-          Please also read the article ‘Difficult People” new on web site.

Toxic implies poisonous, dangerous, distressing to the equilibrium of Self and Others, damaging, infectious, debilitating, sapping strength, interfering with healthy [“normal”] functioning…

Now be careful:  Don’t judge!  The most dangerous thing about toxic people is their frequent lack of insight into their own toxicity and their judgment of Others as Toxic or bad!  A recent episode of the sitcom Two and a Half Men demonstrated the total denial a toxic person can have of his/her own toxicity, beautifully:  The dysfunctional mother of the two anti-heroes reports that she went to a funeral of a woman who was so critical, judgmental, pedantic, self-centred and un-empathic [read “Narcissistic Personality Disorder!] that nobody else went to her funeral.  Her sons finally revealed that her fate was likely to be similar since her personality was identical!

Personality Disorders

Personality Disorders are sets of dysfunctional patterns of behaviour that are usually caused by repeated failures of Significant Others to meet childhood needs appropriately, and these symptoms cause significant distress in relationships with Self or Others at personal, social, work, intimate and family level.  Such Disorders [or PDs] may only be diagnosed in adulthood [i.e. usually after 20 years of age] and the diagnosis may be made only by a clinician, like a Psychiatrist or Clinical Psychologist.  No, your conviction that your mother-in-law is the world’s most toxic Narcissist, is not legal or valid, and may have you sued for character defamation!

There is a list of the diagnosable PD’s on the web site, but do remember

[a] all people have some measure of defensive dysfunctional traits, and most of them are not PD’s;

[b] unless you have said clinical qualification and the person is not in close relationship to you, you are not qualified – or objective enough – to make the diagnosis;

[c] and also not objective or qualified to diagnose yourself.

That being said, since the symptoms are generally caused by very early and chronic interpersonal failures, the chief defense mechanisms are Denial [I’m not like that, thank Goodness!] and Projection [But she/he/all others are!] and Splitting [If you’re not 100% validating everything I say and do, you’re obviously betraying me and must be shunned/won back/punished…!]  So perhaps if we get some inkling that we just may have some of the dysfunctional traits ourselves, there is already potential for growth in that we could come out of Denial.

1:  Fatal Poisoning: Antisocial Personalities

It’s not usually appropriate to talk about degrees of dysfunctionality among the PD’s as all of them cause severe distress at personal, social or work level.  But from a therapeutic perspective the Antisocial Personality Disorder can be the most damaging as it is highly resistant to any intervention:  People can have decades of different kinds of therapy and yet remain as toxic as at the start.  And while other poisons usually cause from moderate to severe illness in relationships, Antisocial PD frequently causes complete destruction of the Other’s sense of self, or even their life.  Previously this category was termed Psychopath [as in the famous movie Psycho], later Sociopath and since 1994, Antisocial PD.  Typical are career criminals, from those who create child pornography to drug pedlars and mass murderers.

The most common Antisocial traits are a complete absence of Empathy for others [people and animals], coupled with compelling deceit and manipulation, and frequently a sadistic enjoyment of others’ pain [as seen in the movie The Silence of the Lambs].  In childhood, symptoms of an inability to feel empathy for others, plus sadism towards animals may predict that a person would have strong Antisocial traits in adulthood, or even the Disorder, if effective and long-term therapeutic intervention is not given early enough.

Criteria for diagnosis include any 3 or more recurrent traits of the following [traits from age 15, but PD is never diagnosed before age 18]:

-          Repeated criminal / illegal acts

-          Deceitfulness / lying / conning others for personal gain

-          Impulsivity & Immediate gratification no matter what

-          Repeated physical violence [breaking things, hurting animals or people]

-          Reckless, disregarding own or others’ safety

-          Consistent irresponsibility [e.g. in relationships, with others’ money or possessions, or at work]

-          Complete lack of empathy or remorse [often, lack of any “real” emotions except pleasure]

Plus history of Repeated acts of Conduct Disorder with onset before age 15.

2:   Violent bouts of illness, sometimes causing death: Narcissistic Personalities

I’ll give more information on the other PD’s at later occasions – probably by adding more articles on the web site – but now also want to talk a little bit about the Narcissistic Personality Disorder [NPD].  Please again remember that everyone of us has Narcissistic traits, and that there are Functional ones, like healthy ambition, good interpersonal judgment, self-respect and self-confidence, as well as the Dysfunctional ones, which I’ll discuss in brief [in no particular order].

Grandiosity:  No matter what you’ve achieved, experienced, or where you’ve holidayed, the Narcissist has done better!  They have a grandiose sense of self-importance and feel superior to everyone else, from Nobel Prize winners to mere Therapists, and are thus highly resistant to therapy:  they’ll go to sessions but keep “proving” how wrong you are and how much they know better!  This is also reflected in other relationships and the critical, judgmental, arrogant and perfectionist attitude is a major stressor in, for instance spouse abuse or emotional abuse in general – whether derogating your child, or being obnoxious to a waiter in a restaurant.  Their “victims” report that it feels like the Narcissist is always on the look-out to catch them doing something wrong, or being slightly imperfect in some way, and this “fault” is then catastrophied and focussed on and punished in humiliating and extreme ways.

Entitlement:  Why should the Narcissist have to wait in a queue like mere other human beings?  Why should the doctor, teller, therapist, spouse, or nurse in a hospital not be instantly available at the moment their need is felt, the bell is rung for attention, or the person is called.  Talk about Immediate Gratification!  While this immediate gratification need is normally in the form of service or attention from others [including pets], Narcissists also frequently have substance addiction disorders, which tends to further impair their insight and judgment, and to escalate their pathology to dangerous levels.

Lack of Empathy:  Or sometimes Fake empathy:  if they believed they lacked empathy, they would have to admit to a flaw, so they deny that possibility to themselves, and research “how to be empathic” [as they research and challenge anything else in order never to be caught of guard], and act as empathic people are supposed to act – sometimes.  Their words may sound empathic but their body language may at the same time be threatening, rejecting or denigrating. Basically their chief defense [against chronic early failures of empathy or positive attention from Significant Others] mechanism is total self-absorption and they are unwilling or unable to recognise and deal with needs or feelings of Others.

According to the DSM [Diagnostic and Statistical Manual of Mental Disorders, internationally used for clinical diagnosis], people with any five of the following [chronic or daily] personality traits, either have “Narcissistic Personality traits” [shown as +, ++, or +++ depending on severity and impact on others] or a full-blown Narcissistic Personality Disorder…  Now, remember that we ALL display many of these traits some of the time or in specific situations, without them being our main, only, or chronic defenses!

-          Grandiose sense of self-importance

-           Preoccupied with fantasies of unlimited power, success, beauty, brilliance or ideal love

-          Believes s/he is special/unique and can only be understood by or be associated with others who are “the best” in any field

-          Demands or invites excessive admiration

-          Sense of entitlement

-          Exploits others to achieve his/her own goals

-          Lacks empathy

-          Believes others are envious of him/her, yet also envies [and often denigrates] success of others

-          Arrogant, haughty behaviours and attitudes

Impact on Relationships:

Borderline Personality Disorder [BPD] can be as destructive to Self and Others in relationships [in fact, commonly more directedly self-destructive than NPD or Antisocial PD] and its defensive causes are usually as early as in the previously discussed PD’s, resulting in equally primitive defensive mechanisms [e.g. Splitting, Projection, Denial].  And people with strong BPD traits cause massive havoc in relationships too, but I will discuss that Disorder on its own elsewhere [BPD sufferers are often overwhelming, so it’s not just a matter of physical space here!]

For now, let’s just consider the common effects of Antisocial PD and Narcissistic PD on relationships. 

Very often we find some sort of abuse of Others with both, and it’s difficult for the lay person to differentiate causal factors:  Is the person abusive because of anti-social tendencies, or because of a deeply repressed terror of being abandoned, or losing control? [Or are they on a continuum of similar dysfunction?]

It’s important to understand that when there is abuse in a relationship – financial, power, social, emotional, sexual, verbal, and especially if its already escalated to physical violence [breaking objects, smashing doors or walls, or physically attacking or threatening to injure others or animals] – it is highly unlikely that a few weeks or even months of couples’ counselling/therapy will create lasting levels of greater harmony.

Unfortunately, the converse is true.  Even when there is some behaviour change on the part of the abusive partner, it may be manipulative [conscious or unconscious] or a False Self formation* underneath which parts of the personality build up resentment and rebellion against the therapist as authority figure, often resulting in higher levels of control and abuse if the person feels that the partner is gaining self-esteem and confidence.

It is never safe to be in any form of relationship with the Antisocial Personality:  even if you’re part of their “gang” and have similar behaviours, you are never safe [“blood in, blood out”]. And there really is no safe way to remain in an intimate relationship with a Narcissistic Personality, not while they’re either not yet in therapy, or even for many years while they are in therapies of various kinds.  While the traits remain, the danger is high, and the behaviours are likely to escalate or at least recur, despite remorseful promises and apparent acts of contrition, that may last for months. Only when a mental health professional can assure you that it’s safe, should you consider being in a close relationship with formerly abusive people.

If you suspect that your romantic or business partner/s may be Narcissists, the only way you can be relatively safe from some form of abuse in the relationship, is to insist on regular [i.e. at least once a week, and probably in terms of years rather than months] couples therapy as well as individual therapy for the abuser.  And maybe the therapist is a religious counsellor or social worker or guru, but, because of the power dynamic and primitive defenses, without some authority figure to whom there is accountability, most clinicians appear to hold little hope for good prognosis.

In other words, if there is ever any form of abuse [psychological or physical, or at any other level, especially if recurrent], get professional help, and urgently!  Do not delay until the co-dependency and the behaviours are so fixed that it’s extremely difficult to find an antidote for the “poison”.

Conversely, if you recognise the traits at toxic level in yourself, it is very important to commit to the right kind of psychotherapy as soon as possible, understanding that the long-term investment of time and money is worth it, as the gains are safer and happier relationships with yourself and Others at all levels of your life, which in turn promotes financial and physical well-being.

*See C20 psychoanalyst Donald W Winnicott’s essays on the formation of the defensive False Self structures

This technique was Presented by Reinette Steyn to the Psychology (PsySSA)Conference in Cape Town on 13 Aug 2009.

Whether big or small, Trauma has always implied disruption of our sense of being “OK”.

The German word Traum means Dream, suggesting an experience in Dream State, or Nightmare, if you will.  Traumatic experiences generally have dream state power: symbolism, irrationality, unpredictability, polarised effects, and 2-dimensional characters – good or bad, victim or perpetrator.

Psychoanalyst Melanie Klein held that the Imagoes or mental representations we create of people who have in some way damaged us, are far fiercer and more relentless than the real life people on whom they are based; they are indifferent to all others’ pain or even delight in it.

I believe the same holds true for damaging or threatening events or experiences in general. 

They seem one-sided and overpower us with their unmittigating attack – Nightmare stuff.

The counter-balance for a nightmare, with all its vivid imagery, movement, unpredictability, and frenetic action, can’t be just a calm dream.  We need a similar strong arousal level as that of the trauma or nightmare experience, one that would stimulate the release of large quantities of positive neurochemicals to neutralise or displace the negative ones.

We need colour, movement, rush of action, stimulation of all senses, and exuberant energy in our healing imagery.  Let’s call it a Brightmare!  A wonderful, bright, positive dream state experience, with imagoes as impossibly real and incongruous to everyday experience, as those of negative trauma states.

The changing of the brain state to a positive but aroused state is an important intervention since we know that our brain functioning is so-called “State-Dependent”:  It is very difficult for us to access positive memories or habits if we’re feeling depressed, or calm memories or experiences if we’re feeling anxious, or powerful feelings when we’re in a trauma-induced powerless state.  And since the brain appears to prioritise highly aroused states as mode of ensuring survival, we need to create a similar level of arousal priority for the brain to change to a more positive and powerful state of functioning.

Different de-briefing therapies appear to have 3 common elements in their various protocols:
1]  Re-visit the traumatic experience in minute details, accessing all 7 senses, and replay with different perspective and speeds.
2]  Re-frame aspects of the experience so that they are more empowering & validating.
3]  Generate a containment / safe space experience.

In EMDR the protocol typically ends with 3 containment steps:
a]  De-potentiate the threatening negative imagoes, for instance by putting them into a Perspex bubble, or a composting tank, or shark cage.
b]  Anchor a feeling of being protected through a suitable image – blue light, angels, huge dog, etc.
c]  Help client to create or access a Conflict-Free Image [CFI].  Examples from patients include floating in a dam, playing with their dog as a child, flying overseas on holiday, throwing clay at opponents across a stream, giving birth, a secret place in a garden, etc.

Making light of actual traumatic events [big or small] is likely to be harmful, invalidating the painful experience, causing repression of the negative impact, and hugely annoying the defensive or protective ego-states, which may have disruptive and damaging consequences…

But we can speed up the process of re-empowerment and stabilisation of the self by enlivening the safe space imagery to create an effective counter-balancing “Brightmare” to the trauma-bad dream experience.  We do this through adding incongruous, laughter-evoking imagery to the client’s CFT or safe space.

Example:  To a young rape victim’s Safe image of eating ice-cream on the beach, one ciould suggest that the “ice-cream baby” had a big protector ice-goose that would nozzle her neck with its flat orange beak, and tuck her under its belly to keep her safe, till she sneezed so hard that it somersaulted backwards and looked very funny trying to regain composure.  Experience shows that clients, old or young, keep remembering the incongruous image and e laughter thus evoked seems to speed up the creation of efficacy and normalcy neuronal pathways.

We can thus play the role of movie or dream state director, generating strong and vivid positive states, to create an exciting Brightmare through suggesting additions to patient imagery, using the following tools:

- Add colour, brightness, temperature, physical comfort – or even slight discomfort such a tickling, texture, smell, taste, sounds.
- Enlarge the protagonist/s [including the Self] to absurdly huge size in relation to other elements or characters.
- Add incongruous characters, actions, occurrences, and situations.  It should end up being “silly” and laughter-provoking, while remaining reassuring and protective.
- Add fast movement, unexpected behaviours or events, dramatic, positive action, and make sure the client is part of the action in a powerful way.

Benefits are numerous, for instance:

- Neuro-chemicals evoked by laughter and energetic imagery create a brain state in which it is easier to recall victory and positive experiences, in contrast to the disempowering state created by traumatic experiences;
- Re-association to three-dimensionality of one’s life and reintegration of positive life experiences into the life narrative can occur readily;
- Through the balancing of Nightmare Dream States with Brightmare Dream States, normalcy is validated and permission is given to the self to laugh and experience happy feelings “in spite of” negative experience, etc.

The possibility for selection of possible characters and events is endless:  Why can’t the Elvis impersonator surfing on a Harley Davidson bike near the person’s safe place not have a mouse with long green eye-lashes playing ego-strengthening songs on the red lacquered guitar across his back, while the foam that shoots up from the Hog comfortingly tickles the client’s cheecks?

As long as the characters and events maintain the client’s sense of safety and security, and integrity of self, and add humour and some form of reconnection to happier or more ppowrful experiences, anything is possible.

RELATIONSHIP HEALING:
MAKING RELATIONSHIPS WORK - SOME ASPECTS OF COUPLES / MARITAL THERAPY

The three essential life skills almost all of us weren’t taught at school:
- How to manage and make money
- How to be good enough parents
- How to be successful in relationships.

It’s estimated that couples / spouses who stay together for financial, religious, family, business, or other reasons when they really don’t get along without even a semblance of peace and joy in each other’s company, added to the divorce rate [over 54% in most western countries] would result in a finding that up to 80% or more of couples are in serious relationship trouble. Serious.

Unfortunately we tend to behave in ways that were modelled to us – by caregivers / parents / teachers / older siblings or extended family, and – alas! – horridly dysfunctional characters in most soap-operas and many books and movies. The problem with television-modelling is the immediacy and the repetitive nature of the characters’ interactions, and that it’s per se “allowed” in our homes. The unconscious mind is given the message that this is how people [may] behave in our home, work or other space. While a book may describe outrageous behaviour, we would interpret it idiosyncratically. (Think of how surprised you felt at times when a book was turned into a movie and the characters just look wrong compared to what you had in mind.)

In visual media, with colour, movement and sound added in screaming vividness, the modelling of behaviour, including facial expressions, micro-gestures, posture, tone of voice, etc., is exact. But we usually don’t get to feel the emotional and/or physical consequences of the behaviours thus modelled. No, we go for a sustenance break during the frequent adverts, and de-brief the impact.

But this does not happen in close real relationships. There we have to ride out the encounter not just for 11-16 minutes a day [all that’s left when advertising time, and subtitles or intro time is subtracted from the 30 minute program!], but we have to live “in the drama” 24/7, day after day, week after week, for months, for years.

It holds for all close relationships, not just romantic ones. Relationships with colleagues, managers or underlings may need to be managed – or survived – for 40 hours or more a week. Relationships with school-going kids draw us in for about 10 hours a day and may drive a parent to distraction during weekends and vacations! Yes, we drive the kids nuts too…

Fact is that our level of esteem for our Self, our trust in our self to care for our self, our regard and respect for our self as a worthwhile and respect-worthy entity, our enjoyment and discipline of self, etc, determines how we behave in relationships. Again, these factors are generally created by negative and positive experience of self-in-relation-to-significant-others when we are very young.

Donald W Winnicott [UK analyst, C20] talks about being a Good-Enough or Not-Good-Enough parent. A good-enough parent basically has relatively few failures in understanding, accepting, respecting and responding appropriately to the child’s needs (physical, social, mental and emotional). This parent’s few failures can be forgive [and usually forgotten] in the matrix of appropriately empathic interactions that provide a properly nurturing environment for the child.

Now let’s look at those qualities again:
- being empathic*, i.e., understanding the world from the child’s point of view, and responding appropriately to his/her emotions and needs
[*by the way, there’s no such word as “empathetic”, which is a bastardisation/erroneous amalgam of empathy & pathetic, two words with completely different meanings!]
- respecting, i.e., granting the child the right and power to impress his/her interpretation of events on the world [e.g. the parent] and have his/her needs and feelings validated
- valuing the child as precious / estimating the child’s value to be high, so that his/her needs and communications are judged high priority
- being consistently trustworthy in care for the child
- giving the child the constant message that s/he is worth respect, trust, adoration, affection and healthy discipline; that s/he is adore-able
- I’d like to add too the list Carl Rogers’ [1940s] idea of unconditional positive regard.

There are many excellent books that teach us how to have really great, functional, and healthy relationships. Some of my favourites are:
- Dr Phillip McGraw: Family First – a blueprint for healthy close relationships in context of family
- Dr Phillip McGraw: Relationship Rescue – for those who’ve already inflicted much injury
- Tony Humphreys: Myself, My Partner – an excellent book, sadly out of print but very worth buying “used”. It works from the basis of relationship with Self to that with Other
- David Richo: How to be an Adult in Relationships – The Five Keys to Mindful Loving – This great book, published in 2002, suggests a holistic, mindful approach, which really helps to improve various kinds of relationships swiftly and with great success
- Thomas Harris: I’m OK, you’re OK – based on Transactional Analysis as proposed in Eric Berne’s The Games People Play, this book is an easy to read, understand and apply in any relationships.

David Richo’s book has an easy 5 concept recipe for success that I have found useful in all relationship counselling or therapy, between adults in various roles, including marriage or intimate relationships, or friendship, or work relationships, as well as between children, and between child & adult,and groups in interaction. [It even seems to work in relationships with dogs – manipulators, cats – controllers, and pot plants – demanders!]

Richo pre-supposes that healthy relationships is our right and obligation – or even “calling”, and gives us the tools that are guaranteed to help us have wonderfully healthy relationships with Ourselves and Others. Here are his “Five A’s”:
- Attention: I am paying close, respectful attention to Me /You
[not ignoring, being unavailable, interrupting, etc]
- Acceptance: I accept me as I am / you as you are, in this moment
[not trying to make someone over to our specifications]
- Allowing: I allow me to be myself / you to be yourself, to be free to grow to the best Self possible
[not being controlling, demanding or manipulative]
- Appreciation: I appreciate myself / you for what I / you have been, and are
[not criticising]
- Affection: I have real affection for myself / you, no matter what
[not acting selfishly or abusively]

No matter what the “diagnosis” of the relational problem/s, behaving from such a mutual mindful and respectful approach, will result in healing. Note that it needs to be mutual to last, but it can start from one side only, eliciting similarly better behaviours from the other side over time: “You teach people how top treat you” – as Dr Phil often says. Also remember that you need to start behaving towards yourself in this mindful manner: not only will others tend to respond to you similarly to the measure they observe you respect yourself, but in doing so you will become your own ally – the “inner child” will no longer have to behave so defensively when there is stress, empathic failure, or disagreement.

But a quick diagnostic tool is useful. Observe how successfully the relationship is working on three tiers represented in this pyramid: 

 The base of the relationship pyramid is Communication. If this is not mutually healthy, clear, respectful and appropriately responsive, the relationship cannot be great [even if the sex is and both parties are equally wealthy!]. You can’t fix Intimacy if Communication is dysfunctional. The next tier is power. Is the financial, social, decision-making, [etc] power shared equally or fairly, according to the needs of both? If not, some aggressiveness / passive-aggression or withdrawal / sabotage is highly likely to subvert both Communication and Intimacy. Finally, if both lower tiers are good, but Intimacy [emotional, physical, spiritual, sexual etc] is not satisfactory, this may cause reflexive problems in Communication and how Power is used. I suggest you try applying the ”Five A’s” and other quality behaviours at all three levels, from the bottom up.

Finally, although self-help questionnaires, books and workbooks can be wonderfully effective, most people will probably need a trustworthy coach-mentor-referee-witness to accompany them on the healing journey, in order to maintain openness and balance different points of view, as well as reintroduce realty when necessary.

I would go to a specialist, not just any doctor at random, if something in my body was seriously impaired. Similarly, I suggest that couples and other people with relational problems, consult a therapist or counsellor [or lay counsellor etc] who is properly trained and knowledgeable, but also thoroughly experienced in the field of relationship therapy. Ask about experience and competency: it is your right, and your responsibility to yourselves and your relational well-being.