Narcissistic Personality Disorder In Therapy: A Pointless and Unpleasant Endeavor

Like everyone on Axis 2, the person with Narcissistic Personality Disorder thinks they are fine. Obviously the problem is everybody else. They will just go through their whole life blaming other people. That’s how they ride.

They rarely if ever show up for therapy, and when they do, it is often at the behest of others who are forcing them into therapy because the narcissists is driving these people insane and ruining their lives. Once in therapy, the narcissist plays games, engages in a boatload of manipulation, does no work on themselves because after all there is nothing to be done, and often engages in a lot of ego and narcissistic games with the therapist, including insulting the therapist, thinking he is better than the therapist and telling him so, deciding that the therapist is a lousy therapist, etc.

If you tell them they are narcissists, will generally either reject the diagnosis, ignore it, blow it off with some humorous blustery remark, decide that psychiatry is a pseudoscience, or say, “So what? I like being this way.”

They might take it as an insult, but they usually will not react aggressively. Instead you will see a spark of recognition and alarm in their eyes. The narcissist is not an idiot. Many are highly intelligent and in fact, sadly it goes with the territory. At some level, most if not all narcissists now what is going on. The problems is they don’t care, or they like to be this way.

If you keep reminding the narcissist of what he is, he will stop being flippant about it and start getting aggressive. Expect dirty fighting, devious and crafty manipulation, nasty insults, or walking out of the room. Keep it up, and the narcissist will just end the relationship. The narcissist is not going to sit there and let you call him a narcissist all day. He’s too good for such degrading treatment. If he cannot do that, at some point, he will probably create a nuclear explosion of a fight and try to terrorize you into not bringing up the subject again.

Generally speaking, they are a complete waste of time in the office, therapy with them is often quite unpleasant, and nothing gets done anyway. It’s not uncommon for the therapist to simply fire the narcissist as client, informing him that nothing is getting done. This a relief to the narcissist, as now he has an excuse to quit the degrading therapy. Technically this is client abandonment and an ethics violation, but the decision is always mutual, and nothing was getting done anyway, so why prolong the pointless endeavor?

Theoretically, the narcissist can be cured. Since lions cannot change into tigers, all we can do with personality disorders is turn the bad side of a basic personality type into the good side of that type. The good side of Narcissistic Personality is Confident Personality. These people can be a bit much too, but they are healthy enough that they can function quite well especially in a hyper-competitive capitalist society like ours. The goal of therapy with an NPD is to turn them into a Confident Personality. But good luck with that.

There is so much more to talk about with narcissism and NPD, but let’s leave that for another day.


Filed under Ethics, Mental Illness, Narcissistic, Personality, Personality Disorders, Psychology, Psychopathology, Psychotherapy

17 responses to “Narcissistic Personality Disorder In Therapy: A Pointless and Unpleasant Endeavor

  1. Pingback: The Definition of “Insufferable” | Beyond Highbrow - Robert Lindsay

  2. Pingback: No, Pathological Narcissism Is Not OK | Beyond Highbrow - Robert Lindsay

  3. GondwanaMan

    Yup, I think I mentioned this before. Narcissists don’t see anything wrong themselves, even as they destroy everything around them. And they generally end up the winners in environments where callous indifference to others is the main ingredient to success.

    • Callous indifference? Why do people need welfare if their neighbors or families care so much about them? It has to be siphoned out of taxes because nobody really wants to give anybody else the sweat out of their anus.

      Nobody sipping wine on his private jet with a high-priced Russian model sucking expensive cocaine off his penis while he sips expensive wine could care at all about hillbillies, low-caste Indians, ghetto blacks…or you…or me.

      You’re absolutely correct, sir.

      To be fair unlike psychopaths they do not harm people, threaten violence to others or even infringe on the rights of others.

      They simply focus intently and entirely on what will benefit them.

      To the credit of Narcissists they do not gossip as much as other human beings because they do not care.

      • Jason Y

        Yeah gossip seems to be a big problem among peasants (sarcasm) 😆 I do notice, jokes aside, that people without work might spend a lot of time talking about others. But then again, busy people might do the same.

    • True, they end up the winners.

      It is total self-centered but nobody you care about like the buddy going through a divorce will matter in 15 years…However, what you do with your time will.

      This is why we have welfare. If people relied on the generosity of others with no welfare we would all starve.

      How many of those high school f*ckups did we know that our peers “cared” about who went on to die in a drunken motorcycle accident anyhow?

    • GONDWANA MAN Look how much money Gates and Warren Buffet give to charity and how little difference it makes.

      How much matter is the average penny-ante narcissist going to make to squirming masses with their early marriages, too many children, lack of opportunity, violent houses, drug addictions, racial divides, ignorance, alcoholism and feelings of hopelessness.

      You cannot piss on a volcano.

  4. Vancouver! Vancouver! This is it!

    perhaps lesbians are also narcissistic. pumpkinperson has made up everything about herself. why would someone do that? it must be some kind of mental illness.

    pumpkinperson is female.
    she is a lesbian.
    she is half white and half black.

    all of this can be found here:

    some quotes:

    Lots of women have close friends. Doesn’t make them gay. Women are different that way. As a man you cant understand.

    As a hybrid I feel no loyalty to any race and this allows me to be one of those rare individuals who can be almost completely objective on matters of race.

    I love Oprah so much I can’t stand it.

    if you peruse these it’s pretty sick-making. of 1400 comments over a 5 year period almost every one is on something related to oprah with a smattering of comments on michael jackson, janet jackson, and other black celebrities.

    it also seems clear that pumpkinperson was sexually abused as a child.

    you know who i am. here’s something pumpkin wouldn’t post:
    BGI Cognitive Genomics Lab
    Building No.11│Beishan Industrial Zone│Yantian District│Shenzhen 518083│China
    认知基因组学 │ │
    ST-RM, BGI

    for those who comment at both blogs, now you know. very weird.

  5. Vancouver! Vancouver! This is it!

    how do you know all this? i think one would have to know a narcissist.

    • Yes unfortunately I know an NPD very well, but that is all I can say about that. And I have run into a couple of others lately. They’re annoying to say the least. If you ask them about themselves and sound fascinated, they can be interesting, friendly, charming, etc. As soon as the conversation comes around to you, they’re looking around the room. Other people bore them. They don’t want to know anything about anybody else. They will listen to you for about 30 seconds, shut you down and interrupt and go back to themselves.

      Also I work as a psychological counselor. I see clients on a fairly regular basis. I’ve logged maybe 4-5,000 counseling hours in the past several years.

      In addition, of course, I have been studying psychology, especially abnormal psychology, forever now. I do reading in it all the time. That is where I got the info about NPD’s in therapy. I have never had an NPD client, thank God.

      The Borderlines are bad enough. I see a Borderline client coming my way and I literally want to dive under my desk and hide. I am serious. They are truly nightmarish. I do not see how anyone can work with them and a lot of them seem so broken that I don’t see how they can ever be put back together again. Some of them almost appear psychotic, or perhaps they are psychotic at times. Some of the most sheer, out and out craziest humans I have ever met where Borderlines. In a lot of ways, they are almost crazier or as crazy as schizophrenics.

  6. Vancouver! Vancouver! This is it!

    as far as i know a narcissist is just someone with an inflated opinion of himself. that’s basically everyone except the clinically depressed. maybe it’s just a matter of degree?

    in a commentary accompanying The King of Kong one of the commentators lists all the DSM criteria for NPD and thinks billy mitchell has all of them. great movie.

    • Nope, not at all. That is normal narcissism or just egotism. Go look up Narcissistic Personality Disorder on Wikipedia. They take the narcissism thing about as far as you can take it and they are ill as Hell. Very annoying and can be unpleasant and I do not recommend getting into relationships or even friendships with them. You’re going to get hurt. All they do is hurt people. They don’t know how to do anything else.

      Narcissists are UGLY. There is often something mean, nasty, yucky or just unpleasant about them. They really rub you the wrong way. Frankly they are not particularly nice people. Rather they tend to be pretty serious assholes. When it gets as bad as NPD, there is a real ugliness and nastiness about it. They’re not very nice people, let’s put it that way.

      Their callousness can be very grating too. It’s your Dad’s funeral. Whoops he couldn’t make it. You’re crestfallen. Why couldn’t he come. BECAUSE HE LITERALLY DOES NOT GIVE A FUCK THAT YOUR FATHER DIED. They often have to insult you now and then to assert their superiority and if you start talking about yourself, this often annoys them and they can turn suddenly mean and cutting. It’s shocking how they can go from disarming nice to just sheer vicious just like that.

      You almost don’t even believe your eyes. I have almost fallen out of my chair a few times when they did that to me. They had been the picture of congeniality when they were talking about themselves and I was acting like a rabid and rapt listener. As soon as I started talking about me, they suddenly turned shockingly vicious just like that. I didn’t even know they had that in them.

      Bottom line is THEY REALLY DO NOT CARE ABOUT YOU. If they are around you at all, it is for some reason other than that they care about you. Perhaps you are useful to them in some ways, usually as a source of “narcissistic supply.”

  7. Robert

    Ann Barnhardt did a long video on the sujbect.

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