Sonya Thomas lcsw

Narcissism – Part 2 of 3

Picking up in our series on narcissism, today we will look at treatment concerns.  There are several important factors when considering whether treatment/therapy will be effective:

  • Leverage – something must matter ENOUGH to a person to get them into treatment/therapy; a job, a marriage, a relationship with their children, a health scare, etc.  The inspiration for treatment may spring from the stakes being high enough, and the consequences too painful to bear if they avoid treatment.
  • Staying in treatment long enough for it to bear fruit is influenced by the therapist being sturdy enough to maintain his/her equilibrium in the face of narcissistic protest.  The therapist will eventually see patterns playing out in the therapy room that exists in the narcissist’s life outside of therapy, such as externalizing, insensitivity, rigidity, etc.
  • Related to the above, it is crucial to remember that externalizing by the narcissist does not have to be on-boarded.  This is true for both the therapist and the partner of a narcissist.
  • Because the narcissist is exquisitely sensitive to perceived criticism, feedback should be delivered pre-emptively with an assurance of genuine concern for their well-being rather than as a counter-attack.
  • Working with the partner of a narcissist to emancipate them from the effects of the externalizing behaviours is important.  The partner will have to develop a bit if “Teflon”.  As therapy unfolds, we want to work with the partner to realize that what they are experiencing is actually not personal, even though it can certainly feel as if it is so.
  • Related to the above, helping to deeply understand the complexities and history that went into shaping a persons psychology is important.
  • Finally, working to treat narcissism is not a short term project.  Managing expectations and a lot of repetition of empathic confrontation, limit setting, etc. is all part of the process.
  • Acknowledging that some people won’t change is also necessary.  Everyone must come to understand what their limits are.