The Narcissistic Therapist

When the Therapist is too Self-Centered

Posted Nov 15, 2013

What makes a therapist want to be a therapist? 

If you think about it, the role of the therapist is remarkably secure. The patient is required to tell all while the therapist chooses when to share, confront or remain silent. It’s a powerful position, and one wonders what brings someone to take on this semi-omnipotent role.

I asked Donna Moss to collaborate together on hidden narcissism in our profession. This is the first of a series called The Narcissistic Therapist.  I hope you find it of use.

Healthy Narcissism:

Just as the lives of our patients need examination, so do ours. Some therapists are out and out narcissists (few), some have narcissistic traits (more) and most have a good dose of healthy narcissism, which is a positive belief in oneself and pride in one’s work.

Healthy narcissism you may ask? 

Yes, it’s a good thing to be invested in your career, to believe you can master something difficult and make a difference. Yet taken to the self centered extreme, a narcissistic person is only invested in him or herself, at the exclusion of others. The end game for healthy narcissism is competence and the pleasure of a job well done. While, the end game for a therapist with a narcissistic problem is endless self preoccupation and promotion.

What’s motivating your therapist?

The Narcissistic Therapist:

Whether the therapist is a psychiatrist, psychologist, social worker or pastor, the source of a therapist’s need to be a therapist must be examined.  A therapist, doctor, lawyer, or car mechanic each can have problems of his or her own. 

Does that mean they’re unfit to work? 

Hardly….Good therapists get psychotherapy for many reasons. One benefit is that we know what it’s like to be on the couch (or in the chair). But, perhaps a more important benefit is that we get a better idea of how we might unconsciously influence patients towards our needs - rather than their own.

The patients' needs come first. This is what makes us professionals.

It sounds easy in theory, but it’s not so easy in practice.

By far, most therapists are ethical, caring and competent. And yes, some have narcissistic traits, while others may be obsessive, anxious or moody. No human being is without personality wrinkles or flaws. Nobody’s perfect.

A narcissistic therapist may have a few or more of the following tendencies:

  • She needs to be admired.
  • She answers the phone or texts during sessions.
  • She floats off and doesn’t listen.
  • She uses charisma to charm you.
  • He's easily hurt or angered if confronted.
  • He claims to have a “special” relationship with you.
  • He cancels meetings on a whim.
  • He blurs boundaries and exploits you in some way.

The Making of a Therapist:

Look at any profession. Selfish needs such as the urge for money or status can unduly influence any one. The need to rescue, make money, feel important, wanted, or loved are powerful drivers.  Everyone’s heard stories of lawyers who over-charge, contractors who think they’re competent when they’re not, and clergy who don’t know how to handle people. A competent professional has the skill to recognize their strengths and limitations; whereas others don’t. 

Ironically, too many people quickly choose a therapist from a managed care list, while the same folks can spend weeks researching which car to purchase.  So, evaluate your therapist, just like she’s assessing you. And, if you see signs of narcissism, by all means visit another therapist.  Good help is available!  If it’s a minor issue, consider confronting the therapist with your worries. The good ones will help you feel at ease. The impaired ones will be unhappy with being questioned.

Many therapists go into the field with unmet childhood needs, which is probably no surprise.  Therapists are people from all walks of life, and backgrounds.  

  • One may be overcoming a childhood trauma, and is drawn to help others who are suffering as well.
  • Another may have a powerful need to make money in order to please a demanding father; this can lead to poor decisions.
  • Still, another, may have little intimacy with friends or lovers, and use therapy as a place to feel close to others, and yet safe.  This can go on for years.

Unhealthy narcissism is about garnering attention, money, admiration from a patient. The patient brings trust into the room, and some may be gratified that their therapist shares so much and has a special bond. These arrangements inevitably undermine the psychological health of the patient. 

Yet, a competent therapist can overcome almost any background, by using his or her life experience to become a better person.  We must do an honest self inventory, and keep the patient clean of our own needs. Success is about competence; and competence is about helping the patient, whatever may be driving you. 

The Overwhelmed Therapist:

Life has its ups and downs - therapists included. A well intentioned professional may be drowning in a personal crisis just when a client needs him the most. In times like these, a great deal of juggling seems a constant requirement. Some skillful therapists can do that. They might even USE their own trials to better empathize with a patient.  (Suffering does have something to teach.)  That may work as long as the therapist is aware of it. 

Imagine that you stubbed you toe just prior to talking to your best friend. You’d be thinking about your pain, and not about what she might be saying. That’s normal.  So, when a therapist goes through a divorce, or has an illness in the family or a financial problem – things that can happen to anyone – she is drawn to self preoccupation. Pain, whether physical or psychological makes us self centered. This is a dangerous time in the professional life of a therapist, because mistakes can happen. Pain can bring us down.

Yet, with good training and supervision, the majority of therapists can stay true to the needs of their patients. The key is to recognize our hurts and get help or reach out to our community. Often weakness makes us stronger as we are reminded of the (often) unjust nature or the human condition. We are all human, and we can help another human being in pain. That is a great good.

Self Disclosure:

Finally, we must know our limitations and our strengths. There is a place for judicious self disclosure in the therapy office. It can be used to make a point, or remind the patient that he or she is being understood. When done well, self disclosure can be reassuring and facilitate a better bond between therapist and patient.

One competent therapist writes:

I've had ups and downs in my life and career plenty of times.  To use this in the work I bring examples, but don’t overdo.  Short and sweet, I’ll share an anecdote only if I think it will offer the patient a sense of “normalizing” his or her problem, not minimizing or boasting.  I also use transparency – like sharing something personal and show, hey, I’m and make mistakes too.  Humor’s sometimes useful…as I’m able to look at myself and say, yikes, I shouldn’t have said that.  Patients often appreciate the honesty. And finally, checking in with the process: how are you feeling about our therapy?  Is it meeting your needs and goals?  What do you need from me at this time?  Open, honest communication is the heart of connection, in therapy, life, marriage and parenting

This is a nice example of healthy self disclosure. The goal is to reassure the patient or teach a useful lesson. This therapist evaluates what she’s doing.  Self disclosure is fine; drawing narcissistic attention to oneself is not. The calculus lies in what’s best for the client’s treatment.  And, most professionals know how to balance this equation.

Take Home Message:   

A therapy relationship needs to be a productive relationship. It consists of two people earnestly trying to improve the life of the person identified as the patient. There are ups and downs, productive and unproductive sessions, but the goal is the relief of suffering and more emotional maturity. It often works. And that is a blessing.

Narcissistic personalities are out there, and some end up in the therapy profession. It’s a free country and you can get a second opinion at any time. A secure, competent therapist will encourage you to speak about your concerns or try other approaches. Find a balanced, capable therapist who can really help you.   

Don’t settle for less.


To find out more about Donna Moss, LCSW-R:


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