The narcissist individual and partner triggering the therapist, intensity of narcissism, and complications or difficulty can be considered given elements of the couple therapy. Such couple therapy that involves a narcissistic partner is so difficult that some theorists and therapists question whether it is workable for some couples. As mentioned earlier, Links and Stockwell (2002, page 526) used three characteristics to determine the suitability of the couple for couple therapy. The first issue involves the degree and type of acting out and whether it can be curtailed. The second issue reflects the core of narcissism- the degree of narcissistic defensiveness and vulnerability. The challenge is whether these core narcissistic qualities and the behaviors they cause can be blunted or adapted through the therapeutic process. Implicit is that hardcore narcissistic defensiveness and vulnerability would disable the individual from making enduring change. The third issue is the degree that both partners get sufficient complementary gratification in the relationship. This would mean that the other partner is able to adequately gratify the grandiosity, superiority, and other needs of the narcissist. And, that the non-narcissist partner gets enough of his or her emotional, psychological, social, and other needs met through the reflected glory, status, or other qualities or behaviors of the narcissist. Ironically, this implies that both that less severe narcissism and less narcissistic behavior, and how well the narcissistic partnership mutually works for the partners (despite narcissistic disconnection) differentiate more amenable couples from less suitable couples for therapy.
To the outside observer, being in a relationship with a narcissist seems to be an inherently erroneous choice. "Why would you want to be with, much less be married to a narcissist who treats you like that? Why would you stay with someone like that?" are rhetorical questions clearly expressing the incredulity of a detached person. However, as actual questions, the therapist may find how the relationship works for or serves the other partner. The couple is arguably successful or functional not just when the needs of the narcissist are met but when some core needs of the other partner are met in the relationship. "Spouses with narcissistic partners may need and seek some gratification through the achievements of their partner. They accept the value of deferring their needs to the other, but not to the point where they totally devalue their own needs and destroy the critical balance in the relationship" (Links and Stockwell, 2002, page 526). The reflected glory or status of the narcissistic partner for the other partner may be very satisfying. Since the narcissist is often driven to be successful and achieves significant positive notoriety and has narcissist charisma, he or she may be considered to be quite a "catch" socially. When the relationship is in its earlier stages, a partner may be more vulnerable to being swayed by the exciting energy and status of the narcissist's reputation, achievements, and social status. The crisis of the relationship that has brought the couple to therapy may be because the relative naiveté of the other partner has waned over the course of the relationship. The balance of status versus negative aspects of narcissistic behaviors may have shifted. And/or, the narcissist's deeper characterological flaws may have become more evident as time passed and experience accrued. The narcissist partner may have been attracted to and enjoyed the admiration and validation of the other partner. His or her ego- narcissistic ego needs were and had been served by the starry-eyed adulation of the partner. However, as the other partner gains more negative experience with the narcissist, matures from life experience, and subsequently possibly increases self-esteem, the narcissist may now get criticism and negativity instead.
The therapist should check to see if these bi-directional mutual dynamics still exist and to what degree. It may be the breakdown of this dynamic that has triggered the couples to seek help. "If this complementarity exists, often the couple can progress and the narcissistic spouse will not look for other methods to meet these needs. If this is not available to the narcissistic spouse from the relationship, then that person will continue to seek gratification through multiple affairs or through work." Once again, the therapist needs to be aware of how precipitating behaviors or issues may have a deeper core to create the previously functional dysfunctionality. For example, Links and Stockwell described, "One grandiose man who sought satisfaction through work would spend all week and each weekend at work, totally ignoring the demands and requests from his spouse. Of course, the narcissistic individual felt very uncertain about his success at work and always felt on the brink of total professional failure." The partners may have had more involved interactions previously. That is, the narcissist needed to be admired and his spouse gave admiration. When the admiration faded, the narcissist may then have slipped further and further into his work world where he continued to be adored for his drive. When and as long as the partner of this man accepted or tolerated his retreat to work and away from home, the compensation kept the partners together. However, "If the narcissistic need is demonstrated by continued extramarital affairs, or commitment to everything but the relationship, then the couple therapy is doomed to failure." More to the point, the couple's relationship may be doomed to failure. In reality, some couples still persist as the counter-balance of finances, children, status, lifestyle, keeping or losing reputation, and so forth remain more compelling versus loss of romance, fulfillment, and other qualities of a deeper intimate relationship.
DISLIKING AND FEELING SORRY
The therapist may have significant counter-transference not only disliking the narcissistic partner but also feeling sorry for the other partner. However, the sympathy for the other partner may morph into dismissal, disrespect, and even disgust. "Who would put up with such emotional abuse?" has a potential answer that explains negative therapist counter-transference. The complementary dynamics may go beyond a partner gaining satisfaction in the status and achievements of the narcissistic partner. "Often in this couple, there is a narcissistic individual married to a person with masochistic traits. The masochistic spouse allows his/her own needs to be superseded by those of the narcissistic spouse. The masochistic spouse's need to satisfy his/her own lack of self-esteem by identification with the other person's self-esteem is an essential element of the relationship" (Links and Stockwell, 2002, page 527). The therapist may work to empower individuals or believes in the inherent worth of every individual. However, the individual who seems to seek an inferior role in a relationship challenges the therapist's empathy or sympathy. "There's a scorpion in your bed! Why do you stay in bed with a scorpion!?" The therapist needs to know that there are logical answers for why a person stays with a narcissist.
Links and Stockwell feel that "These couples, in our experience, can have a workable relationship as long as the complementarity of meeting the narcissistic needs provides each member some satisfaction and some flexibility of roles." This implies that the therapist should in some cases accept an inherently inequitable non-egalitarian relationship between two partners. The therapist should recognize that non-mainstream or non-American cultural models with or without characterological issues may support an inequitable model that one or both partners find personally functional. If only one partner believes in and wants to practice an unequal relationship, the couplehood is threatened and therapy very complicated. If both partners accept some unequal relationship as their functionality, then the therapist would need to work within their definitions. The therapist may need to reconcile strong personal feelings about the inherent health of inequitable partner relationships. He or she should take care not to impose personal values about how a couple should function onto the partners. The therapist further needs to determine if the couple's model comes from cultural models (or whether cultural conflict has arisen between the partners' respective models) or if characterological- specifically, narcissistic issues demand the unequal model. A cross-cultural approach is indicated if the issues are primarily cultural.
With narcissism, "The couple therapist can decide that a couple is appropriate for therapy by assessing the three parameters" (Links and Stockwell, 2002, page 527). The role of the therapist in meeting the narcissist's needs becomes important. "We find that to stabilize the presenting crisis, the narcissistic individual will need some of his/her gratification from the therapist." They suggest when possible to have a co-therapy team where one therapist "purposely attend to the needs of the narcissistic individual." Since this is not practical for many therapists, the therapist would need to find ways to connect with the narcissistic partner through appropriate attention. The challenge would be how to do so with strong counter-transference and transference while maintaining therapeutic integrity. The therapist needs to be vigilant that fawning admiration and validation is often dismissed by the narcissist and may be counter-therapeutic anyway. The therapeutic relationship should be driven by theoretical conceptualization of the narcissist's etiology. It defines the intimate relationship and also has implications for the therapeutic relationship. "…the alliance between a masochistic or self-defeating person and a narcissistic individual often has a deep-seated wish to heal an old narcissistic injury that was the result of interactions with a critical or rejecting parent. This person seeks this relationship to try to finally get the love and approval of a parent substitute. Often, early in the relationship, the masochistic partner shows his/her love and admiration while providing caregiving. The initial idealization and admiration build up his/her own self-esteem, and, of course, meet the narcissistic needs of the narcissistic individual. This pattern can fall apart, however, because a narcissistic person demands that the partner act as a slave to his/her needs. Trouble develops when the narcissist sees the masochist as engulfing, and dependent, and the narcissist may look for other players to gratify his/her need, running away from the fear of being engulfed"(Links and Stockwell, 2002, page 527).
The breakdown for the partner or spouse of the narcissist may occur as he or she feels gradually more excluded from the narcissist's professional development in the some cases. For example, for some spouses, "the professional role of the physician-husband may be used for the gratification of his emotional needs—what we now call narcissist needs—and an increasing withdrawal from the family takes place. This is especially painful when the wife has had an important role in the early career development of her physician-husband, and is now left in a hostile-dependent situation that often leads to alcoholism and addiction" (Chessick, 1976, page 523) or other compulsive or acting out behavior. The other partner feels betrayed for not having his or her investment earlier in the relationship honored with ongoing appreciation or benefits. "Mackie sheds further light on the subject by calling attention to the tendency of the practitioner (the narcissist) to 'defend himself against the direct expression of 'sick' or dependent parts of himself and to project these instead onto the spouse or other relatives'; thus he would unconsciously encourage his wife or child sliding into a hostile-dependent position, and becoming 'sick.'" Since the narcissist often cannot acknowledge neither his or her culpability or weakness of any kind, he or she may convince his or her partner that the narcissist holds no responsibility. The other partner is told and encouraged to believe it is all his or her fault. The narcissist can be so convincing that his or her partner virtually accepts that up is down and red is blue. In the isolated dyad, the other partner often has no reference and no social feedback from any outsider to counter falling down the narcissistic partner's rabbit hole. One of the motivations for the narcissist's resistance to couple therapy comes from wanting to avoid any third-person perspective that may find him or her imperfect. Once in couple therapy, the narcissist can have an intensive antagonistic reaction to any therapist suggestion that there are alternative perspectives to his or hers… that is he or she is… wrong! At that point, the narcissist shifts his or her energy or accusations to making the therapist the "sick" professional as he or she had made the partner the "sick" spouse.