Therapy for Narcissistic Abuse: Finding Your Way Back to Yourself

When you've been in a relationship with someone who criticized you, manipulated you, dismissed your feelings, or made you question yourself, it can take a while to realize how much the relationship affected you.

You may know the relationship was unhealthy, but still find yourself thinking about the person constantly. You might second-guess yourself, feel guilty for setting boundaries, or wonder whether you were actually the problem.

These are all common experiences for survivors I've worked with in therapy for narcissistic abuse in my practice over the years. Survivors often try to understand themselves and find answers to questions like: Why am I still affected by this? Why is it so hard to trust myself? How do I move on with my life? Why does it still feel like they're controlling me?

What Is Narcissistic Abuse?

Narcissistic abuse is a term commonly used to describe patterns of emotional or psychological abuse associated with someone who has narcissistic traits or narcissistic personality disorder (NPD).

However, you don't need to determine whether someone was a narcissist for their behavior to have been harmful. Not all people who abuse others have narcissistic personality disorder, and not everyone with narcissistic traits or NPD abuses other people.

Abuse is best understood through patterns of behavior and their impact. The National Domestic Violence Hotline defines abuse as a pattern of behaviors used by one individual to gain or maintain power and control over the other person (National Domestic Violence Hotline, 2023).

Psychological abuse can include:

• Humiliation
• Intimidation
• Manipulation
• Isolation
• Coercive control
• Threats
• Persistent criticism
• Attempts to undermine someone's sense of reality or independence

These behaviors are about power and control, whether or not the person has consistent narcissistic traits. Instead of focusing on whether your partner, parent, or another person is a narcissist, therapy can focus on your experiences, how power and control operated in the relationship, and how it affected you.

Why Narcissistic Abuse Can Be So Confusing

Abusive relationships aren't necessarily painful all the time. There might be periods of affection, apologies, generosity, or genuine connection alongside the control and manipulation. You may have experienced a relationship that felt wonderful at the beginning and then became deeply destabilizing and harmful. That inconsistency makes it difficult to understand what was happening.

You might think:

"Maybe I exaggerated what happened."

"They weren't always like that."

"What if I was actually the problem?"

"They apologized, so shouldn't I be over this?"

In my experience, this self-doubt is often one of the things people seek support for. When you've spent a long time adapting to another person's reactions, trying to survive a relationship, and questioning yourself, it can take time to figure out what you actually think, feel, and need.

Signs of Narcissistic Abuse

There isn't a single behavior that proves someone is engaging in narcissistic abuse. Instead, look for repeated patterns that undermine your sense of self, boundaries, or your ability to have an equal relationship.

Signs include:

• Criticism or belittling: They put you down, mock your feelings, or make you feel inadequate.
• Gaslighting or denial: They deny things they said or did, insist you're remembering events incorrectly, or repeatedly make you question your own perception of reality.
• Blame-shifting: When you bring up something that hurt you, the conversation gets turned around so that you end up defending yourself or apologizing.
• Lack of accountability: They rarely acknowledge their wrongdoing, or they find a reason why their behavior was actually your fault.
• Emotional manipulation: They use guilt, withdrawal, anger, threats, or exaggerated hurt to influence what you do or how you respond.
• Boundary violations: They disregard your stated limits and may become angry, dismissive, or punitive when you try to establish them.
• A need for control: They attempt to control your relationships, choices, time, finances, appearance, or access to other sources of support.
• Isolation: Over time, you may find yourself increasingly disconnected from friends, family, coworkers, or other people who could offer perspective and support.
• Conditional affection: Warmth, approval, or affection seems dependent on whether you're meeting their expectations.
• Walking on eggshells: You find yourself constantly monitoring their mood and changing your behavior to avoid upsetting them.
• A pattern of idealization and devaluation: Someone may initially make you feel uniquely understood or valued and later become increasingly critical, dismissive, or harmful.
• Your needs come second: The relationship revolves around their emotions, preferences, and needs.

Was It Really Abuse?

You may wonder whether you are being too sensitive, because there were good periods, the other person apologized, they were struggling themselves, or you fought back. None of those things automatically means the relationship wasn't abusive.

Instead of trying to decide based on one argument or experience, I encourage people to step back and look at the relationship over time.

Ask yourself:

• Could you express your needs without being punished, mocked, or made to feel guilty?
• Could you disagree without fearing what would happen afterward?
• When they hurt you, did they take responsibility without making you responsible for their behavior?
• Were your boundaries respected, even when the other person didn't like them?
• Did you gradually become more isolated or dependent on them?
• Did you feel like you had to manage their emotions to keep the relationship stable or to protect yourself from them?
• Did you become less confident in your own judgment while being in this relationship?

How Narcissistic Abuse Can Affect Mental Health

Narcissistic abuse is a form of emotional or psychological abuse that involves a pattern of manipulation, degradation, intimidation, coercive control, or other behaviors used to gain power over another person. It shouldn't be minimized because there may not be physical violence or because the person responsible has not been diagnosed with a mental health condition.

Research has linked psychological violence and coercive control with significant mental health effects, including PTSD symptoms, depression, and anxiety (Dokkedahl et al., 2022).

You may experience trauma-related symptoms such as intrusive memories, avoidance, hypervigilance, sleep problems, emotional numbness, difficulty concentrating, or intense reactions to reminders of the relationship. You might feel grief, shame, anger, confusion, or a loss of confidence in your own identity.

Not everyone who experiences abuse develops PTSD, and trauma can look different from person to person. You do not need a formal PTSD diagnosis for your experience to deserve care and support. Therapy can address the effects of abuse whether or not your symptoms meet criteria for a specific disorder.

What Happens in Therapy for Narcissistic Abuse?

Therapy can help you understand what happened and what you need now. In my practice, I've seen that people often need different things at different points in the process. Early on, you may need help putting language to what happened and understanding why you feel the way you do. Later, you might want to work on boundaries, self-trust, relationships, or patterns that developed to keep yourself safe.

We may talk about your relationship history, the ways you learned to respond to conflict, and what you notice happening in your body and emotions now. We can also explore the beliefs that developed after prolonged emotional abuse:

"My needs are too much."

"I can't trust my judgment."

"If someone is upset with me, I've done something wrong."

"It's safer not to say what I really think."

What If I'm Still in the Relationship?

Your safety comes first. If you're still living with or financially dependent on someone who is abusive, therapy can help you think through your options without pressuring you into a decision you're not ready to make. A therapist trained in supporting abuse survivors can also help you develop a safety plan, identify supportive people and resources, and consider practical concerns such as housing, finances, communication, and contact with the abusive person. If you are in immediate danger, contact emergency services, a local domestic violence organization, or the domestic violence hotline.

Consider reaching out for support if a current or past relationship affects your ability to trust yourself, maintain relationships, set boundaries, sleep, work, or feel emotionally safe.

Therapy for Narcissistic Abuse in Seattle

If you've been in a relationship that left you questioning your judgment, your needs, or even your sense of what happened, you don't have to sort through it alone. Therapy can give you space to make sense of the relationship, understand how it has affected you, and begin rebuilding trust in yourself.

At Existential Psychiatry, I offer individual therapy for adults navigating the effects of narcissistic abuse, trauma, and difficult relationship patterns in Seattle and throughout Washington. With more than two decades of clinical experience, I take a thoughtful, individualized approach to understanding what you've been through rather than reducing your experience to a diagnosis or label.

You don't need to have everything figured out before you reach out. If you're ready to understand what happened and what you want for yourself moving forward, please reach out to schedule a free consultation.

Written by Existential Psychiatry Staff

References

• Dokkedahl, S. B., Kirubakaran, R., Bech-Hansen, D., Kristensen, T. R., & Elklit, A. (2022). The psychological subtype of intimate partner violence and its effect on mental health: A systematic review with meta-analyses. Systematic Reviews, 11(1). https://doi.org/10.1186/s13643-022-02025-z
• National Domestic Violence Hotline. (2023). Power and Control. National Domestic Violence Hotline. https://www.thehotline.org/identify-abuse/power-and-control/