When someone in a relationship has a narcissistic personality disorder, it is quite challenging. Who wants to be with a person who thinks he is always right or consumed with his own issues? In fact, relationships often end because of the lack of attention to the other person. The characteristics of the disorder make relationships difficult: Grandiosity, need for admiration, lack of empathy, entitlement, explosiveness, arrogance and envy and more.

Therapy helps but building a treatment alliance with a narcissistic patient is slow and gradual. The person often wants to drop out of therapy or reject the therapist. Therapy requires self-reflection, grappling with insecurities, and allowing someone else to control or question. And asking a narcissist to join a group? Well, if they eagerly agree, you probably have the diagnosis wrong!

The old thinking was that people with this type of personality disorder did not do well in group therapy. Group work requires a patient to give and take, listen well to others, have empathy for others, and be able to connect with other people. Because of these requirements, group work was thought to be unsuitable given the characteristics of the narcissist.

Now, we are thinking that long-term group therapy could be helpful. But long-term is the key. The narcissist has to stay with it and not run at the first sign of insult. Group therapy provides a safe haven to explore  boundaries, receive feedback from other people, develop trust and increase self-reflection abilities. For the narcissistic patient, this means commitment to a group is long enough to establish trust and feelings of safety. And both take time.

One concern is that once the narcissist begins to understand that their feelings are routed in inferiority or sadness, they may be at risk for suicide. But again, the group can help encourage the narcissist that if he sticks with it, those feelings can be resolved. And when you have group support, it helps anyone feel better.