Posted by: counselorcarmella | August 12, 2011

The Narcissist In Therapy

Narcissists don’t  go to counseling because they realize they’re selfish and lack empathy.  They rarely have  insight into  their ways of being.  Diagnosing any personality  disorder can take time and experience getting to know the client. It can be difficult to diagnose a narcissist.  Problems such as depression,  anxiety disorders, substance issues, and  other mood disorders are common and  those symptoms  may have to be addressed before the counselor can get a sense of what is underneath them.   Instruments such as the Personality Assessment Inventory,  the Narcissistic Personality Inventory and  others may provide additional helpful information.  Getting collateral information from  loved ones, including information about the  client’s childhood circumstances,  can be enlightening, as well.


There are some “red flags” that may  alert the therapist to possible narcissism. Whether its symptom relief or something else, therapy is usually about an agenda they have. Everyone should come in with goals in mind, but agendas  are different than therapy goals. That’s been my experience. They want a letter written to someone  helping them get something they want, whether its to DSS, trying to file for disability,  needing counseling for  PTI due to  having committed a crime,  trying to get FMLA from work, needing a psychiatric explanation for why they  should receive certain  special consideration, or  wanting something for an attorney or whatever.  Maybe someone has told them it will look better for them if they go to  a few counseling sessions.  They want their  spouse not to leave them so they  agree to see me  a few times. Sometimes, they want  me to  tell them what they can do to get what they want, as far as getting another person to see things their way.  Other times, they want me to  agree with them that they’re right about something.


Many narcissists come across as charming but shallow.  Obviously, their  comments  tend to be self-focussed and  they  don’t tend to admit to mistakes or be very open to considering  another person’s perspective.   They can  easily become defensive. They  often present with a sense of entitlement.  They often start trying to get special  accommodations. These might be longer sessions, not having to  pay their copays,   or wanting to  talk to the therapist a lot between sessions.  They  act as if they are the most important client the counselor has.


Narcissists often have histories of  job and relationship problems.  They  got fired  because they  wouldn’t  do things the way they were asked to, were disrespectful to  those in authority,  or  because they  became difficult to get along with. Or, they  have quit job after job because they felt unappreciated.  Many try and go into business for themselves but can’t keep employees. Common  professions for narcissists  include doctors, lawyers, pastors, and  politicians.  They like high-status jobs where they can have a lot of influence and where they can  receive admiration and appreciation. They may have a lot of financial problems because they’ve tried to find happiness in possessions or “buying” love. 


They  may  be upset because someone in their life is trying to set limits with them.  Someone may be fed up with their selfishness and lack of sensitivity. They may be upset that a parent, child, or spouse  has called them out on unacceptable behaviors, such as lying,  being unfaithful,  or exploiting other people in some way. They may want help convincing another person to change or want the counselor to “fix” someone in their life who is causing them some sort of difficulty or inconvenience.   


Narcissists are usually not good therapy candidates. They  try and discredit or one up the therapist and  blame all their problems on other people.  If the counselor doesn’t say what the narcissist wants to hear, they  usually discontinue counseling. If change doesn’t happen quickly, they usually  don’t have patience for the process and decide counseling can’t help them.  Many of them come in  wanting a “quick fix” for their  distress or an easy solution for the problem they have. If the counselor can’t  do what they want, they  give up and disappear.


There isn’t  much solid research on what really works when treating a narcissist.  Meds can be helpful with certain symptoms, but don’t change  personality and core ways of thinking and relating. Few narcissists can have the insight or  patience to truly pursue lasting change. Factors such as  willingness to  trust the  therapist,  willingness to    be honest and open to their real feelings and   life experiences, and  a realization of how certain ways of being aren’t “working for them,” make the narcissist  more  likely to benefit from counseling. Recently, treatments that combine the directive aspects of cognitive-behavioral therapy with interpretive, transference-based psychodynamic techniques have been formally studied and proposed as an additional model in the range of approaches to narcissistic personality disorder.


Regardless of the type of therapy used,  therapists should be prepared to set firm boundaries  with  narcissistic clients.  They should be clear about what they can and can’t do  in  the role of counselor. clients who display strong features of narcissism should be carefully screened for substance abuse issues and suicidal thinking. They very likely will not tell the truth about these issues, but  other  family members may “narc” on them out of concern for the  narcissist’s well-being.


clients believed to be suicidal should be asked to sign a safety contract. Family members should be   instructed about how to respond to threats or gestures. I tell them to call 911 rather than going to  the person’s home themselves since suicidal gestures made by a narcissist are often engaged in to get what they want, which is more attention from particular people.    To stabilize the patient, a brief, goal-oriented hospitalization may be necessary. 


Patients with personality disorder who have children should be asked frequently and in detail about their parenting practices. Their low frustration tolerance, externalization of blame for psychological distress, and impaired impulse control put the children of these patients at risk for neglect or abuse.  Domestic violence may  be an issue, as well.  Some narcissists even come in with a  spouse to try and tell the therapist what needs to be “fixed” about that person and  to try and control the therapy. They’ll claim their spouse has some sort of major problem that needs to be dealt with or  want us to “fix” their kid.  They don’t want to be told anything they might do differently to help the situation, though.



  1. […] ''; } Narcissistic Personality Disorder – Clinical Features{clickbanktitle}Narcissistic PersonalityThe Narcissist In TherapyCufon.replace('#header h1, #header h3', { fontFamily: "" });Cufon.replace('#header p.tagline', { […]

  2. Urgently seeking advice!

    For the last few years I have been in a troubled marriage. The serious problems started when my husband’s parents got involved in our relationship. Being a psychology student, following lots of reading, I hv no doubt at all that my father-in-law is a very serious case of NPD and my husband is his co-dependent. My parents-in-law were not happy with our marriage, since it was inter-community and the son committed to me without their approval. Further i became a serious threat to them because i could see thru my father-in-law’s manipulative pressure tactics and protested to my fiance/husband against his father’s obsession to control my life and our relationship. My in-laws hv left no stone unturned in creating conflicts and misunderstandings between me and my husband as well as him and my family. My husband shockingly seems hypnotised by them – he seems under a SPELL. Even though he knows I hv been trying my best to maintain peace, he becomes devilish under their influence — ridiculously blaming me, insulting me and my family, and pressuring me to fall in line with his parents’ wishes. I hv tried my best to prove my innocence, be patient with him and maintain peace. When I point out the two-faced manipulations of his parents, he choses to be blind to the facts. Instead he becomes furious at me. Unfortunately his father seems to be doing well professionally (no surprise, knowing his eerie power to control people, changing colours like a chameleon) — his success makes his son and family feel even more enthralled by him, and act even more dictatorially.
    His parents influence seems increasing and I am scared because i sometimes see him mirroring his father’s feudal mindset and manipulating/controlling tactics. Things are turning more and more ugly and I am now reaching the end of patience since my husband is not showing any signs of improvement. He treats me like a doormat when influenced by his parents, including repeated divorce threats and turning me out of the house. Later he comes and apologises profusely and emotionally, but reverts to misbehaviour within a few hours/days/weeks……this has been going on for over 2.5 years, and I hv lost all trust in his assurances. He is also suffering from ‘stress disorder’ and is on anti-depressants for 4 years (since before our relationship problems started) — but he blames me for his bad health and supposedly suicidal thoughts….another one of the vicious seeds planted by his parents). He refuses to seek CBT which has been advised to him for his stress issues…..I think he is afraid that the counsellor might point out to him the same harsh reality abt his parents and himself that he wants to stay blind to. He seems to me like a child wanting to stay in a world of his own, in his parents’ lap, unwanting to face life on his own, and seeing his parents like demi-Gods.

    Q.1) what is your view on this situation?
    Q.2) Can a codependent (e.g my husband) turn narcissistic with other people (e.g
    With me) under pressure?
    Q.3) with your experience, do you think there is any hope for our marriage?
    Q.4) What are the ways to deal with AND treat such a codependent?

    Please help!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s


%d bloggers like this: