Ask Dr. Ramani: How Do I Go to Therapy with a Narcissist?

Episode Transcript
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Speaker 1 (00:00):
What happens when you take a narcissist to therapy. On
this episode of Navigating Narcissism, I'm diving back into our
DMS to answer your questions about your therapy dilemmas. So
many of you have narcissistic people in your life that
you love and that you want so badly for those

(00:21):
relationships to get better. I know you sometimes wonder could
I make this better if I just went to therapy
with them. Now we're taking on the good, the bad,
and the ugly of going into the room and sitting
on the couch with a narcissist. Get Ready, Therapy with

(00:45):
narcissists isn't for the faint of heart. This podcast should
not be used as a substitute for medical or mental
health advice. Individuals are advised to seek independent medical advice, counseling,
and or therapy from a healthcare professional with respect to
any medical condition, mental health issue, or health inquiry, including

(01:07):
matters discussed on this podcast. The views and opinions expressed
are solely those of the podcast author or individuals participating
in the podcast, and do not represent the opinions of
Red Table Talk Productions, iHeartMedia, or their employees. Our first
question is from Roxanna. She writes, my narcissistic sister has

(01:31):
been wreaking havoc on our lives for years? How do
I tell her she needs therapy without her exploding on
me and actually convince her to go? So Roxanna's question
is a universal question for people who have narcissistic people
in their lives, which is how can I get them

(01:51):
to go to therapy? You know, there's a thing that
people throw around, especially therapists who care about narcissism. It's
that narcissism is the only kind of maladaptive personality style
or mental health pattern where the people who have it
push other people into therapy. And I really think that
that captured sort of the paradox of narcissism. Everyone around

(02:14):
them is going into therapy to cope with this. They
aren't going into therapy, which means not only are we
never going to see progress with them, but it also
means therapists often don't know how to work with these clients. Right.
The big anguish for so many people in these situations
is could therapy maybe help a little? Could it maybe
make them a little more accountable? And above all else,

(02:35):
how do we even get them to consider going This
is a dilemma, and so Roxanna kind of throws a
double dilemma in here where she says, how do I
tell her she needs therapy without her exploding on me?
So to pick a lane, Roxanna, you can tell her
she needs therapy, but the version of that with art
or exploding not so likely. And then the cherry on

(02:56):
top as it was, and convince her to gosation about
asking someone narcissistic to go into therapy is more often
than not going to be unsuccessful, and it could actually
be quite upsetting for you because the odds are they're
going to gaslight you. Oh really, really, who needs therapy here? Hmm?

(03:18):
Maybe you should go in. Maybe you need to double
up on the sessions you're already going to, or in fact,
maybe your therapist is just a scammer, just taking your
money because you seem as disturbed as you've always been.
So by the time this conversation is done, you're thinking
this wasn't worth it. I'm just not doing this. I'm
not gonna put myself in this kind of harm's way
just to try to convince someone to do something that

(03:39):
would be good for them. So here's a couple of ways.
Let's break this down. Number one, does therapy work with
narcissistic people ish? And it's a weak ish because I
have worked with a lot of narcissistic clients over the earth,
and I have to say, learned a ton. You know,
the only way you're going to learn how to box
is to go fifteen rounds in the ring. What I

(04:00):
learned is that the kinds of changes that therapy can
enact with a narcissistic client tend to be very small,
and they don't tend to be at enough of a
consistent or big enough level for the people around them
to notice the change. So the tricky piece with that

(04:22):
is that people think that, well, you're telling me they're changing.
They're changing in a way I can see them. But
I'm not having dinner with them. I'm not going on
vacation with them. I'm not having to cajole them to
empty the dishwasher. None of that's not my problem with them.
I have them for an hour, and in my work
with them, I've got to tell you, it's the hardest
clinical work I've ever done. I've been verbally abused, I've

(04:44):
heard some really terrible things that I can't unhear. I
have heard about them doing terrible things to people, saying
terrible things to people. A lot of therapists would say,
I would have fired that client, right, And that's what
often happens with narcissistic clients. Either they're fired by their
therapist or just when the therapist puts the pressure on
them to really do some emotional accountability work, they get

(05:07):
up and leave. So either way, they're dropping out of therapy.
And in fact, there's data out there that shows that
narcissistic people are probably somewhere between sixty to seventy percent
more likely to drop out of therapy, so it's really
hard to retain them in. And I have read cases
of unicorns, but the reason I've read them is because
they were so unique they got published. For the rest

(05:29):
of us who are working with these clients, we're talking
about baby steps. I've had narcissistic clients I've worked with
who said to me, so, you're telling me that the
only way this whole relationship thing is going to work
out without my wife screaming at me all the time
is if I have this empathy for her and have
to listen to her stuff and like, yeah, sometimes I

(05:50):
see women on the side when I travel and you're
telling me I have to give that up too, And I'm like, well,
I'm not telling you what to do, but yeah, that's
kind of like empathy good. And interestingly, I've had some
clients hear that to let me sleep on that, come
back the next week and say nah, and they filed
for divorce and broke up with the lover. Actually I

(06:11):
put that in my wind column because I thought he
heard this enough to say, well, I don't want to
hurt these people, but I also do not want to
listen to them anymore. And I don't want to deal
with the nonsense. And if you're telling me that dealing
with their nonsense is how you do a relationship, right,
I'm out when to me because now those relationships, which
weren't healthy were ended. I can't tell you how many Christmases, Thanksgivings, Birthdays,

(06:34):
late nights I've had encroached upon by emergency emergency. It's
an emergency. I remember Christmas when the emergency emergency said
to my kids, put those presents on ice, I'll be
right back. You know what the emergency was, A girlfriend
wouldn't wear the new shoes that someone bought for them.
I'm like, I'm out, no, no, no, no, and I'm seeing

(06:54):
that in a tiny little sliver. Imagine what the people
who are in relationships with them are going through. So
the whole thing has meant to tell you that even
if you're able to have this uncomfortable conversation about therapy,
the kind of change that you may need for your
relationship to move forward may not happen Number one. Number two,

(07:15):
for therapy to make that kind of change could take
years and years and years. Folks. We're talking tens, if
not hundreds, of thousands of dollars worth of therapy. There
are a no insurance company in the world that's going
to pay for that much therapy. Okay. The other thing
to keep in mind is that the mistake that a
lot of folks make in narcissistic relationships is that they

(07:37):
attempt to be the narcissistic person's therapist. It's part of
the trauma bonding cycle that you want to be all
things to people in toxic relationship. I'm going to be
their friend, I'm going to be their sober coach. I'm
going to be their therapist. I'm going to be the
house cleaner. I'm going to be their sex partner. You
can't do all of that as one person, and you
certainly can't be their therapists. So that you're often listening

(08:00):
and letting them offload so many of their problems on
you that at some point if you sort of distance
from that, that can actually help you. And if they
keep talking about how much they're struggling with a specific problem,
I can't believe this is happening. I can't believe that's happening.
That might be your entry point. Say you know what,
it sounds like you have a lot going on. They
feel validated. It could really be helpful to talk to

(08:21):
someone who's a professional. You're such an important person and
you do such important things. It really seems like getting
the help you need could be useful. Give them the validation,
fluff them up a little bit, and then you might
be able to say you need another important, educated person
helping you. Is it a little manipulative? If it gets
them in the door, it may be helpful. Even if

(08:42):
a narcissistic person gets five, six, seven sessions, it can
actually make a difference. But what you've got to do
is make therapy palatable a little bit of a doctor
Romedey moment here, Because I practice in Los Angeles. Having
a therapist is a little bit like having a personal trainer,
Like people talk about it in public here, like who's

(09:03):
your shrink. It's not like a taboo topic that like
it could be in other places, but in LA that's
a thing that has actually been an asset for many
of the narcissistic clients I have. They're like, whooh, I'm
going to go see doctor narcissism. I bet I can
break her. That's often been kind of their groove, and
we've actually done some interesting work together because they didn't
get under my skin. But it became a game. That's

(09:25):
a very long way for saying, if you're going to
suggest therapy to your sister, find that tiny little window
of opportunity when she's talking about a specific problem. Tell
her that her problem's really, really important and it really
deserves the attention of somebody who's got training to do this,
because she's an important person and needs that kind of support,

(09:47):
and you might be able to play on her grandiosity,
just a nudger in the door. In our next question here,
Brianna asks why are so few therapists trained in recognizing
narcissism and narcissistic g abuse. I've tried therapy with my
narcissistic parents. It was horrible. Why isn't this more widely
understood among therapists. Well, you know what, Brianna, I'm so

(10:09):
glad you asked this question because it actually allows me
to talk about my passion project, where I'm actually developing
a thirty hour training program for therapists to work with
narcissistic abuse, and am now lecturing actually all over the
world for two therapists on how to learn about this.
One thing I think everyone needs to understand is that
we weren't taught this. Very rarely do graduate programs have

(10:32):
an entire semester course on personality disorders, least of all,
an entire course on narcissism and antagonistic personalities. They just
don't exist. I've talked to ballrooms full of five hundred
people and I'll say, raise your hand if you had
a full semester course on personality disorders, five hands maybe,
And they tend to be younger people speaking to a switch.

(10:53):
And then I've talked to graduate students and said, yeah,
we had a course on personality disorders. We learned about
the biology personality disorder or something like that's important, but
did you learn how to work with them clinically. No.
This phenomenon of narcissistic abuse is very, very new, and
there's a few of us like myself who've been working
in this area for over a decade, and it's about

(11:14):
that new, probably been around for about twenty twenty five years.
My entire graduate career. Entire graduate career, not in my classrooms,
my clinical training, my hospital training, the word narcissism didn't
come up once, not once, And it wasn't until one
series of meetings with a really gifted supervisor who taught

(11:37):
me a little bit about these dynamics. Then the word
did not come up again in my professional career until
I was a professor at a university and then started
my own program of research. So it is simply not
talked about. And then what that means then is there's
this big knowledge gap that many many clinicians out there

(11:58):
are really trying to get the training in. So clinicians
listening stay tuned that training program's coming out soon. But
in the interim, couple of thoughts, try to find a
therapist who's trauma informed at a minimum, trauma informed therapists
will account for your history of interpersonal trauma and interpersonal
issues in your relationships. That can make a big difference.

(12:22):
Second is if you find a therapist who's well versed
in domestic abuse, domestic violence, or intimate partner violence, those
therapists will at least have some of the language of
these kinds of manipulative relationships that have gas lighting and
all of these other controlling dynamics present. But other than
those kinds of things, if you can just find a

(12:43):
therapist who can be present with you in the room,
not doubt you, not put an agenda on you, you'll
be fine. There's a lot of fantastic therapists out there,
just empathic, really well trained people who will get it.
And as with anything, whether it's a dentist, medical doctor,
or therapist, if you don't feel comfortable, it's okay to

(13:05):
find someone else. Not every therapist is a good fit
for everyone. Take your time and find someone you like.
The therapist that you don't like someone else loves, so
everyone finds their place, but give yourself time and permission
to do that. Next, Gina writes, my boyfriend and I
have been in therapy together for three years, we've been

(13:25):
focusing on his narcissism, but it seems like he's made
no progress. I'm not expecting an overnight cure, but what
are some realistic goals to have in couples therapy with
a narcissist. Gina's question brings up two really interesting things
to me. One thing that can happen, and I'm so
glad Gina put the question like this, is that what

(13:45):
we can see is that when a person goes into
couple's therapy with a narcissist, something that can happen is
that the couple's therapist will actually put a lot of
their focus on the narcissistic person because they're the one
engaging in more bad behaviors. It's an interesting play by
the therapist which sometimes works and sometimes doesn't. Where it

(14:07):
can work is that it's almost as though Gina's narcissistic
boyfriend may not go to therapy on his own, but
somehow he's showing up week after week with her. But
she's saying though it doesn't feel like he's making much progress,
and the struggle there is after three years, if no
progress is being made, then this really probably is what
we see with most narcissistic clients there is not likely

(14:30):
to be significant movement in therapy. I mean, I know
she's not expecting an overnight cure, but three years is
a long time. So the bigger question, though Gina's asking,
is what are the realistic goals to have. I'll tell
you one thing that's not a realistic goal is that
Gina's boyfriend is going to change significantly. That's just not
on the table. But a lot of people, a lot

(14:51):
of people go into couples or even family therapy with
a narcissistic person, and I think the key to all
therapy is that a person goes in there with realistic goals.
So what needs to happen is that when you go
into therapy, have very behavioral goals, because those are more
observable and they're more measurable. One of the biggest challenges

(15:14):
in a narcissistic relationship is that we always make assumptions
about the intention of the narcissist. Are you trying to
hurt me? Actually, no, they're not. Believe it or not. No,
they're not. They're just not noticing you. They're not trying
to do anything. You know, you just want me to
be sad wrong again. They're not noticing you enough to

(15:36):
care about that. So, because a lot of folks in
couple's therapy with a narcissistic partner focus on the narcissistic
person's intentions, you're going nowhere fast because we cannot change
another person's intentions. We can't. The best we've got is
a person's behavior, how a person shows up, whatever that

(15:57):
looks like. And then you better figure out what's most
important for you. Is it more participation in some household chores.
Is it how they talk with your children, you know?
Is it the use of certain forms of language, saying
that I cannot have you use certain kinds of obscene
language around the children. It has to be so clear.

(16:20):
So the couple's therapy then becomes a place of accountability,
so that there can be some of that backing and forthing,
so that behavioral piece becomes really important. Another big goal
that people want in couple's therapy is accountability, so therapy
can be a place where the narcissistic person actually learns

(16:40):
how to give an apology. Narcissistic people don't know how
to apologize. The most common way that narcissistic people apologize
they'll say, I'm sorry you feel that way. That's not
an apology. That is an embarrassment, a little bit of
a gas light, and it's definitely a manipulation, but it's
not an apology. I'm sorry you feel that way. That's

(17:03):
how I feel, So you're sorry for my m gaslight.
An apology is i'm sorry. A real apology takes responsibility,
I'm sorry I did something that hurts you, empathy, responsibility
That practicing of how to issue an apology can actually

(17:23):
be something you can work on in therapy because it
is about how language is used. It's about the construction
and the architecture of an apology. The other thing you
want to hold out for as a goal in therapy
is techniques that you can take out of the therapy
and use, whether it's permission to step out of a
difficult situation, some tool that the therapist gives you to

(17:47):
kind of put the brakes on what's happening, things that
you can use between sessions, and then using the couple's
therapy as a place to feel seen, heard, and recognize.
The one thing you never want is to walk out
of couple's therapy feeling more confused than when you walked
in the door. My conversation will continue after this break.

(18:17):
So in this next questions sort of a general question
that asks how do the different types of narcissism show
up in couple's therapy? Such a good question. So I'm
going to put on my teachy cap for a moment,
because I think this is a real opportunity for us
to just have a review of the general types of narcissism,

(18:37):
but then connect to how that could show up in
the therapy room. All right, so let's start at the top.
The most common, the classic, the narcissistic type. We're all
most familiar with, the grandiose narcissist, right, arrogant, pretentious, larger
than life, extroverted, Aren't I great? Tell me more? Tell
me how great I am? Let me pick up the check.

(18:58):
Yeah ya, yay, okay, I was flirting with her, that
kind of narcissist, right, grandiose narcissists when they show up
in therapy, let me tell you one thing they're almost
always going to do, and that's to really show up
with tons of charisma and try to charm the hell
out of the therapist. So, if you don't have a
seasoned therapist, in the room. It can be a little

(19:18):
risky because a grandiose narcissist may come in the room
and say, WHOA, you went to UCLA. I'm a bruin Gosh,
you must be so smart. I was told that's a
really hard graduate program to get into. Wow, I'm so
lucky we're in here. So you gotta be real resistant
to not fall for that. Meanwhile, especially if the partner

(19:39):
sitting next to the grandiose narcissist looks shredded, tired, sad,
a lot of people make the mistake of like, this
person's so big and bright and shiny, kind of feel
bad that they're with this partner who's so glum. Be
careful with that. That glumness is probably years and years
and years of putting up with narcissistic abuse. The grandiose

(20:00):
narcissists may look great in therapy until the therapist calls
them out and may say, you know what, you keep
talking over her, you keep interrupting him. He just shared
his feelings, and you're denying what do you get to
be judge and jury and his emotions. When the therapist
starts doing that, you can almost very quickly see a

(20:22):
switch in the grandiose narcissist. They can become quite angry, petulant,
Sullen and I can all but guarantee you the next
session they either won't show up, or won't want to
show up, or they may not send the payment in time.
So let's go then, because this becomes a natural shift
over to what a lot of folks call the covert narcissist.

(20:44):
The kind of the official term is the vulnerable narcissist
or this covert vulnerable narcissist. How do they show up
in therapy? Well, the covert vulnerable narcissist is chronically irritable,
Sullen has lots of grievances, angry feels that people are
to get them, really thin skinned, can look sad, can

(21:06):
also look really socially anxious. So one thing that happens
from the jump is the therapist actually may wonder is
it this person's depression anxiety? Is there something else happening
with this person? And there tends to be almost more
of a clinical focus on the covert or vulnerable narcissist.
That covert narcissist. Vulnerable narcissist will also look like they're

(21:28):
in such a bad state that they may seem like
they're even more unhappy than you. Covert vulnerable narcissists will
often give one word answers. They'll sort of resent being
asked to engage in this kind of level of emotional conversation,
will feel chronically victimized. Nothing I do is enough, nothing

(21:49):
I've ever done is enough. Everyone is out to get me.
No one has ever told me I've done right by them.
I give and I given. It's never enough. Victim, victim, victim.
And you're trying to go into a deeper communicative space,
and you've exhausted yourself doing that. You need a sharp, sharp,
sharp therapist to pick up on those covert vulnerable kinds

(22:12):
of patterns. Because it's a form of narcissism that's not
often talked about. It often gets missed, and so there's
a real risk that the therapists will think, Oh, there's
an anxious, depressed partner with another partner who's also unhappy
in the relationship, and that's what's being worked on, rather
than those chronically sullen, resentful patterns. Now, when we get
to the more severe issues, we get to malignant narcissism.

(22:35):
Malignant narcissism is where we see patterns like coercive control,
financial control, exploitation, isolation, using fear to menace someone you know,
you better watch out, you better make sure you don't
talk badly about me, because you know what I know
some I know cops like they're not going to believe you,
like that kind of thing, which can feel really unsettling.

(22:57):
It is very unusual, very unusual for a malignant narcissists
to show up in therapy with their partner. It may
happen if, for example, the malignant narcissist is sort of
being compelled to because by the courts they're being compelled
to as part of some other process. Maybe the church
is compelling to, but some other forces saying you've got

(23:19):
to go into couple's therapy. But in general they're not
going to show up, and it can actually be unsettling
for a therapist to work with a couple where there's
a malignant narcissistic client. Domestic violence like physical violence may
also be more likely, so there's dangerousness issues, and it
wouldn't be unusual for the malignant narcissists to even have
sort of a thinly veiled sense of threat that they're

(23:41):
placing on the therapist as well. So when a therapist
is scared, we simply can't do our work. We cannot
work with clients we're afraid of. So in many ways
you almost need more of sort of a particular kind
of seasoned therapist that isn't as sort of flustered by
clients like this. The odds of a good outcome in
this kind of theiry be are pretty close to zero.
This is not a client that's going to engage the

(24:04):
focus in that kind of therapy. Then is mostly the
safety for the non narcissistic partner. But then there's all
those other forms of narcissism. We don't talk about that much.
So when we get into communal narcissism, communal narcissists seem
like do gooders to the world, rescuers save yours. They
try to save the world everything from animals to elephants,

(24:24):
to neighbors to the community to the Little League team.
They go to other corners of the world and look,
I'm saving the world. And make no mistake, they're documenting
all of it on Instagram too. They aren't going to
do this stuff quietly. The tricky bit with these communal
narcissists is at the face of it, they might even
seem like a pillar of the community, but behind closed

(24:45):
doors as ragefull, cruel, and manipulative as any narcissistic person. Initially,
when they show up in therapy, it could very well
be that their sort of communal zaza zoo may win
the therapist over. It's like, whoa, what a humanitarian you're
doing so much, which communal narcissists may also be in
helping professions therapists, teachers, doctors, pastors, those kinds of fields,

(25:09):
So there's almost a built in kind of well, you
must be cool, you're in a gentle job. I've done
this long enough to know there ain't no such thing
as a gentle job. That any kind of person, with
any kind of personality could occupy any kind of job.
So just keeping that in mind that there's at risk
that the communal narcissistic person, it's going to be harder
for the therapists to see that pattern because they may

(25:31):
be hearing about how much this person wants to save
the world. There's also a risk with communal narcissists, so
some of sort of the New Age positivity vibe where
they're like, yeah, just you know, sometimes my energy needs
to be alone and just like I got to be
energizing and feeling the universe, and this other person's trying
to raise kids and keep a household runn while this
other person's energizing, and so that kind of thing that

(25:54):
a therapist needs to pick up and recognize that some
of those sort of kind of woo woo patterns don't
work in a relationship. So a sharp eyed therapist might say,
while you're energizing, are you aware that she was actually
home with three sick children. You need someone who's willing
to do that kind of calling out. But if a
therapist doesn't know what communal narcissism is, it may take

(26:17):
them a minute. Then we get to the self righteous narcissists.
Oh my, oh my. Now, self righteous narcissism is interesting
because it's so rigid. There's an old fashioned word for
it called anancastick. That's just sort of fear vocabulary word
for the day. Nobody uses that word anymore. But it's
really this almost It has this obsessive flair, rigid, hyper moralistic, judgmental,

(26:43):
really weird about money, even when they've got a ton
of it, even if someone might need it. Maybe if
they're in a sort of a bind and they're just
a medical situation. They'll hit back with well, I've always
been very careful with my money, and you you know,
I know you talk about oh I was sick, but
I was careful. You weren't, So I don't know if

(27:06):
I feel comfortable, and I am sure you could figure
out a way to apply for that special kind of insurance.
And you're thinking like, oh my gosh, it's just like
a thousand bucks and someone's health would be better, and
they're like, no, or it would be there's a dinner
party and you get stuck at work because you have
a job where there's an emergency and you show up

(27:26):
at six forty five and they'll say, yeah, we already ate,
but I made you a plate if you want to
take it home, like what is happening? They can be
very religiously abusive, saying well, a lot of the problems
you're in is because you really were not devout enough,
And it can feel so harsh, so invalidating. If you
manage to get a self righteous, narcissistic person into therapy,

(27:48):
and you might, you might. What you're going to see
is the therapist might see this sort of really rigid order.
I think it would be pretty manifest. We often view
really organized, focused, workaholic people. Self righteous people are often workaholics.
They're often viewed very virtuously. They've been so responsible, they

(28:09):
work so hard, they do what they're supposed to do.
Instead of this sort of sense of wow, this person
is showing no empathy. So in the midst of all
their rigid order and workoholism and moral righteousness, they're very invalidating.
It's such a unique pattern that, again it often doesn't
get picked up, but if it does, when the therapist

(28:32):
pushes on that self righteous narcissist, they're very likely to
drop off. And the last group I'm going to talk
about the superficial narcissists. I call these folks narcissist light.
These are the folks who are your Instagram narcissists. They're like, wait, wait, wait, wait,
make sure the light's good. We got to make sure
we get a picture. I'm here, like what are you doing?
You are a Disneyland and you're forty eight years old,

(28:53):
Like really and so, but gotta get the light right,
make sure my ears look good and like Meanwhile, there's
children and they want to go on the rides, and
so it's a very almost emotionally stunted childlike, look at me,
I want fun, fun times. Childlike That's the only way
I can describe it. It's actually kind of fun to

(29:13):
have a few superficial, narcissistic friends, kind of fun to
have at a party. Certainly, they're fun to go to
Disneyland with because you now have a lot of pictures
by the end of the day. But they are not
made for long term relationships, especially when there are responsibilities
like financial responsibilities, children, caregiving, any of that. In those
kinds of relationships, that's the one group where you may

(29:35):
may may have a little bit of a fighting chance,
where with a good therapist they may sort of say, okay, sweetie,
the ears, the whole thing, this isn't working like you're
gonna have. It's time. It's time to grow up, you know,
cross the bridge away from sleeping Beauty's castle and come
back into the light. Because it's exhausting for people who say, gosh,
we had so much fun when we were young. Of

(29:56):
course you did, you know they were so good at
being youthful. It often is sometimes about cleaning up the
emotional hygiene, the superficial narcissists aren't mean people. They don't
have that same kind of cruel, manipulative side. They're just
so selfish and childlike and childish that they're still sort
of conducting themselves like they're twenty five years old. And
while that might be absolutely adorable, and if they don't

(30:18):
get into a relationship, it actually work out great. But
if you are in a relationship with them or have
to rely on them, it can feel really impossible. But
I actually think that group might have a little bit
of a fighting chance in therapy. So as you can see,
it's complex. Not all couples therapy with narcissistic folks is
going to be the same because it's really going to
depend not only on the type but the severity of

(30:39):
the person going in. If the therapist has a good
pair of eyes on them, they may pick up the patterns.
But I have to tell you just a doctor Romney
moment here. There's many times I've worked with a couple
and I'm like, okay, great, clear on your goals and
this and that. But then there's that moment you're like, oh,
I'm dealing with a couple where there's a narcissist and
you literally I would feel sick in my stuff because

(31:00):
then I'd know there's not much forward motion, and there's
usually that moment and it's almost silent, where at least
one person in the couple will say, I think it's
probably timed and therapy, isn't it, And I'm like, yeah,
time's up. So it's tough. But as you can see,
it's very complicated, and I hope that makes clear to

(31:21):
you why it is actually quite difficult for therapists who
do especially to do couple's work, how complicated the narcissism
stuff is, which is why it's important. Not every therapist
is good with every type of narcissist, but if you look,
you'll find that therapist who may actually work really well
with your kind of narcissistic couple match. In my next question,

(31:41):
Charles writes, how do I prepare for a therapy session
with my narcissistic wife? How do I make sure I
get my point across without her taking the lead in
the conversation and ending up totally off topic. Fantastic question, Charles,
and I think actually what Charles is asking would apply
to any kind of thing therapy you would go into,
not just couples, but family therapy, anything with someone narcissistic. Heck,

(32:05):
even your own therapy. But in couples therapy it's tricky.
A lot of people will say one of the hardest
things about their narcissistic relationship is once an argument starts,
the narcissistic person always overpowers and overwhelms them. Narcissistic people
are much better at arguing than ordinary people because they
don't have that much empathy. They really can kind of
go in for the jugular. I mean nothing against lawyers,

(32:28):
but they argue like lawyers. And the problem with lawyers
is lawyers are great in court, but that sort of
like dispassionate, like emotionless argument doesn't work in a human relationship,
and narcissistic people really have that capacity, which can hurt
because you feel hurt, and yet they're trying to argue
logic because their logic can often feel right on point,

(32:50):
your emotions, which have now been gaslighted, can feel almost
impossible to state. So one of the best things you
can do is take some notes ahead of time and
bring those notes in. In fact, I have coached many
clients on how to prepare for going into couple's therapy
with a narcissistic partner. It's a big moment. They're finally

(33:11):
getting their partner into therapy. But they're like, I don't
want to screw up this opportunity, so we make notes.
And I have to tell you when I used to
work with couples. If somebody comes in and reads something
they've prepared, that's a bit of a sign to me,
like this person felt the need to prepare this so carefully.
I'm wondering if they're chronically overwhelmed by the partner and

(33:33):
can't get their words out. There's different kinds of tricks.
Couple therapists use one as the sort of the five
minute game they play. There's a timer set. One person
gets to talk uninterrupted for five minutes. Timer goes off,
next person gets to go for five minutes. Can't be interrupted.
As you can imagine, the narcissistic people do a lot

(33:53):
of face talking, so that can happen. It can be
really gaslighting and sort of destabilizing for the person who
is trying to make their point. It's the therapist's job
in those situations to rain in that person and say no, no, no.
If you have to look out that wendo, you look
at that window, but keep your faces to yourself. If
someone's being interrupted, the couple's therapists will weigh in and

(34:14):
stop it. They'll make sure that people get to make
their points fully. That's what's supposed to happen. But because
narcissistic relationships are so confusing and so overwhelming, it is
crucial that you make notes ahead of time. In an
ideal world, you're an individual therapy and you work with
your individual therapists on it, and you make very clear notes,
what are my goals, what are the things I want

(34:36):
to bring in, what are the scenarios and situations I
want to bring in? Having that will help you really
keep yourself very very organized. Now, if you find that
it's constantly going off topic and the therapist isn't raining
it back in, maybe this therapist may not be a
good fit for you, so you won't want to give
that a chance. And then if you feel like it
keeps going away no matter how organized I am, that's

(34:58):
definitely something that you want to keep in mind. A
little bit of a warning before you go into couple's therapy,
just a reminder, I highly highly recommend that you do
not use the word narcissist, psychopaths, gaslight sociopath. Don't use

(35:19):
those words. Stick to words that identify behavioral patterns. I
do not feel seen or heard in this relationship. When
I talk to this person, they're not listening, and I
can tell by the nature of their answers. We do
not spend time alone together. Always has to involve a

(35:40):
large group, and when I do try to suggest it,
I am mocked and laughed at. Those are patterns and
that's what a therapist can work with. There are some
therapists out there that actually kind of get a little
prickly if you use words like narcissist or gaslight or psychopath.
They don't even want to hear the words, and it
can start the therapy off on bumpy ground. But if

(36:02):
you use patterned language, then that is something that can
be talked about without you being sort of labeled the
problem child in the therapy. That's just sort of a
hack you want to remember, because a lot of folks
will come in and say, oh, my gosh, she's so narcissistic,
and that, sadly for therapists who may not fully understand,
this might make you seem like the one who's antagonistic.

(36:25):
I'm not saying it's fair, but I think it's a
way to get in there. The best moment. The best
moment is if you go in there, you've made your
patterns clear, the therapist is clearly seeing what's going on.
Somehow you come to find out that the therapist is
onto it. That's an incredibly, incredibly validating moment. And once
you sense that the therapist is getting it and is

(36:49):
starting to sort of call out the narcissistic person, a
lot of people will say that that was an incredibly
curative moment for them. So in my next question, Bianca says,
my husband is very charismatic. He makes everyone feel like
the most important person in the room, and that's how
I fell for him. This seems to extend to our
couples therapist as well. It almost seems like he is

(37:10):
love bombing the therapist, and the therapist seems to be
eating it up. I can see from the therapist's perspective,
my husband just seems like the greatest guy in the world,
while I am a stressed out and complaining miss. What
I thought would be our last chance to make the
marriage work now feels like a hopeless dynamic Have you
seen this before? Have I seen this before? First of all,

(37:33):
I might be the only person in the world who
thinks charismatic is a bad word. Like people say I
know someone in their charismatic I'm like, no, no, I can't
meet them. It's like the ogre word to me, So
charismatic is tricky. I love what Bianca said here. It's
so good, says that he's love bombing the therapist kind
of sort of yeah, when come in and admire again

(37:53):
they're credentials and how smart they are, and you know
so much and we're so lucky to see you, and
I know how popular you are as a therapist. However
it is they're love bombing them. Therapists are human beings too. Again,
this is why I keep using the word seasoned. There's
no winning me over anymore. Like I think I've just
been around the block way too many times and have
too many miles on my tires that if someone tries

(38:15):
to caaris their way into my office, I'm like, yeah, no,
but that's again. Back at the beginning of my career,
someone told me I was smart. I think I would
have fallen for it. But the picture Bianca is painting
here of one partner looking stressed out and complaining and
the other one looking really well put together. This is
why we need more training for therapists so they know

(38:37):
what they're seeing, because it is so easy to say, like,
why is this great charming person with this person who
just seems like sort of hollowed out? It's unkind It's
almost like, how is this really psychologically attractive person with
this sort of psychologically not so attractive person. And it's
not that at all. It is that if you understand
the dynamics that when we see charismatic people, a tiny

(39:00):
little alarm should be going off in our head, and
if we see a charismatic person next to a person
that really looks super stressed out, that alarm better get louder.
So have I seen this before? Absolutely? And I think
I want people to know that this dynamic isn't unusual. Ultimately,
anybody can put on a show, right, they can come

(39:22):
in and sort of be performative. In therapy, the therapist's
job is to get past all that performative stuff into
what's really going on. And so the challenge though, is
that what Bianca saying is that my therapist is falling
for it. And the other thing that concerns me about
what Bianca says is, I thought therapy would be our

(39:43):
last chance to make this marriage work. That's too much
pressure for therapy that at that point, if this feels
like therapy is life support, the odds of it pulling
it out. I've never seen a wrecked, destroyed relationship be
pulled back from the rocks. So what I've seen is
boats that are going off a little off course that

(40:04):
therapy gets them back on course. But once that boat
has crashed onto the rocks because they turned into the
wrong harbor, that's it. It's a salvage job at that point,
and you're really trying to help like these two people
maybe sort of dismantle this relationship. So Bianca got into
this at a point where the relationship feels like it
was already pushed to a limit, and the love bombing

(40:27):
dynamic may have also weakened what was happening in that
therapy and then now it feels sort of hopeless. And
it could very well be that this dynamic could mean
that a different therapist could actually work better, and maybe
getting a referral like that to someone new if they're
seeing a therapist of a particular gender or age or
race or anything. It could mean say, let's switch this up,

(40:49):
maybe that dynamic will change it, like find someone who
isn't going to get played. Unfortunately, in reviews of therapists,
that's not one of the things how they'll have, like depression, anxiety,
substance use won't be played. That's not one of the bullets.
But unfortunately, there are some therapists who can really see
it and get it, and there's some who actually don't.
And in this particular case, I actually do worry for

(41:10):
Bianca because this particular dynamic that's happening therapy in her
specific case may leave her feeling kind of gaslighted. In
a case like this, one thing that would be really
important is that Bianca be in her own therapy, because
her own therapist might be able to give her the
guidance she needs to make decisions not only about her relationship,

(41:30):
but how also to make some decisions about whether to
proceed in this particular couple's therapy, seek someone else out,
or other kinds of strategies for how she can emotionally
approach this. We will be right back with this conversation.

(41:52):
So one thing people might wonder like, well, if I'm
morning praying for a couple's therapists, do I need to
be in my own therapy always, always being respectful and
aware of privilege and how expensive therapy can be and
insurance doesn't cover. And I'm very aware of that as
I give this answer. In an ideal world, if people
are in couples therapy, they should be in individual therapy.
Couple's therapy is not a substitute for individual therapy. What's

(42:14):
happening in there, it's a very very different process. You're
a couple, therapist wants you to be healthy, But that
process of individuation and of healing and of building autonomy,
that's not what's happening in the couple's therapy room. That's
what's happening in the individual therapy room. The individual therapy
room is your safe space to say whatever you want

(42:34):
things you absolutely cannot share appropriately in a couple's therapy room.
So in an ideal world you've got both. But always
keeping in mind, though I recognize that the financial burdens
of that much therapy happening really means that this is
a strategy that's available to only a very privileged view.
Something that people do often wonder is like, if I

(42:55):
really like my couples therapists, can I also see them
on the side as an individual therapist? NUNU new your
couple's therapist is your couple therapists. Now you may wonder, well,
what if my partner drops out of couple therapies. I
don't want any part of this, I'm done. Can I
see that person as an individual therapist? Yes, you can,
and many people will sort of go into that place.

(43:16):
Different couple therapists might have different philosophies. Some couples therapists
work only with couples. By the way, there's some people
out there who won't see you unless you're a two.
It's a philosophical thing. I mean, it's not how i'd operate,
but that's how they believe. So if you're not a two,
no therapy for you. But with many therapists, if you're
in as a couple, the relationship ends, or your partner says,

(43:38):
I don't I'm not doing therapy. I don't like this
therapist anymore. But you really have an affinity for this therapist.
There's actually kind of a built in advantage to that
because this therapist knows your history in this relationship, and
they often have that to draw upon, and they also
have sort of a reference for who your partner is.
If I had a therapist fantasy camp, I'd go out

(44:00):
to a restaurant with my client and their partner. That
would be so interesting for me to watch how they
handle that, or even better, actually real therapist fantasy camp
that I'd be in a restaurant where there's a microphone
on their table. I could hear what they're saying, but
they didn't know I was watching them, which seems very surveillancy,
and I know that, but if I was at the table,
it would change them. But if there was a way
I could really watch them when they were out and

(44:22):
about and not just the recollection of one person, that
would give us tremendous insight. Unfortunately, that is not how
the world. Well fortunately that's not how the world works.
But it is not unusual for a person to say
I really liked our couples therapists, and that person went
on to be my individual therapist. That's how a lot
of people have found therapists that they really love. Pugma says,

(44:43):
my narcissistic colleague is always talking about how much therapy
he's doing and how he's killing it. How is it
possible he's in therapy but seems like he's more narcissistic
than ever before. He makes all of our work lives miserable.
Ah yeah, the bragging narcissist in therapy question. It's an

(45:05):
interesting dynamic. In this particular case, Pudma's talking about someone
she works with, But it could be happening in your family.
It could be your brother saying, Hey, everyone, I'm in therapy.
Guess who's the only mentally healthy person in this family?
You know, you're like, what's happening? Because they're just as
bad as ever. Remember, therapy only moves the needle a

(45:26):
diny bit with narcissistic clients, And so because of that,
people really think, Okay, my colleagues in therapy, that's great,
but it's as bad as ever. Here's a little bit
of an interesting thing that a lot of people don't know.
Therapy can sometimes make narcissism worse. What yes, and how

(45:46):
does that happen? If the therapist doesn't understand narcissism and
just keeps hyper validating them like oh, I love your confidence,
like you can do anything and you could be anything.
This and also happen if they're in coaching, they may
actually be magnifying the monster. So this person saying, well,
I hope you know, but my therapist feels like all

(46:08):
of you are limiting me. And my therapist said this,
and my therapist said that, and my therapist said this.
The narcissistic person triangulates the therapists into all their conversations, saying,
I hope you all know you're not good for me,
and you're limiting me because that's what my therapist said.
We don't even know if this is what the therapist
is saying, but that is not uncommon for narcissistic people

(46:28):
to sort of play that game. And if the therapist
doesn't understand narcissism, they may actually be inflaming, emboldening, and
enabling this dynamic. It's really, really, really difficult because I
know when I've worked with narcissistic clients, it's always been
walking on this razor's edge of wanting to form a

(46:48):
secure attachment with them but also not spoiling them, because
that's really where how you create a narcissistic adult. In childhood,
these are kids who are often really spoiled, but they're
anxiously attached, they don't have a consistent, available caregiver, but
when they do, the caregiver spoils them, and that right

(47:09):
there is sort of one of the ways you can
create a narcissist. So as a therapist, I have to
be a safe, consistent place that still holds them to
accountability but also supports them. So I have to have
that sort of therapeutic love for them even when they're
angering me, but also tell them that they're angering me.
Not easy. When it works, it works great. If you

(47:30):
don't do it right, you're actually sort of basically giving
the tantruming child all the cookies it wants. It's not easy.
So when you have this colleague who's saying, I'm killing
it at therapy and things are as bad as ever,
things were going to be bad either way, whether this
colleague was in therapy or not. So all of the
usual rules for working with a narcissistic colleague, making sure

(47:51):
you document being in your own therapy, ensuring that you
build relationships allyeships at work, making sure you have mentors
and colleagues even in different companies that you can turn
to for guidance, Having good supports outside of the workplace,
all of that is going to matter because your narcissistic
colleague is just going to be narcissistic. And if it's

(48:12):
a family member where you thought this is our hope,
they're in therapy and it actually feels like it's worse,
this can affect you. It can take the narcissistic abuse
you're experiencing and you can feel even more helplessness or hopelessness.
But if I can give you only one piece of guidance,
the thing you may not ever want to do is
roll up to that person and say, well, you feel
worse now. So I don't think your therapist is doing

(48:34):
a good job. Don't do it. It's just not worth it.
So unfortunately, in their therapy, it may very well be
they're getting too much of one thing and not enough
of another. And also, you know what, folks, they may
not be telling the truth. You'll never know if they're
actually going to therapy. They may say that they are
because they might be posturing. You just don't know. All

(48:56):
you know is that you're working with someone difficult. So
to Padma, I would say all the usual rules about
working with a narcissistic colleague. In this next question, Orley
sent us her story. When I went to marriage counseling
with my ex husband, it seemed like the therapist was
rooting for us to succeed, no matter what was going
on in our relationship. During one session, she saw my

(49:18):
ex absolutely blow up on me and then storm out.
I sat there sobbing and said, this is what I'm
dealing with and no one sees it. I was facing
a health issue during this time and the best suggestion
my therapist had for me was to tell me to
call my mother for help instead of addressing the larger

(49:40):
issue that my husband wouldn't help me. At the next session,
it was like nothing ever happened. She was right back
to normal, trying to have us both work on communication.
I was doing the work, but I was also dealing
with verbal, emotional, and financial abuse. She never addressed any
of it. I don't know what to do. I feel

(50:00):
like our therapists didn't recognize abuse that happened right in
front of her. How did she not address this? So
this is a really, really tough one. The vast majority
of therapists would call someone out who was screaming at
someone in a room, but unfortunately not all do, and

(50:20):
there have been therapists out there who will say, well,
they're having their process or maybe you're triggering them. All
I can say is I, philosophically do not agree with that.
When somebody is screaming at someone and verbally abusing them,
to me, that qualifies as verbal violence and it's not okay.

(50:41):
And the fact that that was happening in a therapy
room is a signifier that this is happening far worse
in the privacy of their home early. On top of that,
has health issues, which when I read this question, I'm thinking,
it's no wonder you have health issues. A lot of
folks who go through long term narcissistic abuse do develop
a whole host of health issues, some from just not

(51:02):
giving themselves adequate self care, not exercising, having disrupted sleep.
I'm surprised by the number of survivors of narcissistic abuse
who live with autoimmune conditions like lupus, fibromyalgia, or rheumatoid arthritis.
That level of chronic stress over such a protracted time
really does feel like it could be a contributor to
those kinds of stress related illnesses. Here, she's facing a

(51:26):
health issue, and in a way, what the therapist was
almost trying to do was let the husband off the hook.
In a sick, twisted way. It could very well have
been that the therapist knew the husband wouldn't help her,
so call your mom so at least you'll have help.
But the bigger issue for the couple's therapists to address
is why is it that this man wouldn't step up

(51:48):
to take some responsibility in the care of his wife
who was struggling with a medical illness. The sort of
red flags, the therapeutic red flags that are unfolding here,
is that somebody was screaming in therapy and it wasn't
being addressed. Like I said, I do not agree with that.
Nobody needs to speak their truth by screaming it. They

(52:09):
can speak it, they cannot yell it. When that's not
being called out and someone is storming out of therapy
and that is not addressed, I have to say that's
probably a sign that this may not be a safe
therapeutic space for you. I'll always say this therapist may
very well work for somebody else, but in your situation,
if you're screaming, is happening and nothing is being done,

(52:31):
and I'm telling you folks, I've heard this happen over
and over again. The number of people, the number of
clients over the years have said to me, I went
to couples therapy. My partner screamed at me in therapy,
and the couple's therapists said, this is his process. I'm like, oh, no, no, no,
no no. And so a lot of our therapeutic work
was actually sort of undoing the sort of sense of

(52:54):
threat that came from just being in couples therapy. So
when that happens, to give yourself permission to say this
is not a safe space for me, I can find
someone else. There's also a bit of gaslighting that happened
here for this person. They came back into therapy, and
no one ever mentioned that this person screamed in therapy
and stormed out of the room. When something happens like that,

(53:15):
even not in therapy, even in your regular life, where
there's i don't know, someone up ends the table at
a birthday party, or a screams or yells or just
something like that, and then the next week you all
get together and no one speaks of that is actually
a form of gaslighting. Because this really really messed up.
Perhaps even traumatizing thing or very very sort of activating thing,

(53:38):
upsetting thing happens and nobody notices it. You're thinking, am
I the only person who saw that? You doubt yourself
and when everyone's just sort of being dinner like normal,
there's got to be something wrong with me. So even
silence can bring out that kind of gaslighting not mentioning it.
Who knows what the therapist's motivation was for not mentioning it.

(54:00):
But there's a danger when couple's therapy gets solely focused
on communication. Unfortunately, therapy can sometimes be dogmatic, like there's
one right way. Communication is a path forward. Human beings
aren't labrats. We're a lot more complex than that. We're
made up of stories, experiences, trauma. We bring many different
experiences generationally through our cultures. So it's not as simple

(54:24):
as communication is. Everything not so simple. But sadly that
many times people can get stuck in that way of thinking.
What Orley says is, I don't know what to do.
I feel like our therapists didn't recognize abuse that happened
right in front of her. The therapist didn't recognize abuse
that happened right in front of her. How did she

(54:45):
not address this. That how is something we may not
ever answer. I think it's dangerous if I speculate here
why the therapist didn't address it. It could have been
the therapist herself might have been scared in that situation.
The therapist may have a a very clear philosophical point
of view. The therapist might have been fine with him yelling.

(55:06):
We don't know, so it's impossible to address that. It's
also not unusual for people in these situations to resent
the therapist and feel like that's not okay. How can
I'm a terrible person, I'm resenting someone who's helping me.
There are no unacceptable feelings. I'm going to say that
one more time. There are no unacceptable feelings. You feel

(55:30):
what you feel. You have your feeling. You be with
your feeling, and it works its way through. One of
the worst things we do to ourselves is we judge
and we shame our emotional experiences, and that is magnified
for people who are going through narcissistic abuse. Be with

(55:50):
your feeling, you resent your therapist, that's okay. What you
do with that, that's up to you. Some people may
choose to share it, some people may not. Some people
may ask for a referral. Some people may simply stop
going to therapy. This is why it is important to
have one good, supportive therapeutic space in your life. Again, ideally,

(56:11):
if you can your own therapy to share those feelings.
I work on Zoom, they'll say can I turn off
my camera? To me? I feel like whatever the client
asks for and that space is okay. They'll turn it
off and they'll tell me what they feel when they
turn the camera back on. We got to break that
one down, but there's so much shame and that where
do we start. There's no unacceptable feelings you resent your therapist,

(56:33):
that's okay, and sometimes processing that may not only release
someone who left you feeling unsafe in that room, but
perhaps some of the anger you had over other unsafe
relationships that you've had throughout your life. Not every therapist
is good for every client. We are not made for everyone.
It is important that you find therapeutic spaces that feel

(56:56):
safe and okay for you. Why therapists do what they do.
Like I said, it's dangerous to speculate on, but what
you need to remember is if it doesn't feel good,
you can make that choice for yourself to find a space,
whether that's your own individual therapy or a future couple's referral,
that feels better when we love someone. We love the

(57:18):
narcissistic people who are in our life. That's what makes
it complicated. Obviously, we just have the hope that can't
I make this better, and therapy feels like it could
be that space. Therapy with a narcissistic person, even at
the individual level, for us as therapists, is complicated, but
it's very complicated if you go in with them. Every
so often, Yep, there's a unicorn and people say that

(57:40):
we actually made something of this, or at a minimum,
I felt like I had a safe space with a
referee in the room where I could let my pain
be known. However the narcissistic person registered it. I don't know,
but I felt safer having that person in there. Other
people might say we tried, the therapist tried to push
the conversation, it didn't work, they dropped off, and I
ended up with a good therapist. But above all, else

(58:02):
which you have to remember, is that when you go
into therapy with whomever the narcissistic person is in your life,
give yourself permission to say, does this feel Okay. Remember,
not every therapist is perfect for every client. Not every
therapist can work well with every couple or family or whatever.

(58:23):
To give yourself that choice to choose a therapeutic situation
that feels good for you, and if it doesn't feel
good for you, one of the greatest gifts you can
give yourself is to say I deserve to feel safe
and not do it. But it's a complicated conversation, and
I know a lot of people wonder what happens in

(58:44):
that therapy room with the narcissistic client. Listen, I've worked
with a lot of narcissistic clients, and I've seen things
in there that were profound, sublime, hilarious, heartbreaking, terrifying, and
sometimes even optimistic. It's a complicated space. I've been really
privileged to work with clients who are both narcissistic and

(59:05):
who have gone through narcissistic abuse. I've learned from both,
and above all else, I've learned that therapy is science,
it's magic, it's mysticism, it's empathy, it's compassion, and for
anyone going in it can feel like a big risk.
For any of you who are in therapy, good for you,
it's not an easy journey to go on to ever

(59:26):
be vulnerable with another human being,

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Episode Transcript

Host

Dr. Ramini Durvasula

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