Doing Couple’s Therapy With a Narcissist.

Therapy is always worth a try and can help with decision-making.

by Becky Whetstone, Ph.D.

A few years ago, I went to Los Angeles to attend Terry Real’s Relational Life Therapy training. He is world-renowned for his insightful take on male depression, healthy relationships, and narcissistic personalities in marriage, and has written several books on these subjects. (1) All are profound. Terry’s work is based on Pia Mellody’s’ model of Childhood Developmental Trauma; both he and I were trained in trauma by her, in his case many years before I did, and took what he learned and expanded it into a strategy for couples therapy. The fact that he has a plan for dealing with narcissists provoked curiosity because, in grad school, we were told those marriages couldn’t be repaired, and my personal experience has been that narcissists are in the top rung of most difficult people to do therapy with. Do they change? Not in my experience. I have met therapists who claim to love working with narcissists, but I find it hard to believe. I liken it to wrestling with someone four times my size with my hands tied behind my back. As soon as I pick up on the fact that I am dealing with someone with narcissistic traits, I take a deep breath and wonder why I became a couple’s therapist — it’s that hard.

So, no wonder I was willing to pay thousands of dollars to travel to get training from someone who has figured out a way to do it where you don’t come out blistered and bruised, and, you have a small chance at success. In the past, I would encourage each person to get individual therapy, but what I really wanted was for the spouse of the narcissist to get help to learn how to deal with their narcissist partner. They need to know if they are in an abusive relationship, find emotional support, and make sure they know how to get their emotional needs met on their own. Often, couples come in for couples therapy, stay briefly until I say something the narcissistic spouse doesn’t want to hear, and later, the long-suffering non-narcissist spouse returns on their own. They usually say something like, “You hit the nail on the head about my spouse’s narcissistic habits, and since you’ve met them, I want to do individual therapy with you.” That’s always a good idea.

Diagnosing a narcissist.

Narcissism is a hot topic, and the term may be overused in our culture. There is an official narcissistic personality disorder (NPD) diagnosis that psychiatrists created to define the phenomenon. It is found in the DSM V, the diagnostic manual for mental health professionals. (2) The DSM V lists specific criteria a person must meet, and the narcissist you love may or may not qualify for that. Also, people can have more than one personality disorder, and even mood disorders and other fine things on top of that, so diagnosing people accurately is a very difficult art indeed, and maybe impossible. A person who has three personality disorders or more is called a cluster, and yes, I imagine that is where the crude term you may now be thinking of comes from. A lot of the arrogant people we deal with in everyday life may have narcissistic tendencies, but don’t meet the criteria to qualify for the official disorder. In any event, therapists are loathe to give the diagnosis even if someone meets all the necessary bullet points, as insurance doesn’t cover therapy for personality disorders. Why? Unlike mood disorders like depression and anxiety, it’s not treatable, it is a finite problem that does not go away.

An interesting thing I’ve seen is when a narcissist comes in for individual therapy. It is often difficult to see the traits that drive their family, friends, and coworkers, crazy. The person is usually complaining about how terribly they are treated in their marriage, workplace, or in life. I will likely, at some point, ask for an individual meeting with their spouse to get another perspective, or they may come in for a session or two of marriage counseling, and suddenly, I see it, my designated client is the one dealing out the narcissistic abuse, not receiving it. That is why I love being a family therapist because it is difficult to get an accurate picture of any person by their report alone. In couples counseling, or visits with extended family, we’ll get closer to the truth, and I will have a better chance of helping them.

Even though narcissists blatantly come off as confident, and have an air of being better than others, underneath their pumped-up-ness is low self-esteem. The arrogance is how these interpersonally obnoxious individuals compensate for the big secret buried so deeply, something they may not even be consciously aware of themselves. But underneath all the muck, they must know they are as imperfect as the rest of us; it’s just too painful to think about. When the subject of narcissism comes up among friends, I’m likely to say, “Not every asshole is a narcissist, but every narcissist is an asshole.” This has been my personal and professional experience.

How it shows up in daily life.

Here are some narcissistic traits we have all dealt with that make us crazy:

• A person who thinks they know more than others. Not good at listening and learning, but very good at teaching others the way things ought to be.
• They look down their nose in contempt at most people, i.e. “What a loser he is!”
• They have steel-reinforced defense mechanisms. Tit-for-tat, denial, what-about-ism, extreme reactions to accusations, and negative scrutiny.
• They do not restrain themselves in what they think, say, or do. (No boundaries). Diplomacy does not exist unless it is for manipulative and self-serving purposes.
• They draw verbal and emotional blood. (Punitive). “I don’t get mad, I get even.” Recently in politics, we have heard the narcissistic cry, “I am your retribution!” Love the former President (and now candidate) or not, therapists will tell you, he is a narcissist.
• Will not receive negative scrutiny of any kind. No matter what the situation is, even if caught red-handed, seen on video, in photos, or in audio, they didn’t do it, and you are wrong about them.
• Exalt some people, disgust for others. Almost every person they put on a pedestal will fall into the ditch of disdain sooner or later, including their spouse.
• Projection. Accuse others of things they didn’t do because the narcissist wrongly assumes everyone is like they are.
• Resist boundaries. Set a boundary with a narcissist, and they will say, “You are a bitch/asshole.” “You are being mean.” Or even worse, they go scorched earth on you.
• Machiavellian. Seen often in positions of power, it is the philosophy that any means will be used to whatever ends the narcissist wants, which is usually power or money.
• Gaslighting. You suspect they’re up to something, they insist you are off your rocker. You’re not.
• Need admiration from others. If they mentor or serve the community, it’s for the acknowledgment, praise, or hero-worship, not for the cause itself.
• Giving. Generous to people they pity.

Through the years, I have tangled with more than my fair share of these problematic souls and have the scars of their bad behavior to prove it. In family counseling and couple’s therapy sessions. I have been called a “quack,” threatened to be reported to the counseling board, told I was already reported to the counseling board (they were lying), and once had to pull out a can of mace from my chair cushion and put my finger on an emergency 911 button as one huge narcissist with a cowboy hat got up, sauntered over, and stood over me in a threatening manner. Out of the corner of my eye, I could see his wife looking on with wide eyes and an open mouth. I’m not sure she would have helped me had he gone further. These types of things happen because the person doesn’t like hearing the truth, and sometimes, all you can do is just level with them. They’re not going to come back anyway, so do them the favor of telling them what a professional has observed so that once they’ll be told the truth about themselves.

In many cases, the narcissist will call me before a session and instruct me about what they want me to address in therapy, “Well, I will after I tell your spouse you called and asked me to do it,” I say. Or the client may tell me because I am not using a certain technique, there must be something wrong with me. “How come you’re not using Venn diagrams like Dr. Phil, does? Where the hell did you get your degree, from some mail-order place? Where did you go to school, I’m calling them to see if you really went there.”

Heaven forbids they just step aside, have faith in my skills, or anyone’s knowledge, and let me do the job I’m trained for.

Covert narcissism.

A lot has been written lately about the covert narcissist. These are the stealth bombers of emotional abuse. Usually introverted in their narcissism, they are passive-aggressive and may rely on others to build up their self-esteem, perhaps by fishing for a compliment or praise. My kid’s dad, who was a workaholic and overachiever, got early entrance to medical school because he was so intelligent, and finished his residency in surgery by the time he was 29. To say his brain is amazing, and his lust for achievement insatiable is an understatement. I came to understand that this is how he esteemed himself. He has done so much that he doesn’t want to be obvious about it, so he loves to say, “I’m not that smart, but …” and “Look, I never graduated from college.” Of course, this provokes enthusiastic I-beg-to-differ comments from the listener if they know who he is. Interestingly. I was at a ceremony a couple of years ago where he was presented with an honorary college degree. The reason they gave it to him was he donated a lot of money in honor of our late son, and they kept hearing him say he never got a bachelor’s degree. I wondered if this would stop him from that worn-out old comment, but I doubt it.

Therapy with a narcissist.

Dealing with narcissistic traits is dicey at best, and for couples therapy to be truly successful, we need each person to enter the arena with a humble heart — open to admitting what they may be doing wrong and wanting to know how to be better. A narcissist simply cannot do that, and for the record, a lot of non-narcissists can’t either. When clients tell me I am the fourth or fifth marriage therapist they have seen, I get my first hint that I might be dealing with a narcissist, or at least a personality disorder, and prepare myself mentally. Once I hit resistance, I can see and feel it immediately. They may say something like, “Why are you talking to me so much? Why aren’t you speaking with my spouse?” “Sounds like you think I may be the only problem.” “I’m feeling attacked.” At that point, depending on what happens next, there is a 95 percent chance the person with narcissistic traits will refuse to return to therapy, and I’m okay with that. There isn’t enough money in the world that would make dealing with them a pleasure.

So how to break the code and get the narcissist to play ball in the therapy arena? It involves first, Real says, educating them about the details of what their personality really says about them — never using the word narcissist unless you really think it would make a positive difference. The therapist explains that they have come out of childhood with a very damaged ego system, that at the bottom of it is a belief that they aren’t good enough (low self-esteem), and the puffed-up arrogance that has resulted is really a false self-created long ago to get them through life. Most of us do this on some level, becoming pleasers, perfectionists, and many other roles we believe will work for us, all of which are dysfunctional.

The problem with being that way is …

1. You aren’t being genuine and authentic, and it takes a lot of energy to keep supporting a false self by putting on an act every day.

2. It is not relational. People simply cannot have a healthy relationship with a person who looks down on others, and either has an iron wall up or has no boundaries at all.

3. The false self, defensive walls, or boundary-less behavior are a result of toxic shame taken on in childhood. Toxic shame is the underlying belief that a person is defective or not good enough.

So, after educating them about their personality traits and how those traits are not conducive to relationships, we introduce a strategy of joining with them through a little dose of the truth: “How you are behaving is not a good thing, man. Is this who you really want to be? Do you really want to be this person to your children?”

Underneath all the puffed-upness is a real human being who is functional and able to give and take and love deeply. The arrogance and defenses or boundary-less behavior can be controlled because we have evidence that in some circumstances, say in the workplace or with friends, they have complete control of the image they want to portray and act reasonably. If they are great managers of their image when it matters, say at work, then we need it to also matter with family members. We simply must get them to access their better, more kind, and gentler self, the one that Pia Mellody-trained therapists call “The Functional Adult,” and the Christian religion refers to as the Holy Spirit. We want them to use it instead of their ugly side. If a narcissist succeeds in buying into these concepts, then they have a chance at positive outcomes and having healthy relationships with the people they love the most.

When dealing with narcissistic traits, the therapist must find what they value the most. Is it reputation? The outward image of a happy family? The idea that they have it all? The appearance of success? When finding out what that is, we now have leverage to get their attention. “Dude, if your spouse divorces you, that whole idea of you having the perfect life goes up in smoke. You don’t want to lose that, do you?”

Terry Real’s Relationship Grid to understand your marital dynamic.

Another important part of this is to show couples Real’s Relationship Grid graphic. This way you will both know absolutely that your stance is not conducive to having a healthy relationship. Real’s grid is a powerful visual that combines self-esteem and boundary stances and makes it impossible to deny that a person is not functional enough to be relational. If your personality falls into the green area, something isn’t working, and these are the things you need to be working on.

Here it is:

The Relationship Grid graphic shows us that healthy couples fall into the purple circle zone, meaning that their self-esteem is neither better than, nor lesser than and that they understand they are as valuable as anyone else just because they are human. Couples in the purple zone should expect mostly smooth communication, as they are respectful and diplomatic with their partner. When it comes to boundaries, their stance is emotionally available and able to respect their partner’s boundaries, whether physical or emotional.

Now, look at the parts of the grid that are green. A narcissistic person is going to be on the grandiose end of the spectrum, and they will either be walled off or boundaryless. The point of the grid is to get people to figure out whether they are grandiose or shame-filled when it comes to self-esteem, and whether they are walled off or boundary-less on the boundary scale. Most clients with narcissistic tendencies can and will admit to their grandiose tendencies, as well as whatever boundary system they have, which is often boundary-less. The grid illustrates that there is no doubt that any stance in the green areas will not work within a romantic relationship. Of course, if the non-narcissistic partner is one-down and walled off, or boundary-less, we will need to work on them to have healthy self-esteem, to strengthen their spine when it comes to dealing with their “I know best” partner. They must learn to restrain themselves and exhibit moderation in their need for connection and social interaction. With this model, both the narcissist and non-narcissist partners can see what they’re shooting for in getting themselves to the place where they can both find common ground and have a relationship that works to mutual benefit.

Anyone dealing with a narcissistic mate will have their work cut out for them in their attempts to have a toxic relationship turn into one that thrives. The odds are against a narcissist going on a journey of personal growth and sticking with family therapy until the day a couple’s therapist says you’re doing so well, there’s no need to return. The right thing is to try, though, especially when children are involved. One thing the non-narcissistic spouse who is married to an abusive partner, or any partner they are thinking of leaving, needs, is the ability to say, “I did all I could to save the marriage. I gave them every opportunity to change themselves and treat me with respect.” It’s just a tough truth that when someone believes they are the measurement of how all people should be, there isn’t much a couple’s therapist, or anyone, can do, to get them to see otherwise. Real’s suggestions work sometimes, but even then, the narcissist will likely find their better self briefly, then find that the narcissistic problems return. As much as I hate to say it, sometimes leaving is the best thing to do.

Becky Whetstone, Ph.D. is a licensed Marriage & Family Therapist in Arkansas and Texas* and is known as America’s Marriage Crisis Manager®. She is a former features writer and columnist for the San Antonio Express-News and has worked with thousands of couples to save their marriages. She can work with you, too, as a life coach. She is also co-host of the Call Your Mother Relationship Show on YouTube and has a private practice in Little Rock, Arkansas, as a life coach via Zoom. To contact her check out www.DoctorBecky.com and www.MarriageCrisisManager.com. Don’t forget to follow her on Medium so you don’t miss a thing!

*For licensure verification find Becky Whetstone Cheairs.

1. Visit Terry Real’s web site at https://www.terryreal.com for more information.
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Criteria for narcissistic personality traits listed in the DSM V:

Sense of self-importance.

Preoccupation with power, beauty, or success.

Entitled.

Can only be around people who are important or special.

Interpersonally exploitative for their own gain.

Arrogant.

Lack empathy.

Must be admired.

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