In relationships, narcissists tend to dismiss their partner's feelings and blame them for problems.
They may also act in immature ways, like using the silent treatment.
A psychologist who works with them said a narcissist could be taught empathy after some time.
Narcissism exists on a spectrum, with most people exhibiting small amounts of self-centeredness. Few people are diagnosed with narcissistic personality disorder, which is the most extreme form and characterized by someone being extremely self-absorbed, manipulative, and exploitative in relationships.
When someone comes to David Hawkins, a clinical psychologist at the Marriage Recovery Center in Seattle, about their narcissistic spouse, it's usually after they've been on the receiving end of these behaviors for years, he told Insider.
"Typically, it takes people awhile to figure out what exactly is wrong because the narcissistic person is saying, 'It's not me. It's you.' That creates incredible confusion in the relationship," Hawkins said.
Once they read about narcissism and emotional abuse, they reach out because they realize their narcissistic partner may have difficulty with empathy, compassion, and personal responsibility, Hawkins, who helps men heal from narcissism to save their marriages, said.
A willing narcissist who wants to change and save their relationship is capable of learning empathy and healthy relational skills, but it takes time, he said.
During hours of therapy, Hawkins looks for certain behavioral patterns in his clients' relationships to determine how deeply ingrained the narcissist's behaviors are and contemplates the best course of action.
A narcissist will dismiss your feelings
A narcissist will dismiss their partner's feelings or thoughts, saying they don't believe them or that they shouldn't feel or think that way, according to Hawkins.
Name-calling and gaslighting are common dismissal tactics. In couples therapy, Hawkins will point out these and other behaviors to the narcissist as part of treatment.
"They're deeply ingrained character patterns, so someone who's very firm and confrontational, such as myself, needs to say to him, 'Look what you're doing right now,'" Hawkins said.
He said they may say things like, "Why are you bringing this up again? I already apologized," as a way to make their partner feel unimportant.
They'll always find a way to blame you
During couples therapy, a narcissist may refuse to take any responsibility for their part in relationship issues, Hawkins said.
They throw temper tantrums or give you the silent treatment
Narcissists can also act out in immature ways and use extreme manipulation tactics like the silent treatment, Hawkins said.
If a narcissist views something their partner did as an attack, like explaining how a behavior affected their relationship or describing their feelings, they could withhold communication in an attempt to teach their partner a lesson.
Withholding in this way isn't healthy, but it's a defense mechanism narcissists learn to keep up their self-image. If their partner can't critique them, they don't have to face their underlying low self-esteem.
"For whatever reason, you're seeing a person who is wildly insecure and has no real inner confidence that they can depend on. They depend on external validation," Elinor Greenberg, a therapist and the author of the book "Borderline, Narcissistic, and Schizoid Adaptations: The Pursuit of Love, Admiration, and Safety," previously told Insider.
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