I recently facilitated a clinical supervision group (it’s like a consultation group for new therapists) where we were discussing a case where the client seemed to have some narcissistic traits, and the therapist was finding it difficult to make progress.
This conversation made me reflect on how often the term “narcissism” is thrown around these days. It’s a buzzword that people use to describe everything from selfish behavior to full-blown personality disorders, and I think it’s important to set the record straight.
As therapists, we have a responsibility to distinguish between true Narcissistic Personality Disorder (NPD) and narcissistic traits. In this blog post, I want to explore how we can identify the difference, recognize these traits, and how therapists can be equipped to provide therapy not only for individuals who exhibit narcissistic behaviors but also for those who have narcissistic people in their lives.
Narcissism vs. Narcissistic Personality Disorder
Narcissism manifests in various ways, from grandiose self-perceptions to deep-seated insecurity masked by charm and defensiveness. It’s crucial for therapists to distinguish between clients with NPD and those just with narcissistic traits due to external stressors such as trauma or relationship difficulties. Understanding this distinction helps tailor interventions—of course, a psychological evaluation is going to be the best way to confirm a personality disorder diagnosis.
There’s not a simple narcissistic personality disorder checklist, since the symptoms are going to vary by person. However, key indicators of NPD include:
- Persistent lack of empathy
- Resistance to accountability
- Difficulty accepting criticism
- Manipulative behavior
- Controlling behavior
NPD isn’t situational or depending on who the person is with. It’s pervasive, meaning, the symptoms happen across many areas of a person’s life, relationships, and interactions.
Listen to our recent podcast episode about narcissism vs. NPD here:
Can you have Narcissistic Tendencies Without Being a Narcissist?
Yes! This just means that they don’t meet full diagnostic criteria for NPD. They show symptoms or have some of the criteria, but it probably isn’t pervasive or showing up in multiple areas of their life.
People with narcissistic tendencies might be self-centered or lack empathy, but perhaps they are still able to have normal, healthy relationships. It might be that their narcissistic traits show up when they’re under a lot of stress or in certain contexts (like only at work), but it’s not something that is present consistently.
Challenges in Therapy for Narcissists
These are some challenges that Erin discussed when working as a therapist with clients that meet criteria for NPD:
Resistance to Change: Clients with narcissistic traits often struggle to acknowledge their need for self-improvement. Their defense mechanisms, including denial and projection, can make therapeutic progress challenging.
Slow or No Progress: Therapists may experience frustration due to slow or minimal progress. Narcissistic clients can be skilled at manipulating conversations to reinforce their worldview, sometimes leading therapists to question their effectiveness.
Attempt to Manipulate: Client might attempt to control sessions, omit any information that paints them in a negative light, or push professional boundaries.
However, this does not mean that therapy with true narcissists is fruitless…. Quite the opposite. Once you realize what is happening underneath the surface, you are finally able to make progress. As Erin states in the podcast episode:
“Narcissistic folks can be helped, but it’s a tough journey. Narcissism doesn’t just happen—it’s built over time from all the wrongs in someone’s life. I have a lot of empathy for how that happens. But as a therapist, what can be frustrating is that you want to shake them and say, “I can help you, if you’ll just let me.” And that’s where the burnout comes in for us. With narcissists, it often feels like we’re not making any progress at all. I like to remind therapists that you might never know the impact you’ve had with a narcissist, but there’s a good chance you have had some. If they keep coming back, even after six or twelve sessions, that’s something.”
Narcissistic Personality Disorder Treatments
Approaching therapy with someone that has NPD is going to look different than other diagnoses. For example, DBT is the gold standard for working with those diagnosed with Borderline Personality Disorder, while Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI) is considered better for those with NPD. CBT challenges cognitive distortions (like externalized blame and their sense of grandiosity) while Motivational Interviewing can encourage reflection without direct confrontation.
Ultimately your goals and interventions should be centered around building their emotional insight and regulation, encouraging perspective taking, and building their empathy. However, as the therapist, you must:
Set Boundaries and Manage Expectations
This means helping clients understand that they may not be able to change others (e.g., narcissistic family members or partners), but they can establish and enforce boundaries.
You are constantly modeling what these boundaries might look like… this underscores the importance of maintaining firm professional boundaries in sessions to prevent manipulation.
Encourage Self-Reflection Without Confrontation
Direct confrontation often leads to defensiveness. Instead, use open-ended questions and Socratic dialogue to gently challenge distorted beliefs.
In a recent podcast interview, the guest discussed how narrative therapy techniques can help clients with narcissistic traits reframe their experiences in a way that promotes growth.
Teach Emotional Regulation and Perspective-Taking
It is crucial to begin introducing mindfulness and distress tolerance techniques to help clients manage strong emotional reactions.
Many therapists also find that role-playing exercises to help clients consider different perspectives (without feeling attacked).
Use Detailed and Neutral Communication
This looks like encouraging fact-based discussions rather than emotionally charged narratives. You absolutely have to avoid taking sides in relational conflicts to maintain therapeutic neutrality.
A narcissistic personality disorder treatment plan is going to need to include many of these aspects.
Coparenting with a Narcissistic Parent or Narcissistic Ex
When children are caught in high-conflict situations with a narcissistic parent, it can have a profound impact on their emotional and psychological development. As therapists, we have a responsibility to create a safe space where children can express their feelings and learn how to navigate these complicated relationships without internalizing blame or distress. Our role is not to diagnose or label a parent but to empower the child to develop resilience and self-trust.
Here were Erin’s tips from the podcast interview for working with families in this type of case:
Maintain a Safe Therapeutic Environment
- In cases involving high-conflict co-parenting, minimize parental interference to create a secure space for the child.
Empower the Child
- Teach children how to recognize and respond to manipulative behaviors.
- Encourage self-trust and resilience by reinforcing their instincts and feelings.
Supporting the Non-Narcissistic Partner
Being in a relationship with a narcissistic person—whether as a spouse, co-parent, or family member—can be incredibly exhausting. It can be even more exhausting if they co-parenting with a narcissist. Many partners of narcissistic individuals struggle with self-doubt due to years of manipulation and emotional upheaval. As therapists, we can provide clarity, validation, and tools to help them regain a sense of autonomy and self-worth.
These were Erin’s tips for providing therapy to a partner or ex-partner of a narcissist:
Validate Their Experience
- Many partners of narcissistic individuals struggle with self-doubt (“is my spouse controlling?,” “am I the problem?” etc.) due to prolonged gaslighting. Help them recognize their reality and trust their perceptions.
Strengthen Resilience and Autonomy
- Encourage self-care, independence, and personal goals separate from the narcissistic relationship dynamic.
- Introduce assertiveness training and boundary-setting techniques to enhance their confidence in managing interactions.
A few years ago, I also worked with several colleagues to create a book list for people that are going through a divorce. This list also includes recommendations if you are co-parenting with a narcissist.
Therapy with Narcissistic Clients
Navigating therapy with narcissistic clients presents unique challenges, but with the right strategies, therapists can have productive sessions while maintaining professional boundaries. While progress may be slow, each session offers an opportunity to introduce self-awareness, coping skills, and healthier interpersonal dynamics.
By integrating empathy, clear boundaries, and structured interventions, therapists can create an environment where both narcissistic individuals and those affected by them can work toward healthier patterns of thinking and behavior. Although the journey may be difficult, the professional and personal growth gained through this work is invaluable for both therapists and their clients.
Reading to dive into more info on narcissism vs. NPD? Listen to the whole podcast interview, or read the transcript below.
Podcast Transcript
Miranda: Welcome to the Therapist Thrival Guide. My name is Miranda Barker. I’m a licensed clinical social worker, and I’m here with Erin Pash, LMFT, the CEO and founder of Ellie Mental Health.
Erin: That’s me.
Miranda: Today, we’re jumping into a conversation we’ve had a lot of requests for: narcissism. Dun dun dun. This topic comes up all the time because the term “narcissist” is thrown around constantly—often without people fully understanding what it means. There are clinical aspects of narcissism that we can break down, but we also want to talk about things like how to treat a narcissist and what to do if you’re in a relationship with one.
Erin: Totally. My interest in working with narcissism, like many therapists, came from a specialty niche that fell into my lap. I initially wanted to work with co-parents, but it turns out there’s a high likelihood of extremely high-conflict co-parenting dynamics involving at least one narcissist.
Miranda: Why do you think that is? Why is there such a strong overlap between high-conflict divorces and one partner being a narcissist?
Erin: The nature of narcissism makes it difficult for someone to see other people’s perspectives. Narcissists often need control and may resort to disagreement or manipulation. When they’re married, they might mask some of this because they’re in the relationship. But once they separate, the dynamics shift.
The non-narcissistic parent is usually trying to promote what’s best for the kids, while the narcissistic parent often prioritizes promoting themselves—or, interestingly, their position.
Miranda: Ooh, say more about that.
Erin: Yeah, a lot of people talk about narcissism in co-parenting, but what I mean by prioritizing their position is this: narcissists can become so attached to their delusion of their worldview that they will sometimes reject solutions that actually benefit them. For example, the other parent could offer a schedule that gives the narcissist the days they want or the money they want, but they’ll still say no—because they’re married to their position. They can’t dislodge themselves from their delusion.
This stems from the core of narcissism, which is often grounded in a delusional thought process shaped by deep wounding or trauma. Many narcissists have experienced significant hurt, often from abuse or neglect. It’s not their fault—they didn’t choose the circumstances they grew up in. But as adults, they may cling to a rigid worldview as a defense mechanism.
Miranda: That makes a lot of sense. It also explains why confronting that delusion can be so threatening to them.
Erin: Exactly. If their worldview is challenged, it feels like everything they believe about themselves could be untrue. For example, imagine a child who was abused and gaslit into believing their experiences weren’t real. As an adult, they might develop a narcissistic defense, deciding, “No one will ever make me question my reality again.”
In therapy, you can sometimes see the moment when a narcissist’s delusion is challenged. Even if you show them video evidence of something they just said, they might flat-out deny it. It’s a flagrant disregard for reality, but it comes from that deep-seated wound.
Miranda: That’s so interesting—and heartbreaking, in a way. I think one thing I personally struggle with around this topic is figuring out what distinguishes a true narcissist from someone who is just selfish or difficult. Like you said, the term is thrown around so much.
When I worked in child protection, I ran into a lot of true narcissists. It was so common in that field that it almost skewed my perspective—I started to feel like narcissism was everywhere. But now, as a therapist, I actually don’t encounter it as often. I think part of that is because I don’t do a lot of couples or kid therapy anymore. It makes me wonder, clinically, what really defines narcissism?
Erin: That’s a great question. The key clinical marker is the lack of empathy. Therapists often get a gut feeling when something doesn’t add up. A narcissist can sit in front of you, say all the right things, and seem charismatic—but you’ll leave the session feeling strangely off. It’s almost like looking in a mirror and not seeing your own reflection.
Miranda: Like the origin of gaslighting, right?
Erin: Exactly. It creates that disorienting feeling where you know something is real, but it’s being denied.
Another subtle but telling sign—especially in high-conflict couples or co-parenting situations—is projection. Narcissists frequently accuse others of the very behaviors they’re engaging in. For example, a cheating partner might constantly accuse their spouse of infidelity.
Miranda: Oh, totally! I’ve seen that before—like when the guilty party is the one making the loudest accusations.
Erin: Yep. In therapy, this kind of projection is a big red flag.
Another interesting thing about narcissism is that it doesn’t always present as a problem outside of relationships. Unlike anxiety or depression, which can impact every area of life, narcissism may not cause issues in someone’s day-to-day functioning. A narcissist could be a highly successful, fully functioning person. The problem emerges when they have to engage in relationships requiring empathy, compromise, and vulnerability.
Miranda: That makes so much sense. Narcissism might not ruin someone’s career, but it can definitely destroy their friendships and marriages.
Erin: Exactly. And here’s the tricky part: narcissism can sometimes drive success. Some might even argue that it can be a superpower. If your delusion convinces you that you’re the best, you may manifest success and confidence.
There’s also a difference between covert and overt narcissism, which therapists sometimes miss. Overt narcissists are more obvious—the grandiose, “look at me” types who dominate the spotlight. This is more common in men.
Covert narcissism, on the other hand, is quieter and trickier to spot. These individuals might not be boastful, but they still operate from the same worldview. They might fly under the radar at work, quietly believing they’re the best, and become highly successful because of their obsessive focus.
Miranda: That’s fascinating. So, overt narcissists are publicly grandiose, while covert narcissists still have that delusion of superiority but without the noise.
Erin: Exactly. It’s not always bad to believe in yourself, but when it comes at the expense of empathy or self-awareness, that’s when it becomes harmful.
Miranda: That’s like any diagnosis—it’s not a problem until it affects the rest of your life and actually becomes a problem.
Erin: Correct.
Miranda: Interesting. One of the other things we talked about is the differences between men and women with this diagnosis. It feels like men are way more likely to be called a narcissist, but am I wrong? Am I backwards?
Erin: I think you’re wrong. Much like how young boys used to get diagnosed with ADHD because they were bouncing off the walls, and we later learned that women actually have a higher prevalence of ADHD—it just presents more inattentively, so it’s inside their head and harder to see.
I don’t know the exact research on narcissism; I’d have to look it up. But in my experience, I probably run across more covert narcissistic women than I do the overly confident, grandiose-type narcissistic men. Covert narcissism can present with a lot of victim mentality.
Remember, a lot of narcissists will accuse other people of doing the things they do. So, in couples or co-parenting relationships, the covert narcissist will often come in crying, saying, “I’m the victim,” and talk about all the bad things that have been done to them. But if you ask curiosity-based questions, you can start to uncover the patterns.
These are people who can usually shift between waterworks tears and intense anger pretty quickly. They’re doing everything they can to protect the façade.
Miranda: So, what’s the difference between that and histrionic?
Erin: Histrionic personality disorder is more about attention-seeking behavior.
Miranda: Okay. That feels similar, though.
Erin: It can look similar, but people with histrionic personality disorder usually have empathy for others. In fact, I’d say histrionic traits probably don’t impact relationships as destructively as narcissism does.
People with histrionic tendencies are desperate for attention, but they still want to have relationships. It shows up as craving constant attention, sometimes through dramatic or flamboyant behavior.
I’ll give a silly analogy: histrionic personality disorder is like the girl in high school who wants every boy to love her, gets on the tables at parties and dances, but still has friends. She just wants all eyes on her.
Miranda: Okay, that makes sense.
Erin: A narcissist, on the other hand, might be the stereotypical boy in high school who hooks up with every girl, disregarding their feelings. You might call him a “hook boy” or a player. He truly lacks empathy for how he makes others feel because his grandiose sense of self says, “I get to be with whoever I want.”
Miranda: Yep, I totally get that. That makes sense. So, you’re a couples therapist. What happens when you have a narcissist with a non-narcissist—or even with another narcissist—in a relationship? What’s it like in session when one partner is clearly narcissistic?
Erin: It’s hard. I think narcissism, unlike some of the more complicated mental health diagnoses, is uniquely challenging. Even people with deep-seated borderline traits can often get to a place where they can accept their diagnosis.
For example, I have friends with borderline personality disorder, and they’re some of my favorite people to be around. They have this huge ownership and self-awareness. They might say, “I know I can be emotionally intense sometimes, and I’m working on it.”
The same goes for other conditions. Someone with anxiety might say, “I know my worry can impact our relationship.”
But with narcissism, it’s different. Narcissists often live above their worldview. The likelihood of them accepting that they’re narcissistic is slim—because they’re narcissists. They’re more likely to be defensive and fight the label.
When I uncover true narcissism (not just narcissistic traits, which we all have to some degree), the work often shifts to helping the non-narcissistic partner see things clearly. It becomes about them realizing they have a choice.
A lot of couples come to counseling thinking they have ordinary, run-of-the-mill problems. For example, a woman might say, “My husband only cares about his hobbies, and we never go out on date nights.” That sounds like a common relationship issue.
But when there’s true narcissism, you can tell the difference. A non-narcissist, even if they’re defensive at first, will eventually show empathy, care, and a willingness to grow.
My biggest tell for narcissism? When you challenge a narcissist in therapy, they won’t just resist—they’ll challenge you. They’ll undermine you, deny your existence, and sometimes become vindictive.
I’ve had narcissistic clients report me to the licensing board simply because I asked about their feelings of anger. They’ll say, “What anger? I’m not angry!” Meanwhile, they’re literally yelling.
Unfortunately, the outcome is often that victims of narcissistic abuse don’t recognize it. They think the dysfunction is normal.
Miranda: Walk me through some examples. What kinds of issues do couples bring to therapy when one partner is a narcissist?
Erin: So, a lot of the way narcissists will present in therapy is through their charisma. Remember, they’re often very charming. Let’s say, for example, a stereotypical “guy’s guy” comes into therapy because his wife wants him to. If he’s not a narcissist, he might say something like, “If we had sex more, we’d be fine.” It feels raw and unfiltered. And honestly, that is an important issue for many men, though not always. But the key is, they’re blunt because they don’t know how to be tricky.
A narcissist, on the other hand, will come in and say something like, “I just really love my wife and I want to support her. That’s why I’m here. So, anything I can do or work on…” They immediately start charming the therapist. And unfortunately, this happens a lot—therapists buy into it. We’re not always on high alert. I mean, I feel like my radar has gotten pretty good over the years, but it took a lot of trial and error to get there.
When I first started doing co-parenting work, I used to believe people. If I met with the mom first and she told me this compelling story about how awful the dad was, I’ll admit—I went into the appointment with dad holding that bias. And in high-conflict co-parenting cases, they often send you their court orders. Early on, I would read through all of them and create a bias based on what a judge had written. But the thing is, judges only spend maybe 30 minutes with these people. They don’t actually know them. Yet, high-conflict co-parents will treat those court orders like gospel. And technically, yes, they are legal documents, but they only reveal a small part of the relationship.
It took me years of supervision, training, and consultation to learn that you know nothing until you figure it out for yourself.
Miranda: Yeah.
Erin: Oh yeah. You can’t just believe everything people tell you. You can still assume positive intent—because I don’t think most people come to therapy trying to trick their therapist. Like, “What game can I play on the therapist this week?” That would be a huge waste of time. But there are some people who will do that.
You really have to develop your own instincts. You need exposure and examples to get a feel for what seems right or off about a person. I think where therapists who work with high-conflict folks—whether they’re married or not—get lost is by overlooking the details. We often want to validate someone’s feelings and help them focus on the bigger picture so they can apply it in the future. But when you skip over the small things that a victim of narcissistic abuse sees as big things, you miss the real clues.
Miranda: Yeah. This is reminding me of a case I had when I worked in child protection. The dad constantly called CPS on the mom. They were co-parenting and had been divorced for eight years—a long time. And during those eight years, it was nonstop court battles. It never ended.
Dad kept making CPS reports over things that should not have been screened in. But he knew the right trigger words to get them taken seriously. So, you’d interview dad first—he’s the reporter—and he’d be super charming. He’d say all the right things. Everything you’re describing is making me think of this guy.
But then you’d go to mom’s house, and she was exhausted. She’d say, “I don’t know where this stuff is coming from.” She was overwhelmed. And cases like that are so hard. Whether you’re a child protection worker or a therapist, you’re trying to do right by the child. But there’s so much noise, so much fighting, it’s hard to know how to sift through the details and figure out what’s actually important.
Erin: Yeah. And I want to come back to the child protection piece because I’ve seen a lot of that. It is hard. In that system, when someone calls CPS, we often assume the “bad parent” must be the problem. But the system is flawed.
And the heartbreaking part is that there are some parents—like that dad—who use it as a weapon. But there are also parents genuinely trying to get help because their kids are being abused by the other parent. They’re desperate for intervention. So, it’s both. It’s hard to discern. You can have a truly charming parent who is advocating for their abused child, but because they’re so persuasive, they end up being seen as the problem. And I’ll tell you—it happens more often than you’d think.
I’m thinking of a specific reunification case I had. The dad was a blatant narcissist, but the mom was so fed up with dealing with him that she tried to prevent him from failing. She was afraid of the consequences for their child.
Miranda: What do you mean by preventing him from failing?
Erin: So, the kid wouldn’t want to go to dad’s house. And mom, anticipating that, would preemptively ask dad, “Hey, can I keep the kid tonight?” She was trying to be proactive and spare the kid. But instead of dad being seen as the abusive parent—which he was—mom ended up looking like the gatekeeper.
That’s the cruel part of narcissistic abuse—the victim ends up looking like the problem. They feel so gaslit because the rest of the world can’t see what they see. The narcissist seems like such a great person. Or maybe they have a noble job, so people think, “That person could never harm their kids.” But then you meet with the kid, and they say, “Oh yeah, my dad straight-up punched me in the face five times.”
The mom knows this is true. She’s been living with the reality. But she feels like she’s the only one who knows the truth because the narcissist is so charismatic.
So, the best advice I give parents in these cases—and it’s hard—is to stop trying to “win” against the narcissist. The only way to beat them in co-parenting is by outlasting them. You have to let them unravel on their own. You can protect your child when necessary, but stop filing constant ex parte orders. Save it for when you know you need to act. And get really good support and counseling.
In that specific case, I was reunifying a teenage kid with his dad after some previous issues. Mom was trying to stop it, but the kid was open to reconnecting with dad. It took mom about six weeks of gritting her teeth and biting her tongue for the relationship between dad and the kid to fall apart naturally. You have to let it happen between the parent and child. If you fight too hard, it turns into a co-parenting battle instead of a fight between the victim of abuse (the child) and the abuser.
Miranda: Yeah, these cases can make therapists feel like they’re the crazy ones. It’s so easy to get swept up in the chaos. How are we supposed to deal with this, Erin?
Erin: I can tell you’re getting all hot and bothered over there. I’m just gonna sip my water.
Experience is everything. Not formulating any opinions going into it and really checking your bias is huge. One of the superpowers I have in working with high-conflict co-parents is that I was a stepmom before I had my own kids. So I was like a woman on dad’s team.
Miranda: Right?
Erin: Who understood the dad who just wanted… And then I had my own kids. Now fast forward, and I’m still a mom of my own children with my own ex-husband, but my new husband has a baby mama, and there’s a whole conflict there. So I’m like, I’m not even on a team other than Team Child. All I want is for them to have a good life, right? And be able to navigate through life’s adversity.
The other thing we need to remember is that kids don’t get to choose their parents, right? And unfortunately, as much as I might threaten my kids—”I’ll put you back where I got you”—I physically can’t do that. So there is a lot of acceptance. There’s a lot of work around resiliency and acceptance. I think when therapists can focus on that, you do a lot of locus of control work that can sometimes be the best thing for the victim.
What I always tell therapists too—I don’t like when therapists give up on these people. They need help.
Miranda: And…
Erin: If you can do it—if you’re strong enough or truly experienced or skilled enough that you can just shut it off and not care at the end of the day—I challenge those therapists to keep working with those people. Because there’s not enough people to help them. It is hard and it takes a different flavor.
I will also say that a lot of therapists who tap out of working with narcissistic relationships do so because they’re usually victims themselves. And that’s sometimes unrealized. These people are going to have the problems before you and the problems after you. So stick with it as long as you can. And then just remember, you’re a link on the chain. After they’re done with you—or you’re done with them—and you put up boundaries and they keep plowing through them? Yeah, discharge.
Miranda: Yeah.
Erin: You don’t look back. They’re gonna try, and when you cut them off, especially a narcissist, be as neutral as possible about why. Otherwise, they’re gonna come back and try to subpoena you and your records because you made them look bad.
But I also try to remind therapists that if you’re the family therapist, you have to approach it unbiased and with neutral eyes—but it is not neutral work. There’s a difference between right and wrong. I think where therapists get burnt out on these cases is they are forced to take a stance of neutrality.
Miranda: Interesting. Yeah. And then that…
Erin: That challenges their own values. When they’re like, “I know dad is a dick and he shouldn’t have kids, and I have an opinion about it, and I feel like it matters, and I want to do something to help,” but they’re told, “Don’t get involved or you’re going to get reported to the board.”
And I’m here to tell you, you might get reported to the board anyway. So help that—
Miranda: Kid. That’s a good point. That’s a great point.
Actually, you’re making me think of a couple of cases I have now—women in their mid-twenties, fresh out of college—who are struggling with family relationships with parents that might be narcissistic or have narcissistic traits. A big part of the work I’ve done with them is around acceptance and setting boundaries.
Being able to say, “My mom may never change, and I need to be okay with that. This is the relationship, and this is what it’s going to be like. It may never get better. It may never change. She’s not going to suddenly open her eyes one day to how she’s been to me.”
Just finding some of that acceptance. And then navigating, “Okay, given this, what do I want our relationship to be like? How can I set those boundaries? How explicit do I need to be about these boundaries?”
Or there have also been times where they’re explicit about boundaries and that sets the parent off.
Erin: That’s what I was going to say. In a healthy relationship where you have personality differences or some mental health stuff, you can put up boundaries and people might still press against them.
But with a narcissistic person? Don’t expect to communicate boundaries and think that’s going to go well. In fact, they’re going to plow right through your boundaries, pretend your boundaries don’t exist, and then get everyone else who knows you to believe your boundaries are stupid.
Boundaries make narcissists fly off the handle more than anything else I’ve ever seen.
So the acceptance for me, in coaching people who deal with narcissists, is: you just gotta do you. That acceptance piece is, “Yep, I’ll hang out with mom, but she gets 60 minutes at a public restaurant.” Like, literally put it down to the hour, somewhere you can get up and walk away.
Miranda: Yeah.
Erin: And it’s no different than what we tell younger kids who still have to cope with their parent. If they’re not harming you, they can be as manipulative as they want, right? And that is who you’re dealt with.
So how do we, as therapists or as other parents or other supportive people, help these kids? Yes, you’re being manipulated. Let’s call it what it is so you don’t feel like you’re going crazy.
And then give them tools. If you’re at your mom’s house for the weekend and she is highly manipulative or lying to you, what can you do while you’re there to make yourself feel better?
Miranda: What can you do? What would you say? I guess that depends on the age of the kid, but let’s say the kid is in high school. They know what manipulation looks like.
Erin: High school kids? Honestly, most of them end up getting to decide who they want to live with when there’s a narcissistic parent or that level of conflict.
Miranda: Sure. Okay, let’s say a 10-year-old.
Erin: With a 10-year-old, you try and say, first of all—against the grain of your existence—”What are the good parts?”
Miranda: Yeah.
Erin: And you have to get them hyper-focused on the good parts. You often have to give them a pep talk to remind them to teach them about their gut, their brain-body connection. Because a lot of times when you teach a kid that young that something doesn’t feel right, they don’t need to understand that they’re being lied to or manipulated. They just need to know that it doesn’t feel good and then call that out so that it doesn’t stay in the somatic body and doesn’t float up to their brain as a worldview.
Miranda: But they also need to be able to trust that. I think that’s really key, being able to recognize something doesn’t feel right, and not feel gaslit into believing that. On the other side of things, I have other clients who have zero relationship with their parents because of narcissistic or borderline traits or something like that. And then as a result of those relationships, they walk on eggshells with everybody in their life. And part of that is because they learned really early on that they can’t trust their gut. They’re not sure what’s happening or what type of parent they’re going to get that day.
Erin: Yeah. No, but that’s the work, right? And so the earlier we can do it with kids, a lot of parents in a traditional co-parenting relationship, you’d be able to lean on your co-parent. Like if you couldn’t make it to a baseball game, you could say, “Hey, I’m busy. I can’t make it. Will you tell the other kid?” And maybe that parent knows that really you’re just going to a bachelorette party and want to be a woo girl national for the weekend. Your reasons are your reasons, but a kid might not have the capacity to understand that, right? In a relationship with someone who’s a narcissist, they will ask you to lie constantly, but it’ll be against your values.
And I think one of the key things is when kids get to a certain age, you don’t have to throw a parent under the bus, ever. And I would never recommend doing that. But there has to be a point where you stop lying. And I think that’s when kids hit a certain age, eight, nine, ten, you know that they’re like, “Make it make sense.” Something does not make sense. And the narcissistic parent will want you to lie on their behalf to make them look better.
Here’s an example. Let’s say it’s your nine-year-old daughter’s birthday, and she has it at mom’s house this year, and she wants dad to come and brothers and family on the other side to come, but mom doesn’t want that because it’s high conflict. But instead of mom going to daughter and saying, “No, I’m not comfortable with that,” mom wants to go to dad and say, “You need to tell her you’re busy.” But then it hurts dad and kid’s relationship because now the kid thinks that dad wouldn’t prioritize the kid’s birthday. And that’s how you often see it play out.
So whether you’re the therapist or the parent, you would go to that kid and just say, “I’d really love to be there. I am available, but it’s your mom’s choice, and I have to respect her boundaries.” And the narcissistic parent is going to use it against you. They’re going to come after you and say you told her that it was my fault. And yeah, it is. It is. But that’s my whole point. Yeah. And that’s how they’ll try and spin this narrative of, “You just made me the victim. You wouldn’t lie for me.” And it’s: I won’t because I would have loved to see my daughter on her birthday because that’s what she wanted, right?
And so this kind of stuff happens. It happens a lot. And a lot of times, narcissistic parents will be like, “Oh, that’s parental alienation.” And they’ll just—because, again, you challenge that delusional value. And so that’s what we do as therapists, is we help coach parents to help instill confidence in them and make it make sense. Because what we don’t want is the kid walking away and dad being like, “Sorry, I’m out of town. I can’t be there.” And now kids start thinking, “Does my dad even love me?” That ambivalence. They’re like, “But my dad loves me and wants to be a part of my birthday,” and I heard him talking last week—like they already know that things don’t make sense and all the things they’re picking up on.
And so those kinds of things are important. And I say that kind of stuff just as a mom, period. Like, I think we need to talk about—maybe it’s another podcast episode—parental accountability. I don’t let my son play football. I just don’t. My values are that I am not, it’s not worth the risk.
Miranda: You love football.
Erin: I do. You were at the football game last night.
Miranda: I know!
Erin: I feel like a complete hypocrite. A complete hypocrite because I won’t let him play. Maybe if I thought he would be like a professional football player and this is what he could devote his life to, but he is 10, and the hardest part is he’s a very skilled football player. Like, he’s so good. He’s probably better at football than I would ever tell him. I won’t let him play because of the risk of head injuries. But you know what? A lot of his friends play. A lot of his friends’ moms are my friends. I have to own that I’m the parent who, by default, thinks that every parent gets to make their own choice, but other moms might look at me and be like, “Oh, you think your kid’s better than my kid because you don’t care. Like, you think I don’t care about head injuries.” And I hate it.
But I tell Graham when he tells his friends that he can’t play or try out for the football team, I’m like, “Tell them the truth. Tell them it’s your mom’s fault.”
Miranda: Yeah.
Erin: And I think if more co-parents are willing to do that, the narcissistic one won’t. And again, that’s another key trick for a therapist to uncover—that good co-parents are willing to hold on and have that accountability because they’re not worried about a threat in their relationship with their child. My kid is mad at me about it every day, but we have such secure attachment that we’re good. Narcissistic parents don’t usually have secure attachment. It’s actually very ambivalent for the most part. Sometimes it’s avoidant, but most of the time, it’s ambivalent attachment. And so they don’t have the ability to take the heat, which is why they’re willing to make everybody else look like the bad guy instead of them. Yet, their innate symptomology requires them to be in control of the entire narrative.
Miranda: I think that one thing that I struggle with a little bit with this topic, too, is that, like, sometimes as a therapist, most of the time, you’re only getting like a small picture of these different things. And for example, like I had this case a couple of years ago. This is like one of my first cases, Ellie. And it was parents who were never married, and they had a kid who was likely on the autism spectrum. And dad would not come to any therapy appointments. Didn’t want to talk to me at all. And, but it also, I also got the sense that mom wasn’t really letting him either. It was like she was pushing him.
Erin: Yeah.
Miranda: And the constant narrative I got from mom was, “He’s abusive. He, there was DV. He was abusive.” And then, I had been working with this family for a couple of months before I did finally get to talk to dad, and he was like, “That’s ludicrous, like that’s not true at all.” But then you’re having this—at least at the time I was like—”This does not feel right. Like this family, I don’t know who the bad guy is in this.” I don’t know who is the actual abusive person, but honestly, it felt like a little bit of both of them. It felt like it was probably, in reality, maybe two narcissists that were together, but it was just so hard to decipher, especially when I was just seeing like their—it let’s say she was eight or something—it was hard because she wasn’t giving me a lot from either parent, and I was getting a whole lot from mom and just a little bit from dad. And in that particular case, I think that I was having a hard time kind of being like, “What is going on here?” I’m clearly not getting the full picture here, and it’s making it hard for me to do my job. But also, in cases like that, my duty was to the kid and to like work with her and do, you know, like she had anxiety and symptoms of autism, too. So it was just like we were doing this other work over here. But I always felt like I’m missing a whole lot over here.
Erin: So this happens so often, so, so, so often, which is why understanding the parent dynamics on the outset is so important. It’s why we even if we don’t have to get parent consent, we should always try and get it. And what I’ll tell you is that if parents are not together, either both parents need to be heavily involved in the therapy or not at all. Because the classic—and this just happened—the classic is the therapist will work with the kid, do a check-in every other time with mom or dad, and then it takes one lie, one manipulation to completely derail a bias, and we don’t have the opportunity to get the truth. Often we’re hearing a different story from mom, dad, and the kid.
It’s totally valid that kids can’t always articulate the crazy experiences they’re having. There’s really only one truth in these situations, and therapists won’t have full access to it—most courts and people don’t either. It’s easy to pit one person’s viewpoint against another. Lately, I’ve been advocating for not involving parents in high-conflict cases. I know that sounds counterintuitive, but when it comes to these situations, therapy can be sabotaged after a few months when parents start using the kid’s therapy to validate their own position. I like to say, “There are 168 hours in a week, and I only see the kid for one of them. The rest is on you.”
But when it’s high-conflict, the therapy can’t stay neutral. The therapy is sabotaged by the parents, and it often leads to manipulation. Parents need to decide up front whether or not they’ll be involved in therapy at all. With high-conflict cases, the therapist can’t be influenced by parents because the kid needs to feel that they can trust the therapist. Every conversation with the parent outside of scheduling can compromise that trust. Regular therapy might involve parents, but for high-conflict kids, I set the expectation that parents are completely out of the loop. This helps create a safe space for the child to be themselves without any external pressure.
Miranda: That’s exactly what I felt was happening. I’ve always been someone who talks to parents regularly, but this was one case where I felt like I had no clear picture from either side. In hindsight, it would’ve been better to have zero parental input.
Erin: Yeah, exactly. For kids in high-conflict situations, they need an adult they can trust who isn’t involved with the conflict. The therapeutic process has to be separate from that dynamic. It can be a better service to the child to keep parents out of it, and a family therapist can step in for the parents and be the neutral party.
Miranda: That makes sense. It’s such a clear structure—having a family therapist involved. You can stay neutral with the child, and the family therapist can work with both parents.
Erin: Right, exactly. And with high-conflict families, it’s really hard to navigate, but having that family therapist on board to get to know both parents without bias and share insights with you can keep the therapeutic process healthier for the child.
Miranda: That makes so much sense. In this particular case, it eventually fell apart when they switched to virtual sessions. It became really clear that the mom was behind the scenes, which made everything feel really icky.
Erin: I’m going to go out on a limb and say mom was likely the narcissist.
Miranda: Oh, I see that now. At first, she seemed so normal and like a victim, but later on, I could tell—it was all about her. That’s such a good example of how these things can play out.
Erin: Yeah, we get so quick to empathize with the person in tears, but we have to be careful. Just because someone seems like the victim doesn’t mean they are. It’s tough, but necessary to check those instincts.
Miranda: Yeah, it’s not always what it appears to be. It’s easy to fall into that trap of assuming you know the full picture.
Erin: Exactly. Some families will use therapy as a tool to manipulate the process or the therapist. I’ve had clients try to use therapy to get the therapist to write an affidavit or subpoena records, all to prove their position. It’s not about healing anymore—it’s about winning.
Miranda: That’s so true. It reinforces their delusional pattern where their view of the world is the only correct one.
Erin: Exactly. And when working with narcissists, it’s tricky because they don’t often have clear goals. For instance, I had a client who got kicked out of a professional school. He came in seeking validation for why it was unjust, but that’s all he wanted to do—complain. There was no forward progress. I asked him what he wanted from therapy, and he was totally taken aback. He didn’t have a goal, and when I challenged him, he ended up sending me an angry message and even reported me.
Miranda: That’s so wild, but it makes sense. It’s like you were asking him to grow and face things he wasn’t ready to.
Erin: Exactly. The thing is, with narcissists, there’s often no clear path. You have to focus on their goals, but when they can’t see their own flaws, it’s incredibly hard to move forward. I’ve worked with some borderline clients who made terrible choices, but they could still take accountability and move forward. Narcissists are different. When you start talking about changing, they get defensive.
Miranda: So much of it is just about challenging their worldview. If they’re not ready to acknowledge their own role in things, you can’t help them.
Erin: Right. And sometimes you have to work with what they’re willing to engage with, like motivation or acceptance. But you can’t force it. It’s about seeing if they’re ready for change, and if they’re not, you can at least provide space and validation. For some, it’s just about waiting until they’re ready.
Miranda: It’s tough work. And I think people sometimes underestimate how hard it is to help people who aren’t ready to help themselves.
Erin: Exactly. It’s like with one narcissistic client I worked with—they wanted to keep their wife from leaving. We worked on that, but as soon as it required him to change, he was out the door. They’ll engage if it’s about them getting something, but the minute they’re asked to change, they shut down.
Miranda: Yeah, that’s a perfect example of how their goals can shift once personal change is required. If it involves change that requires them to look inward, it’s over.
Erin: And it’s not about having a one-size-fits-all approach. You have to adapt based on what you’re working with. Some narcissists are tough cases, but it doesn’t mean they can’t make progress. It’s just the most challenging when their worldview limits their ability to change. Therapy is about seeing things differently to improve, and that’s where they struggle.
Miranda: I think it also comes down to making sure you’re meeting them where they are, even if it’s just a little bit of progress.
Erin: Narcissistic folks can be helped, but it’s a tough journey. I want to make sure I point out that narcissism doesn’t just happen—it’s built over time from all the wrongs in someone’s life. I have a lot of empathy for how that happens. But as a therapist, what can be frustrating is that you want to shake them and say, “I can help you, if you’ll just let me.” And that’s where the burnout comes in for us. It’s not about the client in front of us—it’s about whether we can make progress with them. And with narcissists, it often feels like we’re not making any progress at all.
So, I like to remind therapists that you might never know the impact you’ve had with a narcissist, but there’s a good chance you have had some. If they keep coming back, even after six or twelve sessions, that’s something.
Miranda: Do you think the motivation for change is more external for narcissistic people? Like, his goal was, “I don’t want my wife to leave me,” not necessarily that he wanted to be better, but that external thing.
Erin: Yes, I think that’s exactly what narcissism is. They won’t accept internal self-improvement, at least not in a real way. They can say they’ll do anything to change, but it’s usually for external reasons. They’re charismatic, but they don’t really want to change. As a therapist, you have to realize that real self-improvement requires tapping into the internal self, and narcissism is a defense mechanism to avoid that. It’s a way to protect the person from facing their real self, even from themselves.
Miranda: It’s like they can do everything right on the surface, but it’s all about avoiding the internal work.
Erin: Exactly. It’s all about defense. They create this shield to protect themselves from vulnerability.
Miranda: That’s a good place to end.
Erin: I agree.
Miranda: One quick side note: when I became a mom through adoption, I had to take the MMPI-2, and I was so stressed because I thought they’d say I had all these personality issues.
Erin: I look a mini online one once. But honestly, it helped me as a therapist. I think one of the best things we can do is challenge what we think we know. These clients will challenge us, but we also have to stay creative. If we can get into the mindset of these people and see things from their perspective, it helps us find ways to support them.
At the end of the day, our job is to support people who are asking for help. If they’re not motivated, there’s not much we can do—unless they’re court-ordered or it’s a teenager who doesn’t get to decide. Then we play Uno. But for everyone else, it’s our job to be creative in our approaches. I don’t have to agree with them, and I don’t even have to like them. But if I’m going to help, I have to try something unique.
Miranda: Absolutely. Thanks for joining us, Erin.
