The Arduous Work of Treating Narcissism: A Therapist’s Guide
Narcissism is difficult to diagnose and treat. As with all personality issues, the narcissistic traits a person possesses exist on a continuum. Not all people with narcissism are the same, and treatment approaches vary from individual to individual. This article is written as a basic guide for treating a person who either self-identifies as narcissistic, or one you identify as having narcissism.
Please note the steps below may need to be repeated over and over again, and not necessarily in order.
Step 1: Understand Narcissism
The therapist must be well versed on what it means to be in a narcissistic relationship. It is one thing to read about narcissism, another altogether to be in a close relationship with someone with narcissistic qualities. Many therapists have no idea how intoxicating, exciting, and heart-wrenching life with a narcissistic person can be.
Understand that the three main traits of narcissism are sense of entitlement, lack of insight, and lack of empathy.
Step 2: Build the Therapeutic Alliance
The therapist must require two things from the therapeutic relationship with a person who has narcissistic tendencies: respect and collaboration. Respect for and collaboration with others is challenging—some might say impossible—for people with narcissism. They will be learning how to practice these interpersonal skills in real time, in vivo, in their relationship with the therapist.
Step 3: Identify the Defenses
The narcissistic person’s defenses come in the form of personality modes or personas (think multiple personalities, but different). The therapist must endeavor to help the person identify some of the protective personality modes they use throughout life. Here are some common examples:
- The critic
- The judge
- The detached persona
- The addict
- The womanizer
- The entitled one
- The victim
- The abuser
- The manipulator
- The rage-aholic
- The superior one
- The bored one
Note: This list is not exhaustive. Therapists should work collaboratively with each person to identify their unique defenses.
All of the above-listed personas are protective personalities that people with narcissism use for emotional protection. The two feelings people with narcissism tend to avoid at all costs are neediness and vulnerability.
Step 4: Identify the Underlying Triggers
The underlying schemas are what cause the need for the protective personas. Think of schemas as triggers or buttons that are pushed when someone causes what is known as a “narcissistic wound.” Here are some common triggers experienced by people identified with narcissism:
- Feelings of emotional abandonment
- Feelings of inner defectiveness
- Feelings of lack of control or security
- Sense of emotional deprivation
- Fear of ridicule or shame
Through both role modeling and psychoeducation, you can teach a person with narcissism about the need for re-parenting the early attachment wounds they have experienced.
It is difficult to identify these underlying triggers because you are working with someone who may have low insight and who may be emotionally “split off” or “blocked” from feeling these vulnerable and devastating emotions. You will likely encounter a protective mode before you will identify the underlying “root” of the problem. Understand that the primary emotional experience the person with narcissism is avoiding is a sense of shame. Rather than experience this sense of shame, the person “flips” into a protective mode.
It is important to help the person with narcissism to manage these underlying feelings of shame by teaching self-compassion and offering healthy self-soothing strategies. Also, as you remain in the relationship with the person, being present with them as they dare to “go there,” they will hopefully learn how to experience and process through relational “demons.”
Step 5: Develop an Inner Healthy Adult/Parent
The job of therapy is to help the person with narcissism learn to re-parent their inner hurt child. The inner child is responding to early attachment trauma or some other type of lack of emotional attunement as a child. Without going into a complete analysis of the causes of narcissism, suffice it to say a developmental component exists.
Developmentally, as a child, the person with narcissism was not properly emotionally regulated in the inter-relationship with the parent(s). This may have caused the child to develop “split off” protective personas as defenses to protect their inner sense of shame.
Teaching the person with narcissism to re-parent their inner hurt child, through the process of imagery, is effective and powerful for initiating healthy change in the person’s inner world.
Step 6: Heal the Inner Child
Even before a person with narcissism learns to re-parent themselves, you, as the therapist, can begin the process by trying to meet their inner hurt child and begin bonding with them. You can be a healthy role model, offering a “corrective emotional experience” for the person. Perhaps you are the only person who has ever been able to reach their inner child in a way that represents safety.
Through both role modeling and psychoeducation, you can teach a person with narcissism about the need for re-parenting the early attachment wounds they have experienced. They may deny they have any such hurts, but explain to them that their behavior “tells on them.” Do not argue with the person; rather, simply state and instruct what is happening.
Step 7: Develop a Recovery Plan
Not only is it essential to heal the inner world of the person with narcissism, it is also important to identify all of the person’s “bottom-line behaviors” and begin a “program of recovery.” In essence, treat the narcissistic symptoms as part of an addiction of sorts that needs to be put in remission.
Here is a list of some possible items to go on the abstinent (“no-fly zone”) list of the person with narcissism:
- Entitlement
- Blame
- Womanizing
- Substance abuse
- Yelling
- Silent treatments
- Dramatic exits
- Passive-aggressive behaviors
- Manipulation
- Defensiveness
Help the person identify their own “go-to” strategies for self-protection.
Conclusion
As you can see, helping a person with narcissism to heal is a challenging endeavor. While you are working within this relationship, make sure you take care of yourself. I will end by offering these final words of advice for self-care:
- Require and model respect.
- Consult often; debrief after each session.
- Exercise and take care of your physical health.
- Do not personalize the behaviors of people with narcissism.
- If you feel defensive, back off, take a deep breath, change something.
- Do not have a power struggle with the person you’re trying to help.
Remember: While it takes hard work to help a person with narcissistic qualities, there is little to be gained from working harder than they do.