My name is Sam Vaknin, and I am the author of Malignant Self-Love and Narcissism Revisited.

I am the author of Malignant Self-Love and the lack of the aforementioned emotional component. Such a person doesn’t love himself, yet is trying to convince himself that he is lovable. She doesn’t trust herself, yet she lectures to herself on how trustworthy she is, replete with supporting evidence from her experiences.

But such cognitive substitutes to emotional self-acceptance simply don’t cut it. They won’t do.

The root of the problem is the inner dialogue between disparaging voices and countervailing truths to the contrary. Such self-doubting is in principle a healthy thing. It serves as an integral and critical part of the checks and balances that constitute the mature functioning personality.

But normally in an organized personality some ground rules are observed, and some facts are considered indisputable.

When things go awry, however, the consensus breaks. Chaos replaces structure in the regimented update of one’s self-image via introspection gives way to recursive loops of self-deprecation with diminishing insights.

Normally, in other words, the dialogue being the inside dialogue serves to augment some self-assessments and mildly modify other self-evaluations.

But when things go wrong, the dialogue concerns itself with a varied narrative rather than with the content of the narrative. The dysfunctional dialogue deals with questions that are far more fundamental and typically settled early in life than normally.

So, in a dysfunctional dialogue, the person would face the question, who am I? What are my traits, my skills and my accomplishments? How reliable, lovable, trustworthy, qualified and truthful am I? How can I separate fact from fiction regarding my life and my identity?

So all these questions are settled early in life, usually in late adolescence. The answers to these questions consist of both cognitive, empirical and emotional components. They are mostly derived from our social interactions, from the feedback we get and we give.

And in a dialogue that is still concerned with this cause, in other words, indicates a problem with socialization. It is not one’s psyche that is delinquent. It’s one’s social function.

One should direct one’s efforts to heal outwards, to remedy one’s interactions with others rather than inwards, to heal or cure one’s psyche, whatever that is.

Another important insight is that the disordered dialogue, the dysfunctional dialogue, is not time synchronic. The normal internal discourse is between concurrent equipoarents and same age entities, psychological constructs.

The aim of such a normal dialogue is to negotiate conflicting demands and reach a compromise based on a rigorous test of reality.

The faulty dialogue, the dysfunctional, the non-performing dialogue, on the other hand, involves widely disparate, different interlocutors. These inner entities that talk to each other, are in different stages of maturation. They are possessed of unequal faculties. They are more concerned in having monologues than in having a true dialogue or polylog.

As these entities are stuck in various ages and various periods of the person’s life, they do not all relate to the same host, person or personality. They require time and energy-consuming constant mediation. It is this depleting process of arbitration and peacekeeping that is consciously felt as nagging insecurity or even in extremes as self-loathing.

A constant and consistent lack of self-confidence, fluctuating sense of self-worth, are the conscious translation of the unconscious threat posed by the precariousness of the disordered personality.

It is, in other words, a warning sign.

And so the first step is to clearly identify the various segments that together, however incongruently, constitute the personality.

This can be surprisingly easily done by noting down the stream of consciousness dialogue and by assigning names or handles to the various voices in it.

The next step is to introduce the voices to each other and form an internal consensus, a coalition or an alliance of voices. This requires a prolonged period of negotiations and mediation, leading to the compromises that underline such a consensus.

The mediator can be a trusted friend, a lover, or frequently a therapist.

The very achievement of such internal ceasefire reduces anxiety considerably and removes the imminent threat.

This, in turn, allows the patient to develop a realistic core or kernel wrapped around the basic understanding reached earlier between the contesting parts of his personality.

The development of such a nucleus of stable self-worth, however, is dependent on two things.

One, sustained interactions with mature and predictable people who are aware of their boundaries and of their true identity, their traits, skills, abilities, limitations, and so on.

The second condition is the emergence of a nurturing and holding emotional correlate to every cognitive insight or breakthrough.

A good therapist aims to provide such a holding environment, and the latter, the second condition, is inextricably linked with the first, only predictable when mature people can provide a holding, emotional environment, a good, warm, nurturing, and safe emotional environment.

Some of the voices in the eternal dialogue of the patient are bound to be disparaging, injurious, belittling, sadistically critical, destructively skeptical, mocking, and demeaning.

The only way to silence these voices, or at least discipline them and make them conform to a more realistic emerging consensus, is by gradually and sometimes surreptitiously introducing countervailing players.

Other voices, which are positive, supportive, enhancing, and empowering, protracted exposure to the right people in the framework of mature interactions, negates the pernicious effects of what Freud called a superego gone wild. It is, in effect, the process of reprogramming, deprogramming, reparenting.

There are two types of beneficial altering social experiences.

The first one is structure, interactions that involve adherence to a set of rules as embedded in authority, institutions, and enforcement mechanisms, for example, attending psychotherapy, going through a spell in prison, convalescing in a hospital, serving in the army, being an aid worker or a missionary, studying at school, growing up in a family, participating in a 12-step group, and so on and so forth.

The second type of beneficial altering social experiences is not structure, interactions which involve a voluntary exchange of information, opinions, goods, or services.

The problem with a disordered personality is that usually is of her chances of freely interacting with mature adults in the course of type 2, non-structured guy. These chances are limited to start with, and they dwindle with time as people begin to keep their distance from the disordered person.

This is because few potential partners, interlocutors, lovers, friends, colleagues, neighbors, are willing to invest the time, effort, energy, and resources required to effectively cope with the patient and manage the often arduous relationship of the absent doubts.

Patients with personality disorders are typically hard to get along with, they are demanding, petulant, paranoid, and narcissistic. Even the most gregarious and outgoing patient finally finds himself isolated, shunned, and misjudged. This only adds to his initial misery and amplifies the wrong kind of voices in the internal dialogue.

Hence my recommendation to start with structured activities in a structured, almost automatic manner.

Therapy is only one and at times not the most efficient choice.

Good luck with your reintegration.