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Sitting with clients who are negatively impacted by a narcissist is hard because it can seem like leaving is the obvious solution… but not all clients are willing or able to do that. And as their therapist, you want a strong foundation to identify this hidden abuse and effectively respond.

We sat down with narcissistic relationship expert Ramani Durvasula, PhD, LCP to talk about techniques to consider while working with ambivalent clients, frame psychoeducational approaches, and more to help clients at these difficult decisional nodes.

What are the classic signs of narcissistic abuse in relationships?

In narcissistic relationships, we see chronic asymmetry. If you have a client who has experienced narcissistic abuse, it’s not unusual for them to come to therapy confused, self-blaming, self-doubting, and with a strong sense of moral injury often asking themselves, “Am I the bad one?”

What are the primary reasons that people choose to stay in these relationships?

There are so many reasons a client might choose to stay in a narcissistic relationship that therapists might not often be aware of or think about. Some of these are:

1. Lack of understanding. Often, your client might not have a good understanding of the fact that they are in a narcissistic relationship and there’s nothing the client can do to change the narcissist.
2. Practical factors. Invisible factors such as money, family court, custody, duty, obligations, fear, finances, and so many more can prevent someone from leaving an abusive relationship.
3. Fear. There’s often a lot of fear involved when it comes to post-separation abuse, of what would happen in family court or custody, and other unknowns that would keep someone in a relationship with a narcissist.
4. Hope. Along with fear, sometimes there can be hope that the narcissist will change.
5. History that people hold on to. Your client might be holding on to the good days and memories, their homes, and other aspects of their current life that they wouldn’t have if they stayed in the relationship.

When therapists are managing this delicate space of ambivalence, we have to remember that it’s about giving the client safe space to share all this confusion. As a therapist, you do not get to tell them they need to leave because this is bad for them. And while it can be frustrating for us as clinicians, the goal is to support them.

With the right therapy, are narcissists like to recognize and change their antagonistic behavior?

No. The odds of all the right details lining up are so low that working with a client on the possibility of that happening is cruel. I’ve never seen it happen. It is not likely to change, and whatever change may happen on the narcissistic person is not enough to course correct for the harms that have occurred in this relationship.

What is the most common mistake that clinicians make when working with clients who are trying to decide whether to remain in this kind of relationship?

Holding an agenda for your client is the most common and biggest mistake. Any form of agenda-holding is dangerous. As therapists, we cannot have an agenda for them. When working with these clients, we must be acutely aware of the delicate balance of all the factors mentioned above, as well as the cultural intersectional factors. It can be very dismissive to tell them to “just get their own apartment.” Our role is to hear their story. We are creating a safe space for our clients to mentally explore what is happening in their relationship.

What is cognitive dissonance and what does it typically look like in clients in an antagonistic relationship?

Cognitive dissonance is the tension that is created by any form of mental or emotional inconsistency. In the simplest example, for some reason you can’t join your friends for dinner at a restaurant. You tell yourself, “well, that’s not a very good restaurant anyway.” It’s the things that a client might tell themselves to reduce the uncomfortable tension.

In a narcissistic or antagonistic relationship, someone might attempt to restore harmony by justifying what is happening in the relationship. They take someone’s angry tantrums day after day and reduce them to “they had a tough day” or “they have a tough backstory,” therefore diminishing the tension and maintaining the status quo. Over time in a relationship, that justification become a schema belief system where the person who is being abused ends up blaming themselves.

Even if a person decides to stay, which they often do in a narcissistic relationship, therapists must guide clients in a clearheaded way, so they don’t keep justifying it or blaming themselves – and so the client has a greater likelihood of saying that the abuse they are receiving is not their fault.