How to help a client with Narcissism

The following questions were posted to Stephen Johnson, Ph.D -Author of Character Styles and Humanizing the Narcissistic Style while doing a project on narcissism.


  • How can we identify narcissism in ourselves and in others?
  • What are good guidelines as healers to help heal narcissism?
  • What advice would you give to someone who is dating a person that has a lot of narcissism?
  • Do you have any of the latest research about narcissism or anything else that you would like to share with us?

How can we identify narcissism in ourselves and in others?

A very important thing about the Narcissistic personality or any other personality is that there has to be a congruence of many things that have to go together, you can’t just take one trait, like in the case of narcissism; narcissists tend to be grandiose and grandiosity is a sign of that but that only that does not make a person narcissist, we have to put together things like: The family history, relationship history, the relationship that you and the client have together and if it all fits, then you have character type that you look at.

Donald Trump shows everything, he is almost too classic to be in a textbook, it’s too easy. So what you see in him is a lot of grandiosity about himself, everything he does is the best, he is wonderful, everybody loves him, etc, etc, etc.

The other thing that you find with narcissists is the opposite of that, worthlessness so very often when you see somebody who is grandiose and if you also can get to the worthlessness, then you really have a narcissist.

The basic issue with narcissism is self esteem and if the self esteem is out lack, it’s both grandiose and worthless, then you have the narcissist style, whether is you or somebody else.

People with this problem are very sensitive to criticism because the criticism hits the worthlessness and they think of the grandiosity as the defense against the worthlessness.

The other thing to remember of all the character structures I’ve written about, is that there is a continuum from the very worst to the very best. The very worst I called character disorders, the very best I call character styles and in the middle is character neurosis.

What you have on the continuum is you have very primitive organization in the personality disorder if people have not grown up yet, they are still operating in a very childlike level. People who are neurotic specially with narcissism tend to not bother other people, they just tend to be narcissistic-ally worried about their self esteem. They sit more in the worthlessness area of the continuum. At the high end you primarily have people who just have a flavor of narcissism. They are not very pathological but they have sort of treads of narcissism and many people have that even if their dominant character structure is something else.

What are good guidelines as healers to help heal narcissism?

First you diagnose it and you diagnose it by looking at the things I mentioned and then what you need to do at the very beginning of therapy with narcissists is indulge their grandiosity, they will tend to idealize the therapist or devalue the therapist but usually what happens is they start by idealizing. And everybody is uncomfortable with that, everybody normal is uncomfortable with being idealized. If you are very narcissistic yourself you enjoy and belief that idealization, but if you are more normal it makes you uncomfortable.

And so which you have to do on therapy with a narcissist is indulge that, let it be, don’t mess with it. And if they begin to devalue you, let that be too, don’t mess with that either. They are so fragile, that they are really presided disorder. They are very fragile, very responsive to criticism, what you see with Donald Trump again, and so you have to be very careful with them at first and not challenge these things.

And then over time when the relationship builds, you can help them by educating them, and without using the word narcissism, that you may never want to use, certainly not at first, you can help them understand how they developed some of the issues they’ve got. And if you have had a good relationship they may confess to you the bad feelings they have about themselves. And you can help them understand how they come by their problems naturally, that is in the family history they were probably criticized a lot, put down and they developed this worthlessness feeling and then they had to defend against that by the grandiosity.

So you can help them understand it first. It’s kind of an educational process at least the way I do it. I help people understand what’s wrong, where it came from, with the message of you come by it honestly. There is nothing wrong with you, you are a normal human being who just went through this kind of history and this is what happens when you have that kind of history, you come out with a self esteem issue and rather than spend your time in worthlessness, you defend and spend your time in the other side.

That brings up another quality of narcissism which is splitting, is either, black and white thinking: you are really good, very very good or very very bad and there is no room in the middle and so what you help people do is get comfortable with the middle. Get comfortable with being good enough, comfortable with being good in some things, not so good in others; accepting that you are a human being.

What advice would you give to someone who is dating a person that has a lot of narcissism?

If it’s really, really bad you may want to run, because very difficult persons will take a long time to heal and what I have noticed is that very often, people under the age of 40 are much harder to help because they haven’t have enough themes in their life, the grandiosity can hold up, particularly if you are very smart, very successful and so on. It’s not until you have some failures in your life around work, around relationships, that you tend to be more open to therapy or to working on yourself outside of therapy. I think any serious narcissist really must have therapy, they are not going to get better on their own, I don’t think and they may live a narcissistic life all their life.

I think the best thing to do to help a narcissistic date is getting your partner to get some work, I don’t think that we can help each other very much on that level. If you are a girlfriend of a narcissist man I wouldn’t try to change him, I will try to get him see somebody who will help him change.

Do you have any of the latest research about narcissism or anything else that you would like to share with us?

The thing that I’ve noticed more as I have gotten older is that the creation of narcissism or any other issue isn’t just in in childhood. That’s when it tends to be the most powerful, the most unconscious, the hardest to help, but you can develop a narcissistic personality by having the same kind of conditions repeated later in life. Not usually in adulthood but often in childhood and grammar school stage, in high school, even in early adulthood like college age people. So I don’t think it’s quite as exclusive to early childhood as I might have thought earlier.

Interview to Stephen Johnson, Ph. D by Salome Torres.

Recommended reading:

NPD, a compassionate approach, Salome Torres

Character Styles, Stephen Johnson

Humanizing the narcissistic style, Stephen Johnson