Take our Narcissism Test

Find a therapist who understands narcissism.

Focus on learning a few interventions to use when a narcissist is triggered and about to become abusive.

Four simple interventions: Be empathic, nonjudgmental, ask open-ended questions, and avoid criticisms.

These methods can also be used by non-therapists who need to deal with someone with NPD.

Most psychotherapists are given no training in how to treat narcissistic personality disorder. However, that does not stop them from ending up with clients who turn out to have undiagnosed NPD. And there is a severe shortage of therapists trained to diagnose and treat NPD. This means that people who want therapy for their own or a loved one’s narcissistic issues may find it hard to find a knowledgeable enough therapist.

Note: I am using the terms NPD and narcissist as shorthand for someone who qualifies for a full diagnosis of narcissistic personality disorder.

The Average Psychotherapist Can Learn Specific Interventions

The good news is that average therapists can learn interventions for common NPD issues even if they have not been trained to do the whole therapy. To that end, when I teach psychotherapists, I often focus on a general issue that all clients with NPD experience. In this post, I explain how to successfully intervene when a narcissist becomes triggered.

What Does “Triggered” Mean?

Narcissists are often hypersensitive to feeling criticized. This hypersensitivity has its roots in their childhood. Something trivial in the present can activate a painful unworked-through past traumatic wound. The client feels the combined pain of both and overreacts to the situation.

7 Parts of a Triggered Narcissistic Response

Negative Feelings: They experience some combination of shock, hurt, disappointment, frustration, sadness, and anger.

Underlying Assumptions: Their assumptions about the other person’s intentions are always negative—i.e., "He meant to hurt and humiliate me.”

Shrinking Perspective: Their whole world shrinks to this one thing.

Loss of Context: They lose access to their memory and understanding of how this incident fits into the larger picture of the relationship, what they did that precipitated what they are responding to, and their long-term goals for this relationship.

Splitting: They see the other person and the whole situation in an unrealistically negative all-bad way.

Defense: The situation is experienced as an unprovoked attack that creates an emergency that must be defended against immediately.

Attack: The only response that feels reasonable is to attack the other person and punish them severely.

Principles Behind Constructing Interventions for Narcissists

Principle 1: Choose an intervention that matches the client’s emotional state.

Fred Pine (1931-2022), the brilliant psychoanalyst, gave his trainees the following advice: Strike while the iron is cold!

This means that if your narcissistic client is already triggered, they are too emotionally distraught to take in new information. Therefore, the correct intervention is to speak in a soothing and supportive way, so they do not split on you and perceive you as their enemy (Pine, 1984).

James F. Masterson’s Empathic Statements: I like James F. Masterson’s (1926-2010) method of constructing empathic statements by beginning with sympathetic words that capture how their triggered narcissistic client is feeling, such as:

“That must have been so disappointing for you when….”

“That must have felt so painful when…”

Rule: Do not confront a triggered narcissistic client. Instead, make empathic statements that only relate to the client’s perceptions of the situation (Masterson, 1981).

Principle 2: Always take the narcissist’s perspective.

It is a beginner’s mistake to try to explain anything to a narcissist about their negative impact on other people. Untreated narcissists do not usually care about anyone else’s feelings unless there is a clear benefit to doing so.

Take our Narcissism Test

Find a therapist who understands narcissism.

Do not try to motivate them to be nicer to people by appealing to their conscience or even logic. Similarly, avoid voicing any judgments about their behavior because you will just end up in an argument.

Narcissists often quit therapy when the therapist tries to explain why their behavior is wrong or hurtful to someone else. That is experienced as a criticism intended to hurt them.

In successful therapy, clients eventually build enough internal support to utilize more reality-based statements. With some lower-functioning clients, you might have to spend most of the therapy only empathizing with their point of view.

Rule: Unless narcissists trigger a legal and ethical “need to report,” in the early stages of therapy do your best not to give any negative feedback and only make supportive empathic statements.

Example: Dan and Helen drove to a party together. He got mad at her for flirting with another man. He decided to teach her a lesson and got revenge by sneaking out and driving home without her. He left Helen stranded alone late at night in another town.

Therapy Intervention: That must have been so painful for you when Helen flirted with another man in front of you. I imagine that you felt a strong need to punish her and demonstrate that she could not get away with treating you like that.

Purpose: These types of empathic statements help narcissistic clients understand and put into words the underlying feelings that led to their behavior. They also build client-therapist trust and rapport.

Principle 3: Ask open-ended questions to increase insight.

When narcissists are triggered, they are operating from an unconscious set of assumptions that are encoded in the brain as neural networks that fire together. This means their response is automatic and happens without much insight or thought (Edelman, 1987).

One of the ways to successfully work with unconscious, automatic responses is to bring them into conscious awareness (Perls, Hefferline, and Goodman, 1951). Once something enters awareness, the person is forced to acknowledge it. The therapist's goal is to help clients understand their own responses better.

On a neuronal level, the therapist is creating a situation that helps narcissistic clients shift from an outdated, automatic response that is mediated directly by the emotional centers of the brain, to using their prefrontal cortex's analytic abilities. The goal is twofold:

Help clients analyze and understand why they are reacting so strongly in the present and feel so endangered.

Help clients reflect on whether they want to continue responding this way or develop a different and better response.

Here is how I might introduce this in a non-shaming, non-blaming way: If you are like most people, you probably regularly update your cellphone and your computer and your software. (I look at my client for agreement. If I get a head nod, I continue.) Unfortunately, it does not occur to most of us to review and update our childhood programming (non-shaming normalization). If you like, I can assist you in doing that here (no judgment or criticism).

Whether you are a psychotherapist who needs some basic guidance on how to handle your clients with narcissistic personality disorder, or someone who is interested in learning how to deal better with a narcissist in their life, there are some easy tips that can make everything go smoother. They are especially useful when the person with NPD is triggered and might become abusive. Under these circumstances: stay empathic, be soothing, ask open-ended questions, and do not confront or criticize their behavior unless you absolutely have to for ethical and legal reasons.

To find a therapist, please visit the Psychology Today Therapy Directory.

Pine, F. (1984). Developmental theory and clinical process. New Haven, CT: Yale University Press.

Masterson, J. F. (1981). The narcissistic and borderline disorders: An integrated developmental approach. Brunner/Mazel.

Edelman, G. M. (1987). Neural Darwinism: The theory of neuronal group selection. Basic Books.

Perls, F. S., Hefferline, R. F., & Goodman, P. (1951). Gestalt therapy: Excitement and growth in the human personality. New York, NY: Julian Press.

There was a problem adding your email address. Please try again.

By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy

© Psychology Today