The Parent Everyone Thinks Is Wonderful
Recognizing Narcissistic Personality Pathology in Couples and Families — and Why Clinicians May Mistake the Distressed Partner for the Problem
By Jean-Ellen Metivier, PhD
There is a particular presentation that I believe couples therapists and individual clinicians need to become much better at recognizing.
Two parents enter therapy.
One is emotional.
They talk too much. They interrupt. They cry. They are angry. They have a seemingly endless list of examples of what their partner has done.
They may appear anxious, depressed, obsessive, hypervigilant or controlling.
They desperately want the therapist to understand what is happening.
Sitting next to them is their partner.
Calm.
Articulate.
Perhaps charming.
They may appear confused about why their spouse is so upset.
They may describe themselves as a devoted parent who simply cannot do anything right in their partner’s eyes.
And if the clinician assesses this couple primarily according to how these two people present during a 50-minute appointment, the clinician may get the entire family system backwards.
The most distressed person in the room is not necessarily the person creating the dysfunction.
Sometimes they are the person who has been trying to survive it.
Narcissistic Personality Disorder Is Not Simply Arrogance
Narcissistic Personality Disorder (NPD) is commonly reduced in popular culture to vanity, selfishness or excessive self-confidence.
Clinically, it is considerably more complicated.
Contemporary models of personality pathology emphasize impairments in self and interpersonal functioning — including identity, self-direction, empathy and intimacy — alongside maladaptive personality traits. Research also increasingly recognizes both grandiose and vulnerable dimensions of narcissistic pathology rather than assuming that narcissism always presents as obvious grandiosity (Day et al., 2024; Miller et al., 2022).
That distinction is particularly important in psychotherapy.
A narcissistically organized person does not necessarily walk into therapy announcing their superiority.
Narcissistic vulnerability can involve shame, hypersensitivity, resentment and extraordinary reactivity to perceived criticism or rejection. Grandiosity and vulnerability can also fluctuate within the same individual.
This is one reason narcissistic pathology can be missed.
Look at the Family System, Not Just the Therapy Session
When I am trying to understand a couple like this, I am less interested in determining who performed better in therapy than in understanding how the family actually functions.
I want to know:
Who has power?
Who carries responsibility?
Who gets accommodated?
Who is afraid of upsetting whom?
And what happens when somebody says no?
Those questions are often much more informative than asking which partner communicates more calmly.
Recent research provides an important reason for clinicians to pay attention to these dynamics. Day and colleagues (2025) found pathological narcissism significantly associated with coercive control in their sample, while overall personality-disorder severity was associated with both abuse and coercive control. Exploitativeness, grandiose fantasy and entitlement rage also showed associations with aspects of coercive control or abuse.
This does not mean that narcissism equals intimate-partner violence.
It does mean that clinicians should assess power and coercive control when significant narcissistic pathology is suspected.
Follow the Power, Not Just the Emotion
This is perhaps the most important principle in this article.
Follow the power, not just the emotion.
Who controls the money?
Who controls access to childcare?
Who decides whether the other parent can work?
Who makes major household decisions?
Who controls transportation?
Who determines how money is spent?
Who decides when the other person can have time away from the children?
Who controls sexual access or affection?
Who controls social relationships?
Who changes the rules?
Who is expected to accommodate whom?
And again:
What happens when the other partner says no?
An anxious, angry or highly activated partner may certainly have psychological difficulties of their own.
But emotional activation does not tell us who holds power within the relationship.
The Public Parent and the Private Parent
One of the discrepancies I believe clinicians should explore carefully is the difference between public parenting and private parenting.
Some parents are tremendously invested in being perceived as wonderful parents.
They coach.
They attend the visible school event.
They take one child on an impressive weekend trip.
They post photographs.
They tell colleagues about their children’s accomplishments.
They may genuinely enjoy some of these experiences.
But none of that tells me very much about what happens Tuesday night at 7:30.
Who knows that the child has outgrown their shoes?
Who notices that their clothes no longer fit?
Who schedules the dentist?
Who knows the pediatrician?
Who remembers medications?
Who talks to the teachers?
Who gets up with the sick child?
Who knows that one child is being bullied?
Who knows what the teenager is frightened about?
Who notices that somebody hasn’t eaten?
Who manages bedtime?
Who arranges childcare?
Who buys the groceries?
Who carries the mental load of parenting?
A parent can be deeply invested in the identity of being an excellent parent while remaining remarkably uninvolved in the repetitive, mundane and largely invisible labor of parenting.
Clinicians need to assess both.
When Children Become Extensions of the Parent
Healthy parenting requires recognizing that children are separate human beings.
They are not extensions of us.
They are not evidence of our success.
They are not responsible for maintaining our self-esteem.
Research on parental narcissism increasingly supports concerns about these relational dynamics. A 2025 systematic review examining empirical research published between 2015 and 2024 found parental narcissism associated with poorer parent-child relational and psychological outcomes. Antagonistic aspects of grandiose narcissism were particularly associated with colder and more conflictual relationships, while vulnerable narcissism showed associations with child maladjustment through mechanisms including attachment insecurity, scapegoating and maladaptive parenting (Orovou et al., 2025).
Clinicians should therefore pay attention to selective parenting.
Is one child idealized while another is chronically criticized?
Is the athletic child celebrated while the struggling child is ignored?
Does the parent become disproportionately invested in the child whose accomplishments reflect well upon them?
What happens when a child has autism, ADHD, anxiety, a learning disability, behavioral difficulties, a gender identity, sexual orientation, career interest, personality or worldview the parent did not anticipate?
The clinical question becomes:
Can this parent love the child they actually have — or primarily the child who supports the parent’s preferred image of themselves?
Individuation Is the Real Test
Children eventually say no.
They disagree.
They prefer another parent sometimes.
They develop their own friendships.
They choose clothing we don’t like.
They have different political or religious beliefs.
They fall in love with people we didn’t choose.
They become adults.
Healthy parenting requires tolerating that separation.
For a person with significant narcissistic pathology, however, individuation may be experienced as rejection, humiliation, betrayal or loss of control.
That makes children’s growing autonomy an extraordinarily important area for clinical assessment.
Ask:
What happens when the child disagrees?
What happens when the child says no?
What happens when the child prefers the other parent?
What happens when the child succeeds independently?
What happens when the child embarrasses the parent publicly?
What happens when the child stops performing the role the parent has assigned them?
That can tell us much more than asking, “Do you love your children?”
Most parents will say yes.
Empathy Is More Complicated Than Having It or Not Having It
Clinicians also need a more sophisticated understanding of empathy in narcissistic pathology.
The literature does not support the simplistic idea that people with NPD necessarily possess no empathy.
Empathy is multidimensional.
Research and clinical reviews suggest that affective empathy may be particularly impaired or unstable while aspects of cognitive empathy — the ability to understand another person’s psychological state — can remain relatively intact (Baskin-Sommers et al., 2014; Di Giacomo et al., 2023).
That distinction matters.
Understanding what another person feels is not identical to emotionally resonating with their experience.
It may help explain why someone can appear extraordinarily empathic in certain social circumstances yet behave very differently toward intimate partners or children.
The question is therefore not simply:
“Can this person identify another person’s feelings?”
It is:
What do they do with that information?
The “Sex, Drugs and Rock ’n’ Roll” Question
I sometimes jokingly call another pattern worth assessing “sex, drugs and rock ’n’ roll.”
I want to be careful here.
There is no basis for saying that people with NPD generally cheat, use substances, gamble, compulsively shop or engage in secret sexual behavior.
These behaviors are not diagnostic criteria for NPD.
But clinicians assessing a family characterized by entitlement and coercive control should ask about private gratification, secrecy and asymmetrical responsibility.
Is money being spent secretly?
Are there hidden credit cards?
Unexplained withdrawals?
Affairs?
Pornography or other sexual behavior being concealed from the partner?
Gambling?
Substance use?
Expensive hobbies?
Gaming?
Travel?
Collecting?
Vehicles?
Secret debt?
The specific activity is not necessarily the central issue.
The structure surrounding it is.
One partner may essentially communicate:
I work hard.
I deserve this.
This is my money.
I don’t have to explain myself.
Stop controlling me.
Leave me alone.
Meanwhile, the other parent is trying to pay for groceries, children’s clothing, childcare, medical expenses and school activities.
That is not merely a disagreement about hobbies.
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It may represent entitlement, deception, financial abuse or coercive control, depending upon the broader pattern.
Who Gets to Be Left Alone?
Everyone needs privacy.
Everyone needs hobbies.
Everyone needs time away from their children.
Wanting solitude is not pathological.
But clinicians should become curious when one person’s right to be left alone depends upon the other person’s obligation never to be left alone.
Who gets uninterrupted leisure?
Who disappears into another room for hours?
Who gets weekends away?
Who pursues hobbies?
Who has discretionary money?
Who gets to sleep?
And who remains responsible for the children while that happens?
Sometimes what initially appears to be a disagreement about “personal space” is actually a profound asymmetry in entitlement.
One person’s time belongs to themselves.
The other person’s time belongs to the family.
One Person’s Wants Become Needs
This is another pattern worth examining closely.
In dysfunctional relationships characterized by significant narcissistic pathology:
One person’s desires can gradually become needs, while the other person’s needs become demands.
One person needs a weekend away.
The other is selfish for requesting two hours.
One person needs an expensive hobby.
The other is irresponsible for buying children’s clothes.
One person needs privacy.
The other is secretive for closing a door.
One person deserves sexual gratification.
The other’s sexual boundaries become rejection.
One person’s anger is justified.
The other’s anger becomes evidence that they are unstable.
That asymmetry deserves clinical attention.
Parenthood Is an Exercise in Frustration Tolerance
There is another remarkably simple assessment question:
What happens when this parent doesn’t get what they want?
Parenting requires almost continuous delayed gratification.
Babies wake us up.
Toddlers interrupt conversations.
Children get sick before vacations.
Teenagers need rides.
Children cost money.
They ruin schedules.
They need attention precisely when adults would rather be doing something else.
Healthy adults become frustrated.
Sometimes we even become angry.
But we regulate ourselves because the child is the child and the adult is the adult.
For someone with significant narcissistic pathology, frustration can become particularly revealing.
What happens when a toddler interrupts them?
When the spouse asks them to help?
When money earmarked for something they want must instead go toward a child’s needs?
When sexual attention isn’t available?
When the weekend plan changes?
When someone asks them to stop drinking, gaming, shopping, working or pursuing a hobby and participate in family life?
Watch what happens when entitlement encounters a boundary.
Listen for Accountability
Another important clinical marker is the capacity for genuine accountability.
Not:
I’m sorry she feels that way.
Not:
Apparently I’m the worst father in the world.
Not:
Nothing I ever do is good enough.
Not:
I’ve apologized a thousand times.
Genuine accountability sounds different:
I did this. It hurt my partner or my child. I understand why it hurt them. I should not have done it. I need to change my behavior.
That requires the capacity to tolerate shame without immediately converting shame into blame.
It requires mentalization.
It requires curiosity about another person’s internal experience.
And it requires enough psychological stability to remain engaged when one’s preferred self-image is challenged.
Watch What Happens When the Therapist Challenges the Parent
The therapeutic relationship itself can provide important information.
What happens when the therapist disagrees?
What happens when the clinician asks the parent to consider the child’s perspective?
Can the person become curious?
Can they tolerate ambiguity?
Can they recognize their own contribution?
Can they acknowledge contradictory information?
Or does the therapist suddenly become incompetent, unfair or biased?
Does the partner punish the spouse after therapy?
Does something disclosed during treatment later become ammunition?
Does the person attempt to recruit the therapist into an alliance against the other partner?
Those behaviors deserve attention.
The Distressed Partner May Look Like the Patient
This is where I think clinicians can make one of their biggest mistakes.
Imagine living for years in an environment in which expectations constantly change, your parenting is undermined, money disappears, disagreements escalate, your partner must be accommodated, and you are simultaneously trying to protect several children and keep the household functioning.
Then somebody finally gives you 50 minutes to explain what is happening.
You might talk fast.
You might cry.
You might interrupt.
You might bring lists.
You might be furious.
You might look anxious.
You might desperately try to convince the therapist to believe you.
Distress is not the same thing as pathology.
The therapist needs to determine whether the distressed partner is organizing the dysfunction or reacting to it.
Sometimes it will be both.
But presentation alone cannot answer that question.
Do Not Diagnose NPD From a Checklist
There is an equally important warning on the other side of this discussion.
A selfish spouse does not necessarily have NPD.
A controlling parent does not automatically have NPD.
Infidelity does not establish NPD.
Neither does pornography, substance use, excessive spending, poor parenting, anger, lying or financial irresponsibility.
And one partner’s description of another person is not sufficient for confidently diagnosing that person with a personality disorder.
NPD requires careful assessment of enduring personality functioning across contexts.
Contemporary personality research also increasingly supports dimensional assessment of personality dysfunction rather than relying exclusively upon categorical labels (Day et al., 2024; García et al., 2024).
But diagnostic caution should not become diagnostic blindness.
A clinician can appropriately say:
I don’t yet know whether this person meets criteria for Narcissistic Personality Disorder. But I am observing entitlement, impaired intimacy, problems with empathy, exploitation, coercive control, unstable self-esteem regulation, difficulty tolerating autonomy and a substantial discrepancy between public and private functioning. This requires further assessment.
The Children Cannot Become Supporting Characters
When children are involved, the assessment cannot stop with the couple.
Children are not simply evidence in their parents’ marital dispute.
Their functioning matters independently.
When ethically and clinically appropriate, clinicians should consider collateral information, developmental history, school functioning, medical follow-through, attachment patterns and the child’s functioning with each caregiver.
Who actually parents this child?
Who knows them?
Who comforts them?
Who frightens them?
Who allows them to disagree?
Who requires emotional caretaking from them?
Who supports their independence?
And perhaps most importantly:
Who permits this child to become a person separate from the parent?
Couples Therapy Is Not Always the Right Treatment
Finally, clinicians need to recognize when ordinary couples therapy assumptions no longer apply.
Couples therapy generally assumes that both people can participate voluntarily and communicate without significant fear of retaliation.
When coercive control, intimidation, serious deception or abuse is present, that assumption needs to be reassessed.
The therapeutic task cannot simply become:
“You both need to communicate better.”
Communication skills do not solve a power imbalance when one person is frightened of what will happen after communicating honestly.
Safety, coercive control, child welfare, retaliation risk and each person’s capacity to participate freely need to be assessed.
Sometimes individual assessment needs to precede conjoint work.
Stop Asking Who Looks Sick
Perhaps we need to stop asking which person looks the most psychologically disturbed during the appointment.
Instead:
Follow the power.
Follow the money.
Follow the responsibility.
Follow the parenting labor.
Follow the secrecy.
Follow the entitlement.
Follow the fear.
Follow what happens when somebody says no.
Follow what happens when a child becomes independent.
Follow the discrepancy between public parenting and private parenting.
And follow the capacity for accountability.
The composed person sitting quietly in the therapy room may indeed be the healthier partner.
But composure is not evidence of psychological health.
Likewise, the angry, crying, anxious person may have substantial psychological problems.
But distress is not evidence that they created the system to which they are reacting.
Our responsibility as clinicians is to look beyond presentation and understand the organization of the family itself.
Because when children are involved, getting that assessment wrong doesn’t affect only the couple.
It affects an entire family.
References
Baskin-Sommers, A., Krusemark, E., & Ronningstam, E. (2014). Empathy in narcissistic personality disorder: From clinical and empirical perspectives. Personality Disorders: Theory, Research, and Treatment, 5(3), 323 — 333. https://doi.org/10.1037/per0000061
Day, N. J. S., Green, A., Denmeade, G., Bach, B., & Grenyer, B. F. S. (2024). Narcissistic personality disorder in the ICD-11: Severity and trait profiles of grandiosity and vulnerability. Journal of Clinical Psychology, 80(8), 1917 — 1936. https://doi.org/10.1002/jclp.23701
Day, N. J. S., Kealy, D., Biberdzic, M., Green, A., Denmeade, G., & Grenyer, B. F. S. (2025). Coercive control and intimate partner violence: Relationship with personality disorder severity and pathological narcissism. Personality and Mental Health, 19(4), e70038. https://doi.org/10.1002/pmh.70038
Di Giacomo, E., Andreini, E., Lorusso, O., & Clerici, M. (2023). The dark side of empathy in narcissistic personality disorder. *Front
