Mental health.

Why Some Therapists Won’t Work With Narcissists.

Countertransference and narcissistic personality disorder.

Write Mind Matters
5 min readMar 19, 2022

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Photo by Dane Deaner on Unsplash

Talk therapists support a person with narcissistic personality disorder (NPD) using psychodynamic or cognitive behavioural therapy along with other forms developed from the therapist's clinical experiences.

“No standardized pharmacological or psychological treatment has been established for persons with narcissistic personality disorder.” — Paroma Mitra and Dimy Fluyau.

Long-term therapy that includes medication for prevailing symptoms of depression, anxiety, paranoia, and psychosis is recommended for managing NPD.

If narcissists make it to therapy, which normally only happens when they’ve reached a crisis point far beyond where we would take things, they often sabotage or terminate therapy, assuming the therapist hasn’t already terminated due to countertransference.

Countertransference and early termination are two reasons therapy rarely work for people with NPD. A list of challenges in treating patients with NPD follows. See the full table with references here.

TABLE 1. Challenges

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