Therapy involves a lot of trust. Engaging in therapy, doing the work, requires an immense amount of vulnerability and honesty. Add to that the fact that you’re doing all that work in front of someone who, a few hours ago, was close to a total stranger. Finding a skilled professional to build that kind of relationship with can sometimes feel like the most daunting part of the whole process, regardless of whether you’ve been contemplating therapy for years or you’re in a moment of crisis. So here are my thoughts on finding a mental health professional that will understand what you have been through and understand what narcissistic abuse is, so that you are not re-traumatised.
Sometimes the right therapist just seems to land in your lap. But more often than not, finding the right person for you takes a bit of effort. It sometimes comes with frustration—and a few false starts—but it’s worth the search. Once you’ve found them, you’ll never look back.
Where To Look
Narcissistic abuse is a particularly insidious form of psychological and sometimes physical abuse – often not recognised for what it is by the victim and partly outside of the conscious awareness of the abuser.
If you had a narcissistic parent or caregiver, the therapeutic work for this kind of abuse would be deep – touching the original traumas that set the tone for your core beliefs, thoughts, emotions and behaviours, and what you told yourself as a result of those experiences – subconsciously at a very young age – about how your life would turn out.
Healing from the hurt, sadness, confusion, anxiety and anger that results from a relentlessly disapproving, unempathetic and totally self-focused parent can be one of the challenges of a lifetime. But it can be done.
The therapy does not focus on why the narcissist in your life developed the disorder. It will focus initially on what happened and on clarifying the damage done to you before moving on to the healing work. The fact is you are not here to be a victim of that disorder – you have rights too.
While the therapy is tailored to each client and their prevailing issues, overall my aim is to help you achieve a more concrete self-concept with greater degrees of self-esteem, self-acceptance and self-compassion. Other work will include developing an academic knowledge of narcissism; alleviating self-doubt; using anger in a healthy way towards recovery; developing greater confidence; addressing trust issues, putting in place stronger boundaries and levels of assertiveness; learning strategies for dealing with narcissists without being re-traumatised, and an enhanced ability to recognise them in the future.
I also don’t focus on the area of forgiveness, rather my view is that achieving a ‘letting go’ of what went on as an empowered survivor is the ideal.
I strongly discourage seeing a therapist whom a family member or close friend is also seeing. There are many reasons for this; some of them involve important ethical boundaries that (unfortunately) not all therapists follow. Your trusted therapist and therapy space should feel like yours so that you can engage with the relationship on as deep an emotional level as needed. At first it may not seem like such a big deal—“I don’t care if you see my therapist, too! She’s great!”—but that feeling might change when your loved one loves her, too…or doesn’t. Then your sacred space doesn’t feel so safe anymore.
Most therapists have some presence on the internet. You can do a basic search for a therapist in your area. If you have a clear sense of what kind of therapy you want (more on that in a minute), add in those keywords. Beware that many therapists are not great with technology or design (this isn’t what you’re hiring them for). Often, very good therapists don’t bother to update their websites; their practice is so full, they just don’t need to. Beware of over-branding and of people who declare themselves experts. Emphasise, instead, the person’s actual experience and interest in what you’re looking to sort through or heal.
Beyond search engines, there are a number of well-developed therapist directories, like Psychology Today and Good Therapy, where therapists pay to have their profiles listed. (That’s a pretty standard element of advertising for therapists.) Take some time to pore through the results. Be sure to search through the insurance you hope to use as well as the proximity to your home or office. Unfortunalty due to the sensitive nature of narcissistic abuse, many therapists won’t actually list this as their specialism, instead we have to look to places like YouTube or other social media platforms for specialist treatment.
What to Look For
There are many (many) different styles of therapy, but once you know a few of the areas of focus, there is a pattern to them. Some therapists adhere strictly to a single theoretical orientation. I would avoid these people, as they may have more fidelity to their theory than to you. The best therapists integrate what works and customise their work for the person in front of them.
Consider what you would look for if you were searching for a teacher, doctor, or a religious advisor. You’d probably want to know a bit about what subject they were teaching, what part of the body they were focused on, or what they believed in. It can be helpful to start with a self-inquiry of why you’re considering therapy right now.
But don’t get too narrow. The problem with looking for a therapist to do exactly what you want them to do is a bit like self-diagnosing your pain on WebMD and then finding a therapist to deal with that issue. You may discover that your self-diagnosis was totally wrong. In therapy, for instance, you may look for someone for “anger management” when in fact you need support in liberating your voice or in healing old trauma.
Here are some of the words or phrases I look for when doing search for friends and family: psychodynamic, emotional and psychological abuse, depth psychotherapy, trauma-informed, EMDR (eye movement desensitisation and reprocessing), somatic, family systems, attachment theory.
We humans are influenced by painful events and experiences (trauma-informed, EMDR); our bodies are not separate from our minds (somatic and the above); we are more complicated and more vibrant than our conscious minds can understand or foster (psychodynamic, psychoanalytic, depth psychology, and all of the above); and we exist with other humans in systems that impact our lives (family systems and attachment theory).
Finally, there are all sorts of credentials that provide licensure to practice psychotherapy. You may want to look up the different acronyms if they’re unfamiliar to help you understand further what type of training and orientation this person has.
How to Start
Once you’ve got a list of possible candidates, plan to call three to five people to inquire about therapy. Not all of them will have openings. Not all of them will work with your schedule or take your insurance. Start by casting a wide net.
Then consider setting up appointments with a few different people. Especially if you haven’t been to therapy before, you’ll want to experience different spaces and different people to see what feels best for you. Therapists are human. You can expect wide variation in the experience of sitting with different people. Make the effort to find someone you will look forward to going back to, even when stuff gets hard.
What to Ask
Beyond the logistical questions around availability, scheduling, and payment, you may want to ask a prospective therapist a few things over the phone, in email, or in person.
“Have you been in therapy yourself?” The answer should be a very clear “Yes.” You do not want to see a therapist who hasn’t done their own extensive healing work and doesn’t know the vulnerability of being in your chair.
“What are your main areas of expertise, and why do they interest you?” You can take notes if you don’t know the areas of interest, and ask for some books or thinkers who have influenced their work.
“Do you love what you do?” You want a therapist who is alive and present in the room with you. Being well-qualified does not make a person feel good to be with. They’re separate things, and you want both. In fact, I’d rather talk for hours with an unqualified, loving neighbour than a highly trained robot.
What to Expect
You should feel, without having to make excuses for them, that your therapist is totally present with you. This presence is an implicit part of the work you are doing together. Every therapist has bad days and bad weeks. This humanity is an inevitable part of the work. But you should be able to expect that your therapist will pay attention to your words, your body language, and your experience. They should simply feel there with you, in the way that a child knows if their parent is really present or wandering off. Your therapist should never be multitasking. (I can’t imagine a scenario in which that is acceptable, unless the scenario is somehow related to your work.) I’ve heard stories. If this is happening, feel free to ask them what’s going on, or don’t go back. Your therapist should also never fall asleep on you. (Again, I’ve heard stories.) Do not make excuses for them if this happens. Bring it up if you’re curious about what might be happening for them in our dynamic, but do not feel shame or make it your fault. If there’s not space to talk about it, leave.
Therapy is a relationship. You should feel free to ask your therapist about their reactions to you or things they’ve said that didn’t sit right. These little confrontations can be some of the most healing work of therapy. It can help establish your therapist’s presence and your connection, or it can show you that they’re actually not “getting you,” in which case you may want to find a therapist who does. Ideally, the opportunity for confrontation also allows you to work through historic ruptures in old relationships. Try to avoid leaving therapy without attempting to repair the relationship, but at the same time, don’t try too hard if your therapist is defensive or unreflective.
You should receive a basic orientation to the ethics and laws around therapy on your first or second visit to the therapist. Get acquainted with the basic boundaries. If you ever feel anything is strange, ask the therapist what’s going on and feel free to do some research. They’re human, and whatever arises may very well be part of your own patterning, but you’re not paying to caretake them. If the work is not valuable for you, find someone else.
Payment and Diagnosis
Therapy can be expensive. For some people, these costs can seem prohibitive. Some therapists take insurance, but many do not. If money is tight and using your insurance isn’t an option, or if you’re uninsured, I encourage looking for a supervised, unlicensed intern: They’re still gaining their hours toward licensure, so they often provide therapy for a lower fee, and they can be excellent clinicians.
I hope that this blog sheds a bit more light on this difficult and confusing subject. Whilst therapy for narcissistic abuse is wonderful it is also a minefield trying to get the r’right’ therapist for you. Use your intuition and if a situation or person doesn’t feel right, you have no obligation to continue. Remember therapy is about you and your journey back to self. Let me know your thoughts, or share your recommendations of great therapist that have helped you or perhaps even your horror stories. Your comments are valuable and will help others too.
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