If you are in a romantic relationship with someone who qualifies for a diagnosis of narcissistic personality disorder, and you are reading this article, it is likely that you are desperate for help. You have discovered that once the initial glow of being in the relationship wore off, your narcissistic mate stopped telling you that you are wonderful and switched to criticizing and devaluing you. This has led to long, ugly, unresolvable fights.
Your once-great relationship is in tatters, along with your self-esteem. Even worse, you feel helpless, because everything that you try to do to fix things seems to make the problems worse. Now instead of living with your favorite person in the world, you are living with someone who acts as if you are the enemy.
At this point, you are probably out of ideas and patience and are looking for something else that might help turn your relationship around. This is usually when someone thinks: “Maybe going to couples' therapy will improve our relationship and get us back on track.”
Basically, most partners of narcissists tell me some version of the following story:
I am beginning to despair. My self-esteem is in shreds. I cry all the time. I am not sure that I can take this anymore. My partner criticizes everything I do—even the way that I load the dishwasher and wear my hair. When we are out in public, my partner puts me down in front of everyone. When I protest or try to defend myself, they somehow turn it around so that they are the victim, and I am the bad one. I have invested a lot in this relationship, and I do not want to just walk away, if it can be saved. Nothing that I am doing to fix things is working. Do you think couples' therapy will help us?
When I explore what the person actually wants out of couples' therapy, it is generally an advocate who will:
- Explain to the narcissistic mate exactly what she or he is doing wrong.
- Get the person to see how he or she is hurting the non-narcissist partner.
- Convince the narcissistic mate to change his or her attitude and behavior.
Unfortunately, while all of the above are worthy goals and sound reasonable, they are not actually likely to be accomplished in this situation. If your mate truly has an untreated narcissistic personality disorder, the sad truth is that couples' therapy is unlikely to be very useful.
(Note: In this article, I am using the term “narcissist” and “narcissistic” as shorthand ways of referring to someone who qualifies for a diagnosis of narcissistic personality disorder.)
Why Isn't It Useful?
Narcissistic personality disorder can be thought of as a self-esteem regulation disorder in which the person needs continual external validation in order to feel good about themselves. Narcissists also lack emotional empathy for other people. They cannot feel your joy or your pain. They only care about how your feelings impact them. This means that on a gut level, they are unlikely to really care if they do something that hurts you.
Narcissists also lack "whole object relations" and "object constancy." This means that they cannot see themselves and other people in an integrated, realistic, and stable way. In the narcissist’s mind, he or she is either special, perfect, omnipotent, unique, and entitled to everything that is good in the world or worthless, defective, garbage, and entitled to nothing.
This dichotomy also applies to how narcissists view their mates. It is very difficult for people with narcissistic personality disorder to tolerate their mate’s normal flaws and mistakes without comment or criticism. They tend to overshare their negative opinions and act on almost every negative thought that crosses their mind.
Once they start seeing their mate’s normal imperfections, narcissists usually start what I call “The Construction Project.” This involves setting out to change whatever they do not like about their mate—regardless of whether their mate wants to change. They will do almost anything to advance their agenda—nag, criticize, embarrass, threaten, try to control, and enlist third parties in this endeavor.
How Does All of This Affect Couple's Therapy?
Effective couples' therapy requires each member of the couple to be willing to reflect on his or her beliefs, behaviors, and impact on the other person. It is necessary for people in couples' therapy to be able to admit where their behavior or their expectations for the relationship are unreasonable. Narcissists cannot admit their flaws without in their own mind shifting from feeling special to worthless. This makes it highly unlikely that they will actually be able to utilize couples' therapy to try to improve their approach to the relationship.
One of the following four scenarios usually occurs:
Scenario 1—The Narcissist Walks Out
Narcissists are fine while they are telling their side of the story. They happily list their complaints about their mate and find a variety of ways to justify their own bad behaviors. But as soon as it is their mate’s turn to talk, they cannot tolerate hearing anything that feels like criticism. If the therapist insists on treating both of them in an even-handed way, the person with NPD is likely to get angry and refuse to continue the therapy.
Scenario 2—The Therapist Favors the Narcissist As a Strategic Move
Experienced couple therapists who have previously worked with narcissists will sometimes try to avoid Scenario 1 by being extra nice and affirming to the narcissistic partner. Their hope is that the non-narcissistic partner who initiated coming to couples' therapy will understand and tolerate this lopsided situation as the only way to keep the narcissistic mate interested in continuing couples' therapy.
The therapist’s plan, in this case, is to try to bond with the more difficult-to-reach member of the couple, engage him or her in the therapy, then gradually switch to a more evenhanded approach. Unfortunately, all that usually happens is that the non-narcissistic partner feels abandoned by the therapist. As one client said to me:
All that happened is that my husband now thinks that our couple therapist agrees with him that he is fine, and everything is my fault. He is telling everyone we know that even our therapist agrees that I am wrong. How is that going to help me?
Scenario 3—The Therapist Does Not Recognize Narcissistic Personality Disorder
In this scenario, the therapist is unfamiliar with the variety of ways that people with NPD can present in therapy—and how crazy they can make their mates. So, if the narcissistic partner acts calm, and his or her mate is very emotional, the therapist may see the more emotional person as the cause of the marital problems.
This naturally makes everything worse instead of being therapeutic. No one gets help, and the non-narcissistic spouse feels even more alone, unprotected, and misunderstood.
I have actually seen three different women in therapy who had good, old-fashioned nervous breakdowns as a result of being repeatedly gaslighted, abused, and controlled by their very narcissistic mates. In one case, the woman, who had found proof that her husband was cheating on her, ended up briefly hospitalized by her mate for mental problems. He calmly claimed she was paranoid and a danger to herself. The more she got emotional and protested, the more the doctors were convinced that he was right.
Once she finally got herself out of the hospital, her husband then used her hospitalization as proof that she was inherently unstable and should not get custody of the children in the divorce. He painted himself as the long-suffering, devoted spouse trying to help his mentally ill wife.
Scenario 4—Temporary Improvement
I have seen particularly skillful therapists manage to engage the narcissistic partner and help the couple incorporate a few changes. They negotiate a new “contract” about how they each agree to behave. This works for a little while, but as soon as the narcissistic mate gets triggered by something, the agreement is history.
Sometimes, this becomes a repeating pattern. The couple is in and out of couples' therapy over the years. The non-narcissistic mate gets some support, things go better for a while, and then the narcissistic mate slowly reverts to his or her usual pattern. This is the best outcome that I have seen so far.
Punchline: I do not usually recommend couples' therapy when one of the spouses has an untreated narcissistic personality disorder. The narcissistic spouse is highly unlikely to stick with the therapy or participate for very long in a useful manner. The money would be better spent on individual psychotherapy for the spouse with narcissistic personality disorder.
This article is an expanded version of a Quora post.