AP During their second Presidential debate, Donald Trump shadowed Hillary Clinton and repeatedly invaded her personal space - a narcissistic move by Trump in an attempt to intimidate his opponent.

By David M. Reiss, M.D. and Seth Davin Norrholm, Ph.D.

Promoting the launch of Hillary Clinton’s book, “What Happened,” an audio-clip has been released in which Secretary Clinton, in her own voice, recalls the experience of debating Donald Trump. Specifically, the Democratic candidate for President describes how she felt when Trump “wandered” directly behind her as she spoke, in essence “stalking” her on stage.

Obviously, Trump was not exhibiting proper decorum or any of the typical, usual, or accepted behaviors observed during decades of previous Presidential debates. But narcissists like Trump can be counted on to disregard any and all rules to the full extent possible in order to try to gain an advantage.

The design and logistics of the primary debates prevented Trump from physically “stalking” opponents as he did with Clinton during the second Presidential debate. For example, the primary debates involved upwards of a dozen participants; there was no room for wandering; and the TV cameras were focused on the person to whom a question was directed, conceivably at a distance from where Trump stood.

AP The design of the Republican primary debates prevented candidate Trump from physically intimidating his opponents and thus he resorted to demeaning and childish name calling (e.g., Lyin’ Ted Cruz)

But in a one-on-one format, with an open stage, Trump was free to ply his craft.

Clinton acknowledges that Trump’s behavior made her extremely uncomfortable:

Despite all the data already available regarding Trump’s personality and behaviors and despite all the practice she had done, Clinton also admits that she was not prepared to react effectively to Trump’s predictably-unpredictable behavior. In fact, she was thrown off course and distracted, wondering how to respond:

Clinton discusses the decision she made on the spot and how, while internally saying, “You can’t intimidate me,” in reality, Clinton was intimidated and was distracted as she needed to resort to learned coping mechanisms to contain her emotions, while doing her best not to appear shaken:

Since the release of the above transcripts and audio, the media has focused mostly on the aspect of a male attempting to dominate, if not threaten, a female. There has been discussion regarding how difficult it is for a woman to respond to such assaults and the “no win” position in which the woman finds herself (passive acquiescence vs. “coming off as a bitch”).

AP Powerful women such as California Senator Kamala Harris (pictured) are routinely (and wrongly) criticized by male colleagues for displaying the same decisive, dominant behaviors that they often display. For example, Senator Harris recently made Attorney General Jeff Sessions “nervous” during a Senate hearing due to her straightforward, “no bullshit” approach and was later misogynistically described as “hysterical” by her male counterparts.

It has been pointed out that women are repeatedly traumatized by this type of inappropriate behavior by men and that society directly or implicitly demonizes the woman, regardless of her response. There have been descriptions of how such situations are exponentially more difficult for women who have a history of having been victims of abuse.

Those issues regarding gender roles and male-female relationships are valid and important. The male-female dynamic certainly was brought into play within the Presidential campaign in a manner that was disastrously costly to Hillary Clinton.

However, narcissistic intimidation occurs in many circumstances that do not involve gender issues/relationships; one need only look to the verbal narcissistic intimidation Trump unleashed during the primaries toward opponents such as (“Little”) Marco Rubio, (“Low Energy”) Jeb Bush, and (Lyin’) Ted Cruz.

AP Florida Senator and one-time Republican Presidential candidate Marco Rubio was a constant recipient of narcissistic intimidation by then candidate Trump.

As noted, the narcissist feels entitled to disregard all rules. Not only rules of formal debates, but rules of accepted courtesy and manners, rules of logic, expectations of consistency, guidelines of common decency and, of course, any commitment to honesty.

These deviations from normalcy will occur within a narcissist’s personal relationships, family relationships, business/workplace activities, social interactions – and, of course, as therapists we are exquisitely aware, during any attempt to provide counseling, therapy, or any type of “intervention.”

A fairly obvious corollary of the narcissist’s refusal to respect any rules or conventions is that attempting to respond to the narcissistic based upon logic, rationality, fairness, or decency will inevitably fail. In that regard, the rational person is effectively going into a warzone with both hands tied. One need only read the comments directly aimed at Trump on his Twitter feed to see well-intentioned but ill fated attempts at engaging him directly with logic and rationality.

TWITTER Senator Lindsey Graham (R-SC) attempted to appeal to President Trump, via Twitter, with logic and reason following the President’s response to the deadly events in Charlottesville, Virginia over the weekend of August 12-13, 2017. As Republican Congress members are increasingly seeing, this strategy often proves futile.

It is almost equally as obvious that attempting to ignore the narcissist’s assaults is a losing strategy, amounting to nothing more than surrender. While a sophisticated observer might appreciate the unjust assault that is occurring and empathize with the target while criticizing the narcissist – by ignoring the assault the target has effectively accepted and implicitly embraced the weakened position of an impotent victim.

Less obvious, often the “downfall” of victims of narcissism – and the second alternative that Clinton considered and rejected – is the response of directly confronting the narcissist or “fighting on his own terms.” Although that may be effective in dealing with a particularly weak or “inexperienced” narcissist, any narcissist deserving of that title has honed the skill of responding to anger by “fighting dirty” to the extent that it has become second nature. No (even half-way) reasonable, rational person will ever have the ability to survive a “gutter fight” with an experienced narcissist. (Again, see the experiences of Jeb Bush, Marco Rubio, Ben Carson, etc.)

IAPSP Psychoanalyst Heinz Kohut is best known for the development of Self Psychology and authored a book entitled The Analysis of the Self: A Systematic Analysis of the Treatment of Narcissistic Personality Disorders.

What IS one to do?

There is a school of psychological theory and psychotherapy practice that specifically addresses this issue. This is not to say that a narcissist can be contained in other situations by a person trying to be “therapeutic” – that is a prescription for disaster. However, the interpersonal techniques described by Self Psychology can be brought into play with much more effectiveness than any other type of response. Self Psychology was initially developed by Heinz Kohut during the late 1960s and early 1970s.

Note: Author Dr. Reiss had the honor of having been personally supervised in the theory and use of self-psychology over 30 years ago, by eminent psychiatrist Sanford Shapiro, M.D., and continues to use that knowledge clinically on an almost daily basis.

Relevant to this article, applying the theory of Self Psychology to responding to a narcissist can be (heavily) distilled to three rather simple “Rules for Playing with No Rules”:

1) Empathize with the affect (emotion).

2) Do not directly attack the person.

3) Confront the behavior.

By definition, narcissists are emotionally empty and needy, mercilessly craving attention and adulation. In the eyes of the narcissist, others are seen as useless, worthless, or enemies if they are not constantly feeding those emotional needs. If you address a narcissist without signaling respect for those needs, you will immediately be viewed as either useless or a potential source of humiliation, and, as such, someone to be used and discarded, humiliated, attacked, or worse.

Thus, the opening gambit must be to present the narcissist with a small, benign offering, thereby disarming the immediate defensive attack. This can be done through a simple statement that implies at least a modicum of respect for some realistic, but minor (or even imagined), aspect of the narcissist’s grandiosity. In addition, due to the persistent need for adulation and praise, the extreme narcissist is unlikely to view the offering as patronizing.

Of course, if that is all one does, that is the making of a sycophant who will inevitably be defeated.

If, after the initial connection, there is a direct criticism of the person, no matter how diplomatically phrased, “all bets are off” and the narcissist will immediately turn his/her rage and disgust upon the other person.

CNBC Now a subject of the President’s ire, Morning Joe hosts Joe Scarborough and Mika Brzezinski initially provided a source of adulation and reinforcement for then-candidate Trump. The dynamic changed when the hosts began to confront and criticize Trump’s character and public behaviors.

However, if the leverage gained by the initial “compliment” is then used, jiu-jitsu style, to address a behavior rather than to attack the person, the narcissist may be “boxed in.” The narcissist will want to hold on to the (even small) “feeding” and will be unable to simply “turn the tables” on a personal criticism (e.g., “I’m not that, you are that…”). The narcissist may then be able to relinquish the inappropriate behavior without feeling attacked or suffering a loss of self-esteem; or at times, the narcissist will be flummoxed into regression, slinking away as would a small child admonished by a parent.

In a treatment setting, such an intervention often takes the form of a therapist responding to a narcissist’s rage (toward the therapist or regarding some outside person or event) by saying, “It must be really frustrating for someone as (knowledgeable/experienced/thoughtful) as you to have your efforts (fail/be rejected/be disrespected).” More times than not, the narcissist will fully agree that to be the case. That is, the frustration will be acknowledged because the underlying imagined grandiosity has not been attacked.

Then, without directly confronting the fallacious grandiosity (i.e., that the narcissist actual is neither knowledgeable, experienced, nor thoughtful), the therapist can use that momentary bond to direct attention to a behavior, “Let’s see what you might have done differently that could have led to a better result.”

An experienced therapist, working with a narcissist who is at least willing to engage, may then be able to begin to explore the dysfunctional behaviors. If this pattern goes on for a long enough time (which may range from days to years to never), eventually, the therapist may be able to directly address the narcissistic pathology – but we will save that story for another day.

Applying this to the Clinton-Trump interchange, there was an Option C that may not have occurred to Secretary Clinton in that moment. Despite Trump’s avowed disdain for Clinton, it must be recalled that at least at one point in time, he desired the adulation of Bill (and possibly Hillary) Clinton, to the extent of having invited them to his wedding and having greeted them as “friends.” Perhaps Secretary Clinton could have played upon this history, beginning by offering Trump a small nugget of empathizing with his grandiosity.

Option C: Trump weasels up behind Clinton, “stalking” while making facial gestures upon which she, understandably and appropriately, “feels the creeps.” Clinton then steps aside, turns to Trump, looks him in the eye and says calmly, “Donald. Most mature men with your experience and status (the serving has been offered) would show better manners than to wander directly behind a debate opponent (confronting the behavior, not the person) at an important event such as this (another small offering). Clinton then turns away and totally ignores Trump, going on with her response to the question at hand.

Trump would not have been able to say anything like, “I’m not intimidating, you are…” or “I’m not creepy, you’re crooked…” If Clinton went right back to her debate discourse as if she had just admonished a child and it was “no big thing”, Trump would not have been able to say anything without looking horribly foolish.

Yet Hillary Clinton would have made clear to all that she was aware of how inappropriate Trump was being, that she would not let him “get away” with it – and she would not let him distract her from her intended course.

Would it have worked that way? Hell if we know. But no other strategy had a prayer.

About the Authors:

David M. Reiss, M.D. has been a practicing psychiatrist for more than 30 years, specializing in “front-line” adult and adolescent psychiatry. He has evaluated and treated over 12,000 persons of diverse social and cultural backgrounds, from every occupational field. Dr. Reiss has been recognized internationally for expertise in character and personality dynamics. He is often interviewed and quoted in the print, Internet and radio/TV media, nationally and internationally, to help the public understand the psychological aspects of current events. He is an authority on issues regarding social and political phenomena, medical and mental health treatment, PTSD, violence in society, and the functioning of the current mental health system.

Seth Davin Norrholm, PhD is an Associate Professor of Psychiatry and Behavioral Sciences at Emory University School of Medicine, a full-time faculty member in the Emory Neuroscience Graduate Program, and a member of the Emory Clinical Psychology Graduate Program. Dr. Norrholm has spent 20 years studying trauma-, stressor-, anxiety-, depressive-, and substance use-related disorders and has published over 85 peer-reviewed research articles and book chapters. The primary objective of his work is to develop “bench-to-bedside” clinical research methods to inform therapeutic interventions for fear and anxiety-related disorders and how they relate to human factors such as personality, genetics, and environmental influences. His work receives funding from the Department of Defense, NATO, and the Brain and Behavior Foundation. Dr. Norrholm has been featured on NBC, ABC, CNN.com, USA Today, WebMD, POLITICO Magazine, Scientific American, and is a regular Contributor to The Huffington Post.