How to Treat a Narcissist in Couples Therapy: Clinical Insights and Best Practices

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Couples therapy can be a challenging but transformative journey for any pair seeking to mend their relationship. When one partner exhibits narcissistic traits or meets the criteria for Narcissistic Personality Disorder (NPD), the therapeutic landscape becomes even more intricate. This article is tailored to counselors, psychologists, and therapists in private practice, providing valuable insights into effectively treating narcissists within the context of couples therapy. We will explore clinical ideas, setting boundaries, best practices, and ways to empower the non-narcissistic partner while distinguishing between narcissistic tendencies and NPD.

Understanding Narcissism vs. Narcissistic Personality Disorder

Before delving into treatment strategies, it’s essential to differentiate between narcissistic tendencies and Narcissistic Personality Disorder (NPD). While narcissistic tendencies are common to varying degrees in many individuals, NPD is a diagnosable mental health condition characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Diagnosing NPD should be left to qualified mental health professionals, as it requires a comprehensive assessment and evaluation. In couples therapy, you may encounter individuals with narcissistic tendencies rather than NPD, and it’s crucial to identify the distinction.

Clinical Insights for Treating Narcissists in Couples Therapy

  1. Therapeutic Alliance and Engagement: Building a strong therapeutic alliance with the narcissistic partner is a fundamental step. Recognize that narcissists may initially seek therapy due to external pressures, such as the threat of divorce or social expectations. Validate their concerns and frame therapy as an opportunity for personal growth rather than an admission of wrongdoing.
  2. Psychoeducation: Begin by providing psychoeducation about narcissism and NPD. Help the narcissistic partner understand their behaviors and their impact on the relationship. Use empathy and non-judgmental language to foster a sense of safety.
  3. Setting Boundaries: Boundaries are crucial in couples therapy involving narcissists. Clearly define the therapy’s scope and purpose. Discuss the therapist’s role in maintaining a safe and balanced environment. Encourage the non-narcissistic partner to assert their boundaries and express their needs.
  4. Avoid Blame and Criticism: In sessions, avoid blaming or criticizing the narcissistic partner. Instead, focus on the impact of their behaviors on the relationship. Use “I” statements and encourage both partners to communicate their feelings and needs effectively.
  5. Empower the Non-Narcissistic Partner: The non-narcissistic partner often needs support in asserting themselves and rebuilding their self-esteem. Encourage them to prioritize self-care and assertive communication. Help them set realistic expectations for change in their relationship. This could include teaching grey rocking, here is an article all about it: The Evolution of “Grey Rocking”: A Strategy for Dealing with Toxic Relationships
  6. Cognitive-Behavioral Techniques: Utilize cognitive-behavioral techniques to challenge distorted beliefs and behaviors in the narcissistic partner. Help them develop a more balanced view of themselves and their partner. Promote empathy-building exercises to enhance their capacity for understanding and compassion.
  7. Mindfulness and Emotional Regulation: Teach mindfulness and emotional regulation techniques to both partners. These skills can help the narcissistic partner manage their emotional reactions and enhance their empathy. The non-narcissistic partner can benefit from these techniques to cope with stress and frustration.
  8. Individual and Couples Sessions: Incorporate individual therapy sessions for the narcissistic partner alongside couples therapy. Individual sessions can address underlying issues contributing to narcissistic behaviors, such as low self-esteem or unresolved trauma.
Because as Couples Therapists we work so hard to maintain a neutral stance, we can inadvertently serve as enablers to the narcissist’s agenda. This is because they are often taking more and more “ground” in a therapeutic space, and in their demands from their partner in the relationship. It’s critical as Couples Therapists that we educate ourselves about narcissism and sociopathy so that we do not cause iatrogenic harm to the narcissist’s relationship partner. -Dr. Elizabeth Carr, Kentlands Psychotherapy

Best Practices in Treating Narcissists in Couples Therapy

  1. Maintain Neutrality: Strive to maintain neutrality and avoid taking sides in the relationship. The therapeutic space should be a safe environment for both partners to express themselves.
  2. Regularly Assess Progress: Continuously assess progress and readiness for change in both partners. Adjust treatment goals and strategies as needed. Be prepared for setbacks and relapses in narcissistic behaviors.
  3. Manage Expectations: Realistic expectations are essential. Inform both partners that significant changes in narcissistic traits or NPD may take time and effort. Progress can be slow, but it is possible with dedication.
  4. Consultation and Collaboration: Consult with colleagues or seek supervision when dealing with complex cases involving narcissistic partners. Collaboration with other mental health professionals, such as psychiatrists, may be necessary if co-occurring disorders are present.


Treating a narcissist in couples therapy is a nuanced and challenging endeavor, but with the right clinical insights and best practices, progress and transformation are possible. By fostering a strong therapeutic alliance, setting clear boundaries, and focusing on individual growth, therapists can help couples navigate the complexities of narcissism within their relationships. Furthermore, distinguishing between narcissistic tendencies and Narcissistic Personality Disorder is crucial to providing effective treatment. Ultimately, with patience, empathy, and a commitment to change, couples therapy can offer hope and healing for both partners.