When it comes to confronting a client’s pattern of narcissism or grandiosity, it’s safe to say you might meet with some pushback along the way.
So to up your chances of success (and also mitigate the risk of damage to the therapeutic relationship), it can be helpful to pad your treatment plan with a few key components.
In the video below, Ellyn Bader, PhD takes us through them.
So for example, a confrontation can be built over weeks if you know where you’re heading, and you’re not just reacting to the problem of the day or the fight of the week. So if you’re going to be, for example, confronting a pattern of grandiosity and taking a one-up position all the time, or you want to be confronting the way somebody is self-absorbed, I want to have a treatment plan in my head and know where I’m going. And then the therapist has to be able to get out of our own self-criticism. Because the self-criticism that therapists have gets in our way a lot. And you want to come into a session and be able to see how far you can go, see how much of a confrontation you can make, and then back up. So I am always, when I’m working with a narcissistic client, doing a little bit of confrontation, and then backing up and saying, “How are you feeling with me right now? What’s happening between us? What’s this like for you?”
I was confronting a client last night who said, “The only person I ever lied to is my wife.” And I said, “I know you believe that, but it’s just not true. Let’s take a look at a few of the other places that I know that you’ve lied.” And that was not comfortable. But after we talked about that, I said, “Okay. So tell me about the part of you that wants to never come back to therapy. We’ve just been through this. I know it wasn’t comfortable. So I want to hear about the part of you that wants to get away from me.” And there’s that constant back and forth of testing the relationship, acknowledging the stress. I never want to confront when I have to do it from a one-up position.
I mean, or when I’m in a one-up position or when I’m annoyed. Because the confrontations have to be both strong and gentle, and not judgmental. And when you can learn how to confront a narcissist from a position of gentle strength and compassion that comes through, but also you’re not shying away from the reality of what they’re doing and how it’s getting in their way and how it’s hurting them and that you can see it, that makes a very big difference.
For more interventions to help you work with a narcissistic personality, check out the course Expert Strategies for Treating Narcissism. In it, you’ll hear from top experts in the field including Janina Fisher, PhD; Bessel van der Kolk, MD; Deany Laliotis, LICSW; Stephen Porges, PhD; Terry Real, MSW, LICSW; and more.
Now we’d like to hear from you. What have you found helpful in your work with clients with narcissism? Please share your comment below.