYCHOLOGY 226 5.1 VALIDITY 226 5.1.1. Sensitivity to context 227 5.1.2 Commitment and rigour 228 5.1.3 Coherence and transparency 228 5.1.4 Impact and importance 229 5.2 LIMITATIONS OF RESEARCH 229 5.2.1 Role of language 229 5.2.2 Suitability of accounts 231 7 5.2.3 Explanation versus description 232 5.3 BUILDING-ON THIS RESEARCH 233 5.4 RELEVANCE FOR COUNSELLING PSYCHOLOGY 234 5.5 FINAL REFLEXIVITY 237 5.6 REFERENCES 238 5.7 APPENDICES D1: Information Sheet 251 D2: Consent form 254 D3: Details and Definitions on Facelift Surgical Procedures and Non-invasive Rejuvenation procedures 255 D4: Ethics Release Form 264 D5: SA & UK web site directories for psychologists 267 D6: Semi-structured Interview Questions and Prompts: Face-to-face and e-mail format 268 D7: Debriefing Sheet 271 D8: Table of sample of unsorted themes for the 6 participants 272 D10: Table of Narcissistic Characteristics 276 8 City, University of London Northampton Square London EC1V 0HB United Kingdom T +44 (0)20 7040 5060 THE FOLLOWING PARTS OF THIS THESIS HAVE BEEN REDACTED FOR COPYRIGHT REASONS: D3: Details and Definitions on Facelift Surgical Procedures and Non-invasive Rejuvenation procedures Pg.255 -264 www.city.ac.uk Academic excellence for business and the professions ACKNOWLEDGEMENTS I would like to say thank you to all the women who took part in this research. I was humbled and inspired by their experiences of being in midlife and undergoing cosmetic surgery. Their willingness and co- operation in taking part in this research is deeply appreciated and valued. Particular thanks go to Prof. A. Widgerow for going out of his way to contact the participants who live in South Africa. His help was invaluable in giving me access to these women and their experiences of a topic that is still largely surrounded by secrecy. My thanks also go to Dr. Virginia Eatough (external supervisor) of Birkbeck College, University College London, for her assistance and support in the construction of the IPA section of the research. My thanks are also extended to Dr. Jacqui Farrants (internal supervisor) of City University who gave guidance and emotional support for the structure of the total portfolio.