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Marcus sat in my office describing, with remarkable eloquence, why his wife of sixteen years was destroying their marriage. She was demanding. Ungrateful. Emotionally unstable. She didn’t appreciate his sacrifices—the long hours at the firm, the income that gave her a comfortable life, his willingness to “put up with her moods” for the sake of the children.
Forty-five minutes of this. I barely spoke. When our time ended, he stood up, shook my hand firmly, and said: “This was helpful. Same time next week? I think you’re really starting to understand what I’m dealing with.”
I understood, all right. Just not what he thought I understood.
I understood that I’d just met someone who might never be capable of loving another human being. Not because he was evil. Not because he chose cruelty. But because somewhere in his development, the capacity for recognizing others as equally real got stuck, frozen, never quite finished forming. And now I was supposed to help him save his marriage while knowing that he might be fundamentally incapable of the reciprocity marriage requires.
This is the work that breaks therapists. Not the dramatic crises, not the suicidal clients, not even the trauma work. It’s this—sitting across from someone who experiences you as scenery in their movie, who will use every ounce of your empathy as evidence of their specialness, who will take everything you offer and give back nothing because they literally don’t understand there’s supposed to be a “back.”
The Therapeutic Relationship That Never Forms
Every therapy approach I was trained in assumes something fundamental: the therapeutic relationship. Two people in a room, one in pain asking for help, the other offering expertise and care. There’s asymmetry, sure, but there’s also mutuality. Recognition. The basic acknowledgment that we’re both real.
With narcissistic clients, that never happens.
It’s not that they refuse the relationship. They don’t even understand what you’re asking for. From their experiential world, you’re not another subject with your own inner life. You’re a function. A mirror. A tool. Sometimes a very useful tool, even an indispensable one. But a tool.
Marcus came back for months. Paid on time. Never missed sessions. Followed through on homework. From the outside, it looked like engaged therapy. But something was off, something I couldn’t name at first.
Then one session I got sick mid-hour. Bad sick—sudden vertigo, nausea, had to excuse myself to the bathroom. When I came back, pale and shaky, and apologized that we’d need to reschedule, Marcus looked annoyed.
“Is this going to be a regular thing?” he asked. “Because I rearranged my schedule to be here.”
Not concern. Not “are you okay?” Not even basic human recognition that I was clearly unwell. Just irritation that I was malfunctioning. Like when your car breaks down on the way to an important meeting.
That’s when I understood viscerally what I’d known intellectually: I wasn’t a person to him. I was a service.
Why Everything We Try Makes It Worse
Here’s the disaster: almost everything we’re trained to do in therapy feeds narcissism.
Empathy? They hear: “You’re right to feel aggrieved. Your feelings are important and valid. You deserve to be understood.” Every empathic reflection becomes confirmation of specialness.
Unconditional positive regard? They experience it as their due. Of course you accept them unconditionally—they’re obviously worthy of acceptance. Your warmth proves what they already knew: they’re remarkable.
Exploration of feelings beneath defenses? They’ll perform vulnerability beautifully when it serves them. I watched Marcus tear up describing his father’s coldness, and I felt my heart opening to him, wanting to help. Then immediately after, in the same session, he described firing an employee who’d asked for family leave with the same coldness his father showed him, and felt completely justified. The vulnerability was theatre. Real enough in the moment, perhaps, but unconnected to any capacity for change.
The therapeutic relationship itself—the warmth, the attention, the 50 minutes where they’re the center of someone’s complete focus—is narcissistic supply. For many narcissists, therapy is perfect: they get to talk about their favorite subject (themselves), receive admiration disguised as professional attention, and pay someone to validate their worldview. Why would they change? They’re getting exactly what they need.
I’ve watched humanistic therapists try to create safety for narcissistic clients to be vulnerable, only to watch the narcissism bloom like algae in a nutrient-rich pond. The safety becomes entitlement. The vulnerability becomes manipulation. The acceptance becomes confirmation that they were right all along—they are special, they do deserve better treatment, everyone else is the problem.
And psychodynamic interpretation? Forget it. Tell a narcissist their grandiosity defends against a wounded inner child, and they hear: “I’m so special even my defenses are interesting. My pain runs deeper than ordinary people’s pain. This explains why I’m different, why normal rules don’t apply to me.”
The interpretation itself becomes another way they’re exceptional.
The Day I Stopped Being Nice
Six months in, I stopped trying to do therapy with Marcus the way I’d been trained.
“Your wife called me,” I said one session. This was true—she’d left a desperate voicemail asking if I could help her understand whether she was crazy. “She says she’s planning to leave you. File for divorce. Take the kids.”
He waved this off. “She threatens that every few months. She’ll never actually do it.”
“Why not?”
“Because she can’t. She’s financially dependent on me. She hasn’t worked in years. Where would she go?”
“Her parents’ house. They offered. She has a job offer from her old firm—part-time, but enough to manage. She’s been consulting a lawyer for three months. She’s serious this time, Marcus.”
For the first time in six months, I had his attention. Not empathic attention, not therapeutic attention—but real attention. The kind you give to actual problems that might actually affect you.
“So here’s my question,” I continued. “How much do you care about staying married?”
“Obviously I care. I have kids. Divorce would be expensive. Her family would make my life hell.”
“Then we have a strategic problem. You want to stay married. That requires your wife’s cooperation. She’s currently planning not to cooperate. We need to figure out what changes that.”
Notice what I’m not saying. I’m not saying “you need to change.” I’m not saying “try to see her perspective.” I’m not saying “work on your empathy.” All of those statements would bounce off him or feed his sense of persecution (everyone wants to change him, nobody accepts him as he is).
Instead: You want X. X requires someone else’s cooperation. That person isn’t cooperating. This is a problem you need to solve.
This framing works because it doesn’t require moral development. It requires instrumental reasoning—figuring out how to get what you want. And narcissists are often excellent at instrumental reasoning. They’re survival machines, optimization algorithms. Give them a problem they care about solving, and they’ll solve it.
The Moral Incompetence Nobody Sees
Here’s what I’ve come to understand after working with dozens of clients like Marcus: narcissism isn’t primarily a defense. It’s a developmental arrest. They got stuck at a stage of moral development most of us pass through as children.
Think about a four-year-old. Can’t really grasp that others have inner lives as complex as theirs. Doesn’t experience guilt as distinct from fear of punishment. Cares about others primarily instrumentally—mommy is important because she provides comfort and food, not because she’s a subject with her own equally valid experience. This is normal at four. It’s supposed to be outgrown.
Narcissists never quite outgrew it. The moral capacities that usually develop—genuine empathy, appropriate guilt, concern for others independent of how it affects you—they’re just… not there. Not repressed, not defended against. Absent. Like color vision in someone who’s colorblind.
This has profound implications. You can’t develop a capacity in someone who doesn’t recognize its absence. If you don’t experience empathy as valuable, you’re not motivated to develop it. If you don’t feel guilt, you don’t see guilt as something you lack. From their perspective, they’re not morally incompetent—they’re morally superior to all the weak people who let emotions cloud judgment.
So therapy can’t start with “develop empathy” or “learn to care about others.” Those goals are unintelligible to them. We have to start somewhere else entirely.
The Strategy That Sometimes Works
With Marcus, I abandoned therapeutic empathy and embraced strategic consultation.
“Your wife says you’re emotionally unavailable. What does that mean to you?”
“She wants me to talk about feelings constantly. It’s exhausting.”
“Okay. So her complaint is ‘not enough emotional talk.’ Your goal is avoiding divorce. Divorce is expensive and complicated. How much would you need to change to avoid it?”
“I’m not becoming someone I’m not.”
“Agreed. So what’s the minimum viable change? What’s the least you could do that might be enough?”
This is the key question. I’m not asking for transformation. I’m asking for optimization. What’s the smallest intervention that solves the problem? Narcissists will engage with optimization problems—they like efficiency, they like strategy, they like winning.
“I could probably check in with her more. Ask about her day. That kind of thing.”
“How often would you need to do that?”
“Maybe… twice a week?”
“Try it for a month. Track whether it changes her threat level about divorce.”
He tried it. It wasn’t enough—his wife needed more than performative check-ins. But here’s what happened: through repeatedly acting like he cared (even though he was doing it purely instrumentally), Marcus started to develop something that looked almost like caring.
I’m not claiming he developed genuine empathy. I’m not sure that’s possible. But repeated behavior, even instrumentally motivated, can sometimes create new neural pathways. Act like you care often enough, you might start to actually care, at least a little, at least sometimes.
Or maybe not. Maybe Marcus just got better at performing care. But his wife says things are better. The kids seem happier. His marriage survived. Is that enough? Is it ethical to help someone become a better manipulator if the manipulation leads to less suffering for everyone around them?
I don’t know. I think about this constantly.
When You Realize You’re Enabling Evil
Not every narcissist is like Marcus. Some are worse.
I worked with a man once—brilliant, charming, successful businessman. Came to therapy because his company board insisted after several sexual harassment complaints. Spent three months helping him develop better “strategies” for workplace relationships. Taught him to read social cues better, to recognize when his behavior was creating problems, to adjust his approach for better outcomes.
Then one day he described, casually, how he’d used the skills I’d taught him to manipulate a subordinate into dropping her complaint. He’d read her emotional state perfectly, said exactly what she needed to hear, convinced her that filing formally would harm her career. He was pleased with himself. He’d solved the problem.
I’d made him better at being predatory.
I terminated therapy the next week. Told him I couldn’t continue working with someone who used therapy to become more effective at exploiting others. He was genuinely confused. He’d done exactly what we’d been working on—identifying what someone else wanted, figuring out how to get his desired outcome, optimizing his strategy. Why was I upset?
Because there’s a difference between narcissism and sociopathy, and I’d missed it. Narcissists lack empathy but can still care instrumentally about relationships they depend on. Sociopaths don’t care even instrumentally—they’ll burn everything down if it serves them in the moment.
You can sometimes work with the first. You cannot work with the second. And you need to know which you’re dealing with.
What We Owe the People They Damage
The hardest part of this work isn’t with the narcissists themselves. It’s with their partners, their children, the people who’ve spent years being eroded by someone who can’t love them back.
They come to therapy exhausted, confused, convinced they’re the problem. Because the narcissist has told them they’re too sensitive, too demanding, too emotional. Because the narcissist seems so certain, so convincing. Because if you’ve been in relationship with someone who can’t recognize your reality for long enough, you start doubting whether your reality exists.
My job becomes reality testing. Calibration. Helping them see that:
Yes, relationships require compromise. No, you’re not being unreasonable to expect basic empathy.
Yes, you did something wrong in that argument. No, that doesn’t explain or excuse everything they did.
Yes, they might change. No, you cannot make them change. No, loving them harder won’t fix their incapacity to love you back.
This is delicate work. I’m trying to help them see their partner’s limitations without destroying whatever they want to preserve of the relationship, without slipping into bitter resentment that prevents any possibility of future connection.
The question I always ask: “Can you live with who they actually are, right now, if they never change?”
Not who they could be. Not who they promise to become. Not who they are on good days. Who they actually are, consistently, when nobody’s watching.
Most of the time, the answer is no. But they need to arrive at that answer themselves, not have me tell them. Because leaving someone you’ve loved—even someone who couldn’t love you back—requires mourning the person you wished they were.
The Children Who Learn to Disappear
The real tragedy is the children. Kids of narcissistic parents learn early that their feelings don’t matter, their needs are burdens, their perceptions are wrong. They learn to read the narcissistic parent’s emotional weather perfectly, to adjust themselves to minimize conflict, to disappear as much as possible while still fulfilling their function (admiring the parent, making the parent look good, serving the parent’s needs).
As adults, they come to therapy not understanding why relationships feel impossible, why they can’t set boundaries, why they’re always exhausted trying to manage everyone else’s feelings while their own feelings seem somehow illegitimate.
They describe their childhoods and it sounds normal to them. Dad was successful, mom was attentive, they had everything they needed materially. They feel guilty complaining. They must be too sensitive. They must be wrong to feel hurt about things that happened decades ago.
Then I ask: “Did your parents ever ask how you felt and actually want to know the answer?”
Long silence.
“Did they ever apologize for hurting you—really apologize, not just ‘I’m sorry you feel that way’?”
Another silence.
“Did they ever seem genuinely curious about who you were becoming, separate from who they wanted you to be?”
And something cracks open. The recognition that what they experienced as normal—being furniture in their parents’ lives, being tools for their parents’ needs, being unseen by the people who were supposed to see them most clearly—was actually a profound deprivation.
The work then is helping them recognize that their parent’s narcissism wasn’t their fault, doesn’t define their worth, and is a real limitation that affected them deeply. Not to breed resentment, but to create clear-eyed understanding: your parent lacked something most parents have. That’s tragedy. It’s not your fault. And it doesn’t mean you’re unlovable—it means you were never really loved in the way children need to be loved.
The Philosophical Problem We Avoid
Here’s what haunts me: narcissism is fundamentally a philosophical problem, not a psychological one. It’s about how someone relates to reality itself.
Narcissists experience reality as confirming their perceptions. When reality contradicts them, reality must be wrong. Other people aren’t subjects with equally valid experiences—they’re either allies (confirm narcissist’s worldview) or enemies (challenge it). There’s no middle ground, no genuine uncertainty, no recognition that perspective is partial.
This isn’t psychological defense. It’s ontological commitment—a way of organizing being itself. And you can’t therapize someone out of their ontology.
What you can sometimes do is create practical problems their ontology can’t solve. Trap them gently in contradictions between goals and strategies. Make behaving better instrumental to interests. Create conditions where treating people well serves them.
But you can’t make them care. You can’t develop a capacity they don’t have. You can’t turn someone who experiences others as objects into someone who experiences others as subjects.
And maybe that’s okay. Maybe the goal isn’t transformation. Maybe it’s harm reduction. Make them slightly better at coexisting with people who aren’t them. Teach them to simulate empathy well enough that the people around them suffer less. Help them want to keep relationships badly enough that they’re willing to change behavior even without changing experience.
Is that enough? Is it honest? Is it ethical?
I don’t know. But it’s better than the alternative—giving up completely, or worse, spending years providing narcissistic supply while calling it therapy.
What I Tell Young Therapists Now
When supervisees ask me how to work with narcissistic clients, I tell them this:
First, know you’re going to fail most of the time. They’ll quit therapy, or stay forever without changing, or use everything you teach them to become better manipulators. Accept this going in.
Second, protect yourself. Don’t expect gratitude, warmth, reciprocity, or recognition. You won’t get it. If you need those things from clients to feel effective, don’t work with narcissists.
Third, be strategic rather than empathic. Find what they care about instrumentally (avoiding divorce, keeping job, maintaining image) and work from there. Forget about moral development or genuine caring. Aim for behavior change.
Fourth, watch for the line between narcissism and sociopathy. If they’re actively trying to harm others and enjoying it, if they show no instrumental concern even for relationships they depend on, terminate. Don’t enable predation.
Fifth, do more work with the people they’ve damaged than with them. Partners, children, employees—these are the people who need and deserve therapeutic attention. The narcissist might never change. But the people they’ve hurt can heal.
And finally: know when to quit. Not every client benefits from therapy. Some people aren’t here to change—they’re here to recruit you into validating their worldview. Don’t do it. It’s not therapy. It’s collaboration with harm.
Marcus is still married. Still sees me monthly. Still fundamentally incapable of loving his wife the way she deserves. But he treats her better. Behaves like he cares, most of the time. Is that enough?
His wife says yes, for now. His kids seem okay. The simulation of care is close enough to actual care that it functions. Maybe that’s success. Or maybe it’s just the best we can do with human development that stopped too early and can’t be restarted.
Either way, I sleep at night knowing I’m not making things worse. In this work, sometimes that’s the victory.
Aleksandar Fatić spent three decades learning that some people can’t love you back, and that’s not your fault, not theirs, just the way their development got stuck. He directs the Institute for Practical Humanities in Belgrade and thinks too much about questions that don’t have good answers. Contact: a.fatic@iph.edu.rs
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