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Narcissistic Personality Disorder: Does Group Therapy Help?

You change how people deal with narcissism, not the narcissist.

We all know them--the narcissist that thinks they do everything right. The man or woman who ignores you, and who is so self-absorbed they have no use for your opinions, feelings or needs. But can group therapy help? The general understanding is that people with narcissistic personality disorder, NPD, are not fixable, and that you should stay away from them. Many therapists tell their clients to avoid or leave a narcissist because people with NPD are self and other destructive. The are only interested in the ruthless pursuit of attention and adulation, are grandiose about their accomplishments. Alternately, they can become very depressed. They are no fun to be around: narcissists are the cancer of society.

Someone with NPD is immersed into the secondary drives of narcissism, aggression and materialism. It can be so profound that the primary drives of compassion, empathy and humanitarianism are lost. The worst of the narcissists use a false presentation of the primary drives as a way to cover their pathology. They espouse being empathic, non-aggressive and anti-material, all the while operating from a deeply wounded place. Narcissists are empty people who fill their emptiness with self-importance, with little or no capacity for genuine empathy.

How do they do in group therapy?

First let me say that if someone with NPD voluntarily signs up for group therapy the diagnosis is probably wrong. Narcissists don't need therapy (since they are perfect) and therefore don't need to change. But on occasion, for legal, marital or social reasons the narcissist finds his way into group. The results can be quite interesting.

The effort for the narcissist to take over the group, establish himself or herself as the most important person in the group, or the smartest, or the most resourceful will manifest very quickly. But the treatment within the group isn't to directly confront the person with NPD. The facilitator must support the group's reaction to the narcissist. What you change is how people deal with narcissism, not the narcissist.

John was the self-imposed answer man for the group. He had advice, information and knew what everyone should do in very situation. In short order members were telling him they didn't want his advice, and explained to him why he was so annoying and they could understand why, by 42 he had already had 4 wives.

John was never bothered by the feedback, continued his unbridled advice -giving. The facilitator was frustrated too. None of her direct interventions with John, trying to get him to realize the negative impact of his behavior, worked.

After a consultation the facilitator switched tactics. She started having the members talk about what it was like to have someone in their life that didn't listen, that always set themselves up as better, and couldn't see how hurtful he was being.

The group unified over their feelings, and then were each encouraged to talk about the people in their lives with whom they had had these feelings.

John was speechless.

The strategy worked for helping the group members feel empowered, share strategies for coping with the self-absorbed in their life, and connected to each other through their experience.

John never talked about his needs while he was giving advice. It took a very long while, but eventually the need to be appreciated and admired caused John to understand the group norm --to talk about your needs and feelings and why you're having them. The change in his behavior came as a result of the members being empowered. They stopped accepting his dominance, talked about their own needs, and he eventually made changes that were helpful not only in the group, but in his personal life as well. It wasn't a quick fix, but it was a lasting one.

More from Dan J. Tomasulo PhD., TEP, MFA, MAPP
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