Narcissistic Personality Disorder Couples Therapy

Although individual psychodynamically informed treatment is generally recommended to achieve lasting character change, other therapeutic modalities have a role in special circumstances. Conjoint marital and individual therapy have been found useful in the treatment of narcissistic decompensations of what Bird et al. dubbed "the 'collapsible' man of prominence." These authors described prominent, successful, narcissistic men who presented in childlike crises characterized by feelings of helplessness, inadequacy, desperation, and confusion. Although they tended at first to blame work-related stress, closer evaluation revealed that a threat to the stability of their marriages was the true precipitant. They needed to be viewed as faultless, perfect, and strong, and without the admiration of their wives, their sense of well-being collapsed and their self-cohesion fragmented. Their wives functioned as primitive selfobjects. The wives themselves had strong needs for self-effacement and service to others, yet even they had come to the ends of their ropes with their insatiably demanding husbands. The treatment involved intensive long-term individual psychotherapy for both spouses, as well as conjoint marital therapy for those couples who, through their individual therapies, had come to the point of being able to modify their marital interaction. The husbands were then able to tolerate conflict within the marriage without collapse. The wives no longer needed their husbands to depend on them for admiration and were able to abandon the position of the fed-up, angry wife.

In addition to such matching of narcissistic and masochistic partners, we have frequently encountered marital pairing of narcissistic with borderline personalities. In such couples, the ever-demanding borderline partner serves as an externalization of the narcissistic individual's own superego. In this way, the narcissist's inner psychic struggle is externalized, and his or her own relentless superego demands are simultaneously defended against (the "irrationality" of his wife's demands) and satisfied (he continues to "try," hopelessly, to be the "perfect husband"). His emotional detachment and guardedness against intimacy are also easily rationalized in the face of such a threatening partner. At the same time, he can vicariously enjoy the acting-out of aggression while disavowing it. The elucidation of such dynamics in conjoint individual and marital therapy can contribute to a loosening of destructive marital patterns. According to one student of marital therapy for narcissistic individuals, successful therapy can serve as a "reparative interpersonal experience".