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Therapy for narcissism

Narcissism is one of the more difficult disorders to treat (Young et al, 2003).People with narcissism find it difficult to give and receive genuine love. They were often emotionally deprived in childhood and as a result have learned to overcompensate for this by developing a conceited, self serving personality. They often appear entitled and expect a lot form others whilst giving little in return. Their motto seems to be “What’s in it for me?” They rarely practise self sacrifice and have little real empathy for others.

Not all narcissists are diagnosed with Narcissistic Personality Disorder (NPD) but many have traits consisting of: seeing themselves as defective.  They believe that any exposure of a flaw will lead to rejection. Many narcissists  have a ‘lonely child’ within them. They often have little awareness of this though. Feeling average is one of the worst feelings for a narcissist and this is why they surround themselves with high achievers and like to exaggerate their wealth, intelligence etc. Underneath all their bragging they are often excruciatingly insecure.

Therapists tend to work with the ‘lonely child mode’ and help the client to identify their inner loneliness and emotional deprivation and find ways to help the client to self soothe and nurture this inner void. Many narcissists cope with this void by being aggressive and lashing out at the slightest criticism. They also use dominance and bullying to protect themselves from being ‘found out’ and scared and vulnerable. They get so used to this pattern of behaviour that they begin to identify with this false persona and this makes therapy even more tricky.

Childhood origins of narcissism:

Loneliness and isolation

Insufficient limits (set by parents)

History of being used or manipulated

Conditional approval (by parents)

In treating clients with narcissism, therapists overarching goal is to help them learn how to get their core emotional needs met. Narcissists find it hard to accept genuine love, They can accept admiration, approval and attention but cannot take in love. They can often choose loving partners though but give very little back. They only give in order to get.

The three most common modes of narcissism:

Lonely child – they feel unloved and unloveable. Feelings of inadequacy dominate. This is the underlying feeling.

Self aggrandizer – Overcompensation for lonely child mode to protect themselves. In this mode they behave in an entitled, abusive way. They also seek status and behave in insensitive ways. This is the mode they use to deal with others.

Detached self soother – When alone, they usually flip into this mode of detached self soother. In this mode the shut off their emotions and engage in activities that will soothe them or distract them from feeling. In the absence of validation from others, the Lonely Child tends to surface and the detached self soother is a way to avoid the pain of the lonely child.

Narcissists and relationships

Narcissists often choose partners that will make them look good to compensate for their feelings in inferiority. They often devalue their partners in order to feel superior and boost their own self esteem. Some even become sadistic and humiliate their partners. The more the partner tries to please the more it backfires. The more the partner fights back, the more the narcissist will value their partner’s approval.

Therapy for narcissism

Therapy involves the therapist bonding with the lonely child, creating a safe environment without judgement. The therapist values the client for expressing vulnerability and gives the client unconditional positive regard. Clients are often not very self aware and don’t even realise they have problems establishing true intimacy. Through therapy, clients can begin to realise that they have been lacking true connections with others. The therapist encourages the client to stay in lonely child mode and meet those early needs in therapy. The same message is always given by the therapist – “It is you I care about, not your achievements or performance”.

Sooner or later the client begins treating the therapist the same way they treat everyone else – in a condescending or challenging manner. It is important for the therapist to stand up to the narcissistic client or else they will lose respect. The therapist needs to be appropriately assertive and set limits for their client.

1. Therapists empathise with narcissistic point of view and are tactful in confronting entitlement.
2. Therapists neither defend themselves nor attack back when the client’s devalue them. A therapist must rise above the content and not get ‘sucked’ into the narcissist’s world.
3. Therapists assert their rights nonpunitively. Example: “You are probably not intending to hurt me, and deep down what you are feeling is misunderstood, but I am not comfortable with the way you are speaking to me”.
4. Therapists do not allow themselves to be bullied by clients into doing things they do not want to do.
5. Therapists establish that the therapy relationship is mutual, based on reciprocity, not on master-slave principle.
6. Therapists look for evidence of underlying vulnerability and point it out each time it occurs.
7. Therapists rise above specific incidents and ask the client to explore the motivation behind entitlement, self aggrandizing, devaluing or avoidant statements. They do not get caught up in the content of arguments. Rather, they address the way the client is behaving and the effect this has on others.

One of the best ways therapists can show narcissistic clients that it is okay to be vulnerable is to be vulnerable themselves. Acknowledge when they feel hurt, admit mistakes are are willing to be imperfect. Even if these clients view this as weakness, it is still important for the therapist to express appropriate vulnerability. Narcissistic clients take time to shift their thinking and behaviour but with effective therapy and client motivation, a lot can be achieved.

Mandy X

Mandy specialises in Cognitive Behavioural Therapy and helps clients with Narcissism. Get in touch if you require Skype counselling or would like further information.

Author: Mandy Kloppers

Mandy is a qualified therapist who treats depression, anxiety, OCD, PTSD, trauma, and many other types of mental health issues. She provides online therapy around the world for those needing support and also provides relationship counselling.