The Narcissist in the Room: Therapist's Guide to Navigate Working with Narcissism

One of the most challenging things in therapy is to deal with a client who stands in his  way of growth and betterment. The spectrum of personality disorders poses the same challenge. Within this spectrum, narcissism is one of those difficult personality types, which poses a dare for the therapist.  

“Narcissism is voluntary blindness, an agreement to not see beyond the  surface.”- Sam Keen

The three main characteristics of narcissism are entitlement, lack of empathy and lack  of insight. Dealing with a narcissist is an entirely different ball game. It is a very  arduous process where the therapist has to ensure that the client looks beyond himself,  which is exactly what he struggles to achieve. Hence, the first step while working with  narcissists is to understand their personalities. It is important to read about this  personality type so that the therapist is thorough with its features and can identify them in a client.  

Key signs of Narcissism

While the next step may seem extremely strenuous, it is the foundation of therapy forming a therapeutic alliance. Here are the steps (almost) a guide to working with clients with narcissist trait.

Narcissism is very draining; it is stressful to deal with.  So, after understanding the signs of a narcissist and identifying them as one, we need  to ensure that we are capable of changing and forming a therapeutic alliance with  them.  

It is important to understand that we are dealing with a person who wants all the respect and attention for themselves and will not be in a space to collaborate with us.  So, dealing with them while keeping that in mind is a good idea. With time, trying to  work on these interpersonal skills with respect to their relationship with us, that is, their therapist, is the need of the hour. 

While working on your relationship with the client, maintaining clear boundaries and calling them out on unacceptable behaviours will help you maintain your sanity. Empathizing with a narcissist can be tough but understanding that this is how they  function will help you keep personal opinions aside while building a therapeutic  alliance with them. However, this can be challenging considering that narcissists  show no signs of empathy and understanding, which brings us to our next section.  

According to Barbara Heffernan, a life coach and psychotherapist, although narcissists are incapable of empathy, they know the emotions and feelings of other people. However, their primary motive in life is to gain traction and they lose interest  in anything that does not align with that.

Therefore, understanding their triggers will help you navigate with them in a way that they don’t give up on therapy. 

She also mentions that it is very common for such clients to leave after 3-5 sessions  and hence, retaining them and helping them will need you to recognize their triggers  and defence mechanisms while actively building rapport with them. 

Redirecting their focus and helping them to focus on their problem behaviours can be  a major trigger for them as they stay under the impression that there is nothing wrong with them. So, using adequate therapeutic techniques from cognitive behavioural and dialectical therapy can help bring that focus to the right place.  

According to research, you can use a combination of techniques from psychotherapy,  cognitive behavioral therapy, gestalt therapy and transference-based psychotherapy to help deal with clients exhibiting narcissism. The aim is to understand their past and help manage  

their thoughts and feelings while realizing their negative schemas and unhelpful patterns.

Doing this in a way that they don’t feel attacked and stick with the process is crucial  for the alliance to succeed. While there may be no one tried and tested way to deal  with narcissistic clients, understanding the above techniques and borrowing from  them can help.  

As Claire Law, a relational psychotherapist and author, puts it, “when the narcissist  flies off the handle or make outrageous demand, validate how they’re feeling without  agreeing with the unacceptable behavior. This shows empathy while still upholding  your standards.”

So remember, taking care of your boundaries and calling them out  wherever necessary is as important so that you don’t feel stressed and tense.  

Dealing with clients diagnosed with narcissism requires a deep understanding of their past and emotional  traumas but can only be successful after they put in the necessary work too. 

For we can only help someone after we have helped ourselves.