My Research: Narcissistic Abuse: A Therapist’s Perspective from Research to Practice

Having completed my Master’s research on the topic, and through experience of working with clients I’ve spent a great deal of time exploring the impact of narcissistic abuse not just on paper, but in the therapy room, face to face with those who are living through it.

Narcissistic abuse is often deeply misunderstood. It doesn’t always come with visible wounds or dramatic events. Instead, it manifests subtly and cumulatively through manipulation, gaslighting, emotional control, blame-shifting, and often a deeply confusing cycle of idealisation and devaluation.

My clinical and academic work has focused on understanding how this form of abuse shows up in therapy, how it affects clients psychologically and emotionally, and how we, as therapists, can respond effectively and compassionately.

What Makes Narcissistic Abuse So Difficult to Name

One of the most complex elements of narcissistic abuse is that it is often invisible even to the person experiencing it. Many of the clients I work with come into therapy feeling lost, anxious, ashamed, confused and sometimes with uncontrolled anger and rage, that they cannot explain or understand.  They speak about a relationship, past or present, that has left them doubting themselves, walking on eggshells, or unable to trust their own perceptions.

Often, they don’t describe what’s happened as “abuse” at all.

This is partly because narcissistic abuse works by eroding a person’s sense of self and distorting their emotional reality. It’s also because the term itself is not widely recognised in clinical training or diagnostic manuals. While coercive control is now increasingly understood in legal contexts, narcissistic abuse still sits in a grey area, both socially and professionally.

From Research to Practice  

I interviewed psychotherapists about their experience of working with survivors of narcissistic abuse. 

What emerged was both validating and challenging:

Many therapists recognised the patterns and language of narcissistic abuse in their clients' stories, but few felt confident using the term. There’s still discomfort around labelling, and many clinicians are cautious about pathologising someone as a ‘narcissist’.

One of the key findings of the research is the destructive, toxic, entitled and self-serving behaviours of the abuser which has the hallmarks of narcissistic traits and characteristics, even if this does not necessarily make the abuser a narcissist. The experience of the victim is real but can be very difficult to express and understand. It is not about the labelling but about validating and naming the abuse.

What became clear is that having a shared language matters. Clients often feel relieved and empowered when their experience is finally named. Being able to recognise their experience for what it is, abusive psychological & emotional harm, can be a vital first step in the healing journey.

Therapy as Reparation

Survivors of narcissistic abuse need more than validation, they need skilful, trauma-informed support that helps them rebuild a sense of self that has been systematically undermined.

As a therapist, I’m always mindful that these clients may carry shame, guilt, and a complex emotional bond to their abuser. Trauma bonding, attachment wounds, and internalised gaslighting are common. The therapeutic relationship itself can sometimes trigger these dynamics, requiring careful attention to boundaries, pacing, and being attuned to what is happening in the therapeutic relationship.

But the therapy space can also become a site of real transformation. When a client begins to reconnect with their own voice, trust their intuition again, and feel safe in a relationship without manipulation, that’s where healing happens.

Looking Ahead: Why This Work Matters

We are only beginning to understand the full impact of narcissistic abuse, both clinically and culturally. What I know from my research and practice is that this is not rare.

These relational dynamics are more common than we realise and they cause real harm.