Working Therapeutically with Someone in a Narcissistic Relationship

In September 2021 Brighton Therapy Partnership hosted an online workshop on ‘Narcissism and Working with the Children of Narcissists’ (on-demand catchup available) with our brilliant guest speaker Professor Julia Buckroyd. You can watch the trailer below.

Ahead of the workshop our guest blog from therapist Tess Taylor explores narcissism, how to identify a client who may be dealing with someone with the disorder and how to work with them in therapy.

What is Narcissism?

Narcissism is “too much interest in and admiration for your own physical appearance and/or abilities,” according to the Cambridge Dictionary.

But what is “too much”? Where is the line between self-love, valuing yourself, and being able to put your own needs first, and being a narcissist?

What is narcissism - a definition

Understanding Narcissism in therapy

Narcissistic Personality Disorder (NPD)

Narcissistic Personality Disorder (NPD) is characterised by “dramatic, emotional or erratic” behaviour, according to research from the Royal College of Psychiatrists. People with this condition usually have a grandiose sense of self and excessive need for attention and admiration.

They are likely to:

  • Have a strong sense of self-importance
  • Prioritise their own needs above all others and expects others to do the same
  • Be resentful of other people’s successes
  • Desire unlimited power, success, beauty and intellectual brilliance
  • Need validation and admiration from others for their self-worth
  • React negatively to criticism
  • Lack empathy for others.

People with NPD are less likely to seek help from a counsellor or psychotherapist. It is usually someone in a relationship with them who will end up needing support and insight into what they are experiencing. This could be their spouse, partner, colleague, close friend or child. However, there are people who show strong traits of narcissism who may seek help when an event leaves them feeling less valuable or less important.

Variants of Narcissistic Personality Disorder

There are broadly two subtypes of NPD which have emerged from clinical writings and research:

  • Grandiose subtype
  • Vulnerable/hypervigilant subtype.

The grandiose narcissist is characterised by extraversion, low neuroticism and overt expressions of feelings of superiority and entitlement. Owing to their grandiosity, they believe that they are somehow above the rest of us, and that they, therefore, are entitled to special treatment. In their view, our job is to cater to their needs. They are true egomaniacs.

The vulnerable/hypervigilant narcissist is characterised by reflecting introversive self-absorbedness, high neuroticism, hypersensitivity even to gentle criticism, and a constant need for reassurance. You can find out more about these two subtypes here, in an article by Dr Berit Brogaard in Psychology Today.

Kernberg and Kohut

The contrast between the two are presented in the psychoanalytical writing of Otto Kernberg (1975) and Heinz Kohut (1971).

According to Kohut, a narcissistic person alters between “irrational overestimation of the self and irrational feelings of inferiority,” relying on others to regulate their self-esteem and give them value.”

The therapist’s role is to help the client feel understood, help them recognise intense feelings of narcissistic injuries, including those experienced by the therapist, and allow them to develop self-regulation of their own value and self-esteem.

You can read an in-depth academic article about Kohut’s self-psychology model in this following piece by Jamie McLean (October, 2007) published in the US publication Psychiatry (NCBI: National Center for Biotechnology Information): Psychotherapy with a Narcissistic Patient Using Kohut’s Self Psychology Model.

Managing narcissistic personalities

Managing narcissistic personalities

Kernberg’s theory focuses on the effect of object relations on self-esteem. He believes NPD develops as a result of experiencing being let down in early relationships and that it is a pathological development, where aggression is the central role.

His methods for treatment follow Freudian thought, where the therapist should remain neutral rather than supportive. The emerging defences of grandiosity and idealisation are then interpreted and confronted. The aim is to modify the narcissistic pathological structure of the client’s personality.

The website shares a helpful breakdown of Kernberg’s concepts and explains the different narcissistic concepts, for example, what normal adult narcissism and infant narcissism might look like, as well as explaining Kernberg’s definition of NPD. You’ll find the Learning-Theories article here – Narcissism (Kernberg).

What is the impact of being in a narcissistic relationship?

Common experiences in clients who are in a narcissistic relationship are:

  • Being controlled
  • Feeling lonely
  • Low self-esteem
  • Feeling unimportant/invisible
  • Lack of independence
  • Experiencing a lot of emotional distress

In therapy, many clients who are in narcissistic relationships may feel unable to really connect, for fear of abandonment. It is common for them to want to please the therapist, ensure they are on time and abide by the rules. The need for positive feedback and reassurance may also be present (see the work done by Sue Gerhardt in her book “Why Love Matters” ).

So, as therapists, we need to understand the relationship that the client is drawn into and explore the reasons for this. In a “chosen” relationship, usually both sides receive something from each other; a need is met, whether it is conscious or unconscious, healthy or unhealthy.

Often when clients have grown up with narcissistic care givers, they are drawn into relationships as adults with narcissistic partners. This is usually an unconscious attraction, which evokes familiarity from their past experiences of relationships. The client then has the ability to exercise well-learnt skills of wanting to please their partner, whilst pushing aside or not prioritising their own needs. They become co-dependent on their narcissistic partner.

A relationship between a narcissist and a co-dependant can be likened to a ‘dance’. In order to dance well together, one partner is the leader and the other is the follower. It feels magnetic and familiar. For the co-dependent person, this ‘dance’ can feel like a positive experience. This is because they are using their already-established skills of picking up on cues of their partner’s needs and then fulfilling them.

A relationship between a narcissist and a co-dependant can be likened to a dance

A relationship between a narcissist and a co-dependant can be likened to a dance.

Sometimes they predict those needs even before the narcissist is aware of them. This means they are offering safety and security in the relationship, which can evoke feelings of pride in the co-dependent partner. This dysfunctional attraction usually progresses from initially experiencing their narcissistic partner as ‘perfect’ to, as time goes on, ‘so wrong’ or even ‘harmful’. As Ross Rosenberg says:

“The soul mate of your dreams is gonna become the cellmate of your nightmares”.

You can read more about this idea in Ross Rosenberg’s article in the US publication Counseling Today called The dance between codependents and narcissists.

What is it like having a narcissistic parent?

Allan Shore offers a theory that describes a common childhood experience with a narcissistic parent by viewing the baby stages as well managed. The baby is under the parental control, which is what narcissists enjoy, receiving feelings of power and being needed.

Once toddler stages are reached, and the child develops its own mind, a narcissistic parent tends to struggle. Their own needs are no longer being met and they find the child increasingly wanting separation unbearable.

The parent may then become inconsistent towards the child. They feel able to give the child what he/she needs in one moment, then unattuned, withdraw, and even be resentful in the next moment. This creates an insecure attachment.

Emotional development in infancy is closely related to social interaction. Toddlers need help with managing their feelings from their parent in order to be able to self-regulate later in life. This includes controlling their own behaviour and learning to not act impulsively.

A narcissistic parent does not provide this important regulation. Instead, they tend to evoke shame and humiliation, causing the child to lose confidence in the relationship. They may become prone to depression, triggered by loss or humiliation.

Narcissists often fail to give the tools of self regulation to their children.

Narcissists often fail to give the tools of self regulation to their children.

Children of narcissistic care givers often experience:

  • Emotional abuse/neglect
  • Trauma
  • Excessive criticism and excessive praise
  • Vulnerability being unacceptable/intolerable
  • Unrealistic expectations

While it is often unlikely that a client with strong traits of narcissism or NPD seek out therapy, they may reach out if they have experienced a live event that has left them feeling very unimportant, for example. Understanding the ‘why have you come to seek therapy now?’ can help with uncovering where the client places the responsibility for their need for therapy.

How to work with your client who is in a narcissistic relationship

It is most likely that as therapists we will be working with clients who are in relationship with a narcissist.

Providing a good therapeutic relationship is the first starting point. We need to understand the client’s past experiences in order to gauge how they may experience a relationship with a therapist.

The client is the focus in therapy, which could initiate feelings of uncertainty or discomfort. They may come into therapy with ambivalence about whether it will work. The client could find it very difficult to talk about painful feelings for fear of being misunderstood or being “too much” to handle.

As a therapist, some main aims in helping a client who is in a narcissistic relationship are to:

  • Help the client to understand what they are drawn in by and the feelings that are evoked.
  • Explore and understand the persistence of their “needs being met” in a dysfunctional way, including past experiences.
  • Educate and bring awareness to how to identify narcissistic traits.
  • Help the client increase their self-confidence, self-esteem and their own identity.
  • Make space to understand and prioritise their needs rather than their partner’s.
  • Support their growth to break the repeated patterns which are harmful to them.
  • Encourage relationships that are healthy.

There are different methods of therapy used to help clients who show strong traits of narcissism or has NPD. Counselling, psychotherapy and typically CBT can all be helpful.

As a therapist helping a client who shows narcissistic traits, some main aims are to:

  • Build and maintain a positive therapeutic alliance, while being aware of negative feelings being evoked in themselves.
  • Assess the different subtypes that the client presents.
  • Aid development for the capacity to experience vulnerability as less threatening.
  • Explore the root causes and examine early years relationships.
  • Help the client identify their narcissistic behaviours and the impact of them on themselves and others.
  • Enable learning and develop new patterns of thinking.

If you want to read more about the treating clients with NPD you may find it helpful to read an academic paper called Principles Of Psychodynamic Treatment For Patients With Narcissistic Personality Disorder by Holly Crisp, MD, and Glen O. Gabbard, MD which was published in the Journal of Personality Disorders (2020).


Narcissism tends to display as a personality trait that exists on a spectrum. NPD is a diagnosable mental illness. Usually, the client who seeks out therapy tends to be in a narcissistic relationship; they are the co-dependant, rather than the narcissist.

Awareness of the relationship dynamic that is played out between the two, and how that can impact on building a therapeutic relationship, gives insight and awareness for what may be triggered in the transference and countertransference.

A therapist’s awareness of their own relationship with narcissism may alleviate strong projections and projective identification occurring in the work. Gaining an understanding of the root causes around a client being drawn into a dysfunctional relationship pattern allows for growth into healthier relationships both with others and themselves.

Guest blogger Tess Taylor is a psychodynamic counsellor working in private practice on the outskirts of Tunbridge Wells. She trained with and then worked for The Counselling Centre, a non-profit charity that provides affordable and accessible counselling. During this time, she gathered extensive experience working with a wide variety of presenting issues. Tess specialises in working with trauma, relationship difficulties and addiction. Her work is her passion along with writing, yoga and being a mum.

If you would like to learn more about narcissism and working with the children of narcissists, you can watch our online workshop via our streaming platform Therapy Education Online. Presenter Julia Buckroyd is Emeritus Professor of Counselling at the University of Hertfordshire, and has published numerous books on the subject of disordered eating. During our CPD workshop she explores the genesis of narcissism, the impact on children of narcissists and how, as therapists we can work with this client group. Watch the trailer below.

*There are affiliate links in this post, if you buy a book from one of these links we get a very small fee. Every little helps – Thank you *

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