September Video of the Month
Written by: Taylor Watson
Timeless Presentations from Erickson Foundation Events
This ongoing series highlights keynotes, workshops, and dialogues from past Erickson Foundation conferences, showcasing influential voices in psychotherapy. These archival recordings offer more than historical interest; they hold lasting clinical value. Each session distills complex clinical ideas into lived examples, practical insight, and enduring therapeutic relevance.
This month’s selection is…
EP05 Point/Counterpoint 12 - Technical Approaches to Narcissistic Personality Disorder: Featuring Otto F. Kernberg, MD and James F. Masterson, MD
Few topics in mental health have become as widely discussed in recent years as narcissism. The term narcissistic personality disorder (NPD) has made its way into social media, podcasts, and everyday conversation, often becoming a catch-all label for difficult relationships. Yet true narcissistic pathology is far more complex than simply being arrogant, self-centered, or entitled. For clinicians, understanding that complexity is essential.
In this engaging discussion, two pioneers in the treatment of personality disorders, Otto Kernberg and James Masterson, offer a thoughtful exploration of narcissistic personality organization, differential diagnosis, and treatment. Although recorded in 2005, their conversation remains relevant for today’s clinicians seeking to understand not only what narcissism looks like, but why it develops and how meaningful therapeutic change can occur.
One image that came to mind while watching this presentation was the scene from The Wizard of Oz in which the intimidating Wizard is eventually revealed to be an ordinary man behind a curtain. Narcissistic defenses can function similarly. What initially presents as confidence, superiority, certainty, or grandiosity often serves as a carefully constructed barrier protecting a far more vulnerable internal world.
Another fitting metaphor is that of the hermit crab. The crab’s rigid shell appears strong and impenetrable, yet beneath it lives a remarkably delicate creature. As the crab grows, it must repeatedly leave behind one shell in search of another. Likewise, individuals struggling with pathological narcissism often seek safety within various psychological ‘shells’ – status, achievement, admiration, perfectionism, or power – in an effort to protect an increasingly fragile sense of self. The external armor may appear solid, while internally there remains a person longing for security, connection, and belonging.
One of Kernberg’s greatest contributions during the presentation is his reminder that narcissistic pathology extends well beyond grandiosity. He describes four central areas of disturbance: pervasive grandiosity, envy (both conscious and unconscious), disturbed interpersonal relationships, and an abnormal internal value system. Rather than experiencing stable self-worth, many individuals fluctuate between chronic emptiness and brief moments of excitement fueled by admiration, competition, or external validation. A particularly insightful observation is the difficulty these individuals have in recognizing and appreciating “the good.” Positive experiences, accomplishments of others, or genuine closeness can become difficult to tolerate because they evoke painful feelings of inadequacy or envy. As clinicians, this perspective encourages us to look beneath the presenting behavior and ask what emotional experience the defensive structure may be protecting.
Rather than taking these reactions personally, Kernberg encourages therapists to remain curious and creative. Each rupture becomes an opportunity to generate new understanding about the patient’s internal world instead of simply reacting to the behavior occurring in the room. Perhaps one of the most clinically important reminders is that therapy is not about eliminating aggression. Instead, one of the first therapeutic goals is helping patients tolerate their own aggressive feelings without becoming controlled by them. Once aggression can be acknowledged rather than disowned, it becomes available for reflection, understanding, and transformation.
Ericksonian hypnosis has long emphasized the remarkable capacity of the unconscious mind to integrate experiences that conscious awareness often keeps fragmented. Where Object Relations Theory speaks of integrating split internal representations, Ericksonian hypnosis gently invites communication between divided aspects of experience. Clients often discover that seemingly opposing parts of themselves can coexist without conflict. The admired and the ashamed, the strong and the vulnerable, the loving and the angry aspects of the self are no longer forced into rigid opposition. Instead, they begin forming a more complete and compassionate experience of self.
Ultimately, this presentation serves as a reminder that beneath even the most rigid defenses lies a human being whose early experiences shaped the way they learned to survive. Whether one’s clinical orientation is psychodynamic, cognitive-behavioral, systemic, or Ericksonian, the enduring task remains remarkably similar: to help clients move from fragmentation toward integration, from defensive isolation toward authentic relationship, and from surviving behind protective shells to living with greater wholeness.
Full video presentation can be found here.
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Otto Kernberg (1995) demonstrates a supervision session with a therapist who presents a case of a 42-year-old male with a narcissistic personality and self-destructive tendencies. This male therapist feels as though the therapy has reached a stalemate. Kernberg suggests various hypotheses about the case. The volunteer then describes his reaction to the supervision.
Educational Objectives:
To illustrate the general principles of interpretation.
To illustrate indications, limitations and contraindications of this approach.
This documentary explores the personal life and incredible career work of Milton H. Erickson, M.D., founder of Modern Hypnotherapy. This unsung American genius was a pioneer in psychiatry using radical and unconventional hypnotic techniques to cure not only patients but to control his own debilitating pain and paralysis.
The work of Milton H. Erickson, M.D., often referred to as “The Mozart of Communication,” shocked the scientific community with new and effective theories for therapeutic intervention, which even today defy scientific explanation. But it is his personal story that commands our initial attention.
How does a child born in the silver mining community of Aurum, Nevada, and soon to be ghost town at 7,500 feet above sea level, survive all odds after being stricken with polio to grow into the man destined to become an evolutionary genius in the fields of hypnosis and psychotherapy?
To overcome paralysis and chronic, debilitating pain and muscle wasting, Dr. Erickson ignored his doctor’s prognosis of helplessness and hopelessness, and went on to invent a protocol for hypnosis, which controls the mind, body and spirit. His exceptional work exposes his true genius and continues to lend hope and curative relief to vast numbers of patients through the hypnotic techniques he developed.
In “Wizard of the Desert,” we see an extraordinarily gifted and extremely disciplined man in a wheelchair, whose victories over severe pain, paralysis and life altering medical conditions continue to inspire awe long after his death. Uncompromising in the demands he placed on himself and his family, Dr. Erickson’s story redefined medical philosophies and continues to mesmerize students and audiences alike.
Through the eyes of those closest to him, our film reveals three dimensions of this unsung American genius whose contributions to modern psychotherapy and hypnosis forever memorialized him as the…”The Mozart of Communication; The Eccentric; and The Wounded Healer.”
Zeig (1995) demonstrates the Ericksonian approach to psychotherapy while working with Carol, a woman whose nail-biting habit is rooted in anxiety. After gathering information on her personal history, Zeig helps Carol utilize her values and history to affect change. The process is both humorous and dramatic. After working to change associations linked to the problem behavior, Zeig offers Carol an ordeal that will produce a "guaranteed cure." Hypnosis is offered as the "dessert", rather than the main course.
Educational Objectives:
To describe the method of "orienting toward."
Given a patient, demonstrate appropriate use of the technique of guiding associations.
Joseph Wolpe (1985) begins with Santiago who has a history of experiencing strong feelings of anxiety and discomfort during social situations. Questioning reveals that these problems are most intense when he is in situations in which he experiences a loss of control. Wolpe uses imagery and desensitization to diminish feelings of anxiety.
Educational Objectives:
To demonstrate accuracy in behavior analysis
To apply behavior techniques
