Group Therapy for Narcissists

You know them; perhaps you even live with one–the narcissist that thinks everything he does or says is right. The man or woman who is so self-absorbed they don’t want to hear about your opinions, feelings or needs. They are characterized by their excessive sense of self-worth, egocentric behavior and lack of empathy. Can group therapy help these types of people?  The general consensus is that people with narcissistic personality disorder (NPD) are not “fixable”- they suffer from a disorder of the personality which cannot be changed. Many therapists tell their clients to avoid or leave a narcissist because people with NPD are self-destructive and other-destructive. They are interested only in the ruthless pursuit of attention, power or money and are grandiose about their accomplishments. Alternately, they can become very depressed. Narcissists have sometimes been called the cancer of society.

First let me say that if someone with NPD voluntarily signs up for therapy, the diagnosis is probably wrong.  Narcissists feel they don’t need therapy; they believe they are perfect and therefore don’t need to change. Encouraging someone with narcissism to seek therapy is often difficult; however, there are complications associated with ignoring NPD behavior. Complications can range from difficulties at work and in relationships to depression and substance abuse. While there is no cure for the disorder, psychotherapy and cognitive-behavioral therapy may help lessen some of the negative behaviors associated with it. There is controversial evidence as to whether group therapy is effective or not with narcissists.

It is unusual for people to seek therapy for NPD. Unconscious fears of exposure or inadequacy often cause defensive disdain of the therapeutic process. Specific strategies are utilized for the narcissist to work on increasing their ability to become more empathetic in everyday relationships. Some therapies purport to work on modifying their self-centeredness by helping them identify how to use their unique talents to help others, rather than for their own personal gain. This will not change their perception of “entitlement” but may help them empathize with others.

Narcissists are infamous for their inability to work toward shared efforts of any kind, let alone group therapy. In a group situation, they immediately size up others to determine whether they are potential sources of Narcissistic Supply or if they are competitors. They idealize the first type (suppliers) and devalue the latter type (competitors). Obviously, this is not very helpful in group therapy.

What is Group Therapy for Narcissists?

Group therapy, in which you meet with a group of people with similar conditions, is one approach to treating narcissistic personality disorder. Group therapy sessions are a gathering of narcissistic patients who meet in small groups with a therapist. The challenge is to increase their ability to focus on others and increase their empathetic skills. In social settings, the narcissistic individual focuses on himself and becomes impatient when attention is diverted away from him. He (or she) is unable to engage in normal conversational interactions unless he is the center of the discussion. Through group therapy, these maladaptive behaviors are pointed out by his peers in the group, helping the narcissist gain insight and, hopefully, develop new behaviors.

Group therapy for narcissism is meant to help people with narcissism learn to interact with, support and acknowledge one another as individuals. Discussions focus on common behavior, emotions and thoughts. During these sessions, narcissists learn to empathize with others via group discussions on experiences, behaviors and from confrontations that occur in the group. The therapist maintains control during these sessions by keeping individual talk times at a minimum and participation respectful. This may be a good way to learn about truly listening to others, learning about others’ feelings and offering support.

What are the Goals?

Because personality traits can be difficult to change, therapy may take several years. The short-term goal of therapy for NPD is to address issues such as substance abuse, depression, low self-esteem or shame. The long-term goal is to reshape personality, at least to some degree, so that the narcissist can change his distorted thinking patterns and create a realistic self-image.

Other goals are to help the patient develop a healthy individuality so that he or she can acknowledge others as separate persons, and to increase healthy coping mechanisms. In groups, the therapist is less authoritative (and less threatening to the patient’s grandiosity); intensity of emotional experience is lessened; and regression is more controlled, creating a better setting for confrontation and clarification.

How do they do in a Group?

As mentioned earlier, narcissists do not seek out therapy of any kind, let alone group therapy. But occasionally, because of legal, marital or social reasons, the narcissist finds his way into a group. The results can be quite interesting.

The narcissist will immediately try to take over the group and establish himself or herself as the most important person in the group (or the smartest, or the most resourceful). Interestingly, the treatment isn’t to directly confront the person with NPD. The therapist must support the group’s reaction to the narcissist. What you change is how people deal with narcissism, not the narcissist.

The narcissist won’t have to talk about his needs as long as he is arrogantly giving his own advice. It may take a while, but eventually the need to be appreciated and admired will cause the narcissist to understand the group norm– which is to talk about your needs and feelings and why you’re having them. The change in his behavior will come as a result of the members being empowered as they stop accepting his dominance and talk about their own needs. He or she may eventually make the changes that are helpful in the group, and then also in their own personal life as well. It isn’t a quick fix, but it can be a lasting one.

On the less positive side, the group dynamic is bound to reflect the interactions of its members. Narcissists are individualists and they regard collaboration with disdain and contempt. The need to resort to team work, to follow group rules, to yield to a moderator, and to respect the other members as equals, is perceived by them to be humiliating and degrading. Thus, a group containing one or more narcissists is likely to fluctuate between short-term, very small size alliances (based on “superiority” and contempt) and narcissistic outbreaks of rage and coercion.

Many therapists believe that group therapy for those with NPD tends to be ineffectual. Furthermore, narcissists will tend to dominate the group or tire other group members with their list of accomplishments and grandeur. Because they do not respond well to critical feedback, narcissists are likely to drop out of the group once others start providing feedback about their behavior. Or, on the other hand, the other group members might drop out of the group because they get tired of the narcissists dominating the therapy. Yet other therapists feel that group treatment has its benefits–as the effectiveness of receiving peer feedback rather than the clinician’s– may be more acceptable to the narcissistic patient.