The Challenges of Couples Therapy with A Narcissist

By: Brian Murray LMHC, NCC

Narcissistic Personality Disorder (NPD) is a mental health condition that manifests in an overinflated sense of self-importance. Roughly 70% of those who have the disorder are men. In the United States, it is estimated that roughly 6% of the general population has the disorder.  NPD in a clinical setting is typically rated on a spectrum from mild to severe. In order to be diagnosed with NPD, a person must meet the required number of symptoms as indicated in the Diagnostic Statistical Manual version 5 (DSM-5). This manual is a reference published by the American Psychiatric Association (APA) that lists diagnosable mental health conditions along with the criteria needed to meet the diagnosis.

 

The best way to interact with a narcissist is to focus on their behavior rather than on their words. Pay attention to what they are doing and look for patterns. If you focus only on what they are saying you stand a good chance of being gaslighted. Gaslighting is where the narcissist denies, alters and changes what you, or they, said in an earlier conversation. When you question them or point out a contradiction, they will say something along the lines of how you did not remember it correctly, misunderstood them, it was a joke, you’re crazy or some other comment that makes you question yourself. Over time, the victim of gaslighting begins to question their ability to remember information correctly and may even question their own sanity. As long as the narcissist keeps the victim confused they feel like they are in control of the relationship.

 

Behavior patterns to watch out for are self-centeredness, arrogance, haughtiness, lack of empathy, inconsideration, and an excessive need for admiration. They are very braggadocious about who they know or have spent time with, such as high status and popular people. Additional behaviors to watch for include being superficially charming, cocky, manipulative, selfish, belittling, critical and demanding of others. Superficial charm is something they do to dazzle you into thinking they are wonderful.

 

If you believe you are in a relationship with a narcissist, chances are you have hope that a counselor will change them. Unfortunately, this rarely happens. Narcissists are highly resistant to the therapy process because they rarely gain insight into their own behavior and how it is affecting others. This is because they lack empathy. Narcissists have an external focus of control and so they blame others for their problems. This is called blame shifting. Through blame shifting they place themselves in victim mode. This can be observed through behavior that everyone else is the problem and not them, and this is the reason it’s very difficult to get a narcissist to own and change their behavior.

 

In couples counseling, the narcissist becomes extremely sensitive and reacts negatively to even the slightest of clinical interventions or disagreements. They view interventions as criticism and personal attacks. Most people and even some counselors will go along with them unless you enlist the help of a counselor who specializes in the disorder. Learning how to develop healthy boundaries can thwart a narcissist’s attack and introducing replacement behavior can change them. Counseling a narcissist for authentic change is difficult and can take anywhere from 6 months to 2 years, depending on severity. Usually the narcissist runs out of patience before therapy can have any lasting effect.

 

It’s very common that even when a narcissist leaves counseling the spouse continues to attend. For the spouse, learning new skills on how to take care of themselves in the relationship is imperative in order to survive it. However, this process in the long run can prove exhausting. Even with the greatest of boundary skills, the constant narcissistic badgering can prove too much, leaving most with no other option than divorce.

 

If you are in relationship with a narcissist, please seek help with a professional who is well versed in the disorder. There are tools available for you to identify harmful behavior and develop strategies to protect your mental health and wellbeing.

  To schedule an appointment with Brian Murray,
  Please call our office at 407-647-7005.
  www.lifeworksgroup.org