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  • Ryan Drewianka

A Therapist's Path Toward Focusing on Adult Children of Narcissists

Updated: Jul 10, 2023

Even though I had mentioned that this blog is primarily meant to offer support in a number of ways to those who read it, I feel it's important to also provide some background about my journey as a helping professional.

I believe this background can be helpful to folks for a number of reasons:

  • People who seek therapy are most often in pain. They want to know that the person they seek help from has the knowledge, skills, and abilities to be effective.

  • Effective therapy is based in relationship. My approach to this fact motivates me to provide context about my life insofar that it's beneficial for clients to know.

  • I believe information like this can help build a stronger sense of trust and rapport, with the intention of it leading to more effective therapeutic outcomes.

Read on to get a glimpse of how my client niche has developed over the years, providing yet another example of how my path in life tends to meander (and likely will in the future)!


Graduate School and Inpatient Psychiatric Units

While I attended school part time, I worked as a Mental Health Associate at a local hospital to gain real-world experience in the field. I mostly worked in the inpatient psychiatric units, but occasionally floated to the psychiatric portion of the emergency department as well.

In a way, these two experiences complimented each other quite well. Counseling classes were heavily geared toward learning about the various psychiatric "disorders" (more on that in a later post), theories, and skills. At the hospital, it often seemed like the folks I interacted with fit into the rigid boxes that the DSM-V described, which I had been learning in school.

Many of the course instructors incorporated some version of the question, "what populations do you see yourself working with in your career?" as part of a class introduction or woven into an assignment. As I began the program, and throughout most of it, my general answer to that question was some variation of, "adults with anxiety or depression."

Adult vs. Child/Adolescent Units at the Hospital

There were four psychiatric units at the hospital: three of them were for adults, and one was focused on children and adolescents ranging in age from 10-18 years old. Given my therapeutic interests at the time, for the better part of two years I worked most often on the smaller of the three adult units.

Throughout that time, a friend of mine who had worked on the child/adolescent unit, in addition to a few of my instructors at school, gave me feedback that I'd likely be a great fit working with children and teens. I had thought, what on earth makes you think that?!

Kudos to them: a majority of the time I helped out on the child/adolescent unit, I did walk away feeling a larger sense of gratitude, fulfillment, and just overall joy that hadn't generally been present for me on the adult units. I began to think that maybe they were right and that perhaps I could rethink my professional interests.

If you haven't worked with adolescents in a healing context, there's something that may surprise you: their general capacity to display insight, self-awareness, compassion, love, and even their sheer motivation to learn and improve, demonstrates a maturity beyond their years. Many times it left me speechless.

Community Mental Health

One of the final requirements for earning a counseling degree is completing an internship; doing real psychotherapy with real humans. As my mind had begun to shift away from working with adults and instead toward adolescents, I chose to focus my internship on the latter to truly get a feel for if that age group would be a good professional fit for me.

The counseling agency where I did my internship specialized in child, adolescent, and family therapy. The specific program I worked in further specialized in providing in-home therapy services to clients in the surrounding area.

One of the amazing advantages for clients receiving in-home services is the convenience. Parents don't have to worry as much about wrangling their kids into the car, generally more family members can participate in the sessions if they're at home, and the therapist even comes to you!

It's worth noting, too, that in many instances it's quite necessary to include parents or caregivers in the therapy process for a child or teen, at least in some capacity. That's why family therapy was a service that accounted for most of my hours at the agency, both during my internship and after I got hired-on as well.

Diving Into Family Counseling

Remember when I said I had imagined myself working with "adults with anxiety and depression"? Hah.

A majority of my hours at the agency came from providing therapy or therapy-adjacent services for kids and their families, targeting issues that presented most often as behavioral challenges. Anxiety and depression were often underlying challenges, sure, but those symptoms are generally communicated more via behaviors for young kiddos.

I learned several things from my experiences doing in-home family therapy during the (almost) two years I worked at the agency:

  1. My skills, temperament, and honestly my energy capacity, heavily favor individual therapy over family therapy.

  2. My strengths lie more in guiding deeper, explorative conversations rather than managing physical behaviors.

  3. Anecdotally, a majority of the families I treated could be described as a narcissistic family system.

  4. The sad truth about narcissistic family systems is that, although the child might be suffering from completely valid symptoms, their level of growth and healing is capped by the level of growth and healing the narcissistic individual(s) is/are willing to work on.

  5. Individuals with narcissistic traits are generally severely hurt humans. Their tendencies to offload blame and avoid accountability are often protective measures to defend against the deep insecurities and suffering they feel inside.

  6. The very protective factors narcissistic individuals rely on to feel safe and comfortable are the same factors that often prevent them from seeking or accepting help.

After a while I felt like I was spinning my wheels. So much time was spent trying to help kids who could only do so much within the narcissistic family system they were part of.

I felt called to this profession. I knew there had to be more that I could do to help.

Opening Telos Counseling

Based on the experiences I described above, I knew working with families wasn't the best fit for me, nor was working with children.

However, I still had a strong pull toward helping teens given my work at the hospital and some of the clients I had at my agency job. I also knew, with a stronger feeling than before, that working with folks suffering from anxiety was a good fit for me.

I opened Telos Counseling in 2022 under the group practice of Aslan Institute. As I slowly built my practice I marketed toward teens, though focused a bit heavier on folks suffering from anxiety in general. I also leveraged telos as the namesake of my practice to try to attract clients that might want help with finding purpose or meaning in their lives.

As referrals came in and I started getting to know my new clients more, certain patterns began emerging: age ranges, demographics, interpersonal styles, and family dynamics. These patterns also coincided with the clinical supervision and education I had begun receiving through Aslan Institute.

Aslan Institute's Influence on Telos Counseling

Almost everyone who I began working with presented as a young adult with concerns about anxiety, and several of them mentioned symptoms related to depression.

What blew the doors open for me about how to conceptualize these folks' struggles, and therefore formulate how best to try to help them, were the roles of shame and fear in their lives that I had learned about through my supervisor. Shame, fear, and the resulting fear of shame, often lead to a variety of anxious tendencies in our lives.

In my clients, some of the anxious tendencies I realized I was treating the most were people-pleasing, perfectionism, passiveness (sacrificing your needs for someone else's), self-doubt, overthinking, and co-dependency.

Leaning on my supervisor's guidance, the questions my clients and I started exploring were, where and how did these shame patterns develop? and how do those patterns relate to what you're experiencing now?

The Past Meets the Present

It's common practice for psychotherapists to gather historical information about a client, similar to what primary care providers do for physical healthcare. Family history, health history, developmental history, etc. can all be helpful in conceptualizing the whole person who is in front of us needing care; not just their symptoms or diagnoses.

When exploring my clients' childhood and home life, some of them described experiences that suggested the presence of emotionally immature caregivers.

Caregivers that display emotionally immature behavior can present in many ways, including: not accepting accountability for their actions and blaming others; conditional love; shame-based language; denial or gaslighting; or reduced ability (if not inability) to validate others' emotions or accept the needs of others.

Undercurrents of Narcissism

Narcissism, from a psychological perspective, is generally defined as "a condition in which somebody is only interested in themselves and what they want, and has a strong need to be admired and a lack of understanding of peoples' feelings."

A narcissistic family system is characterized by a parent exhibiting strong narcissistic traits which then influence the thoughts, feelings, and behaviors of other family members. In other words, the narcissistic parent's needs outweigh everyone else's.

It's important to note that narcissism is a trait we all possess to some extent, and exists on a spectrum. Most of us fall somewhere in the middle of the normal distribution. For the caregivers we're talking about, their score on this trait trends toward the extreme end.

At this point ask yourself: how might being raised by a parent exhibiting these behaviors affect your beliefs about yourself or the world? How would they affect how you relate to others? Or how would they affect your relationship with the tasks you need to complete or the achievements you accomplish?

The anxious tendencies some of my clients discussed above began to make more sense.

Tying It All Together

My professional experiences working with clients came full circle, in a way. I began with the belief that I wanted to work with adults, and have since discovered that I tend to do my best professional work with young adults. Folks in that stage of life are navigating the realities of adulthood while learning how to become their own selves, independent from their families. I also entered this career path believing I wanted to work with folks suffering from anxiety and depression. Although I've found that to remain true, it doesn't tell the whole story. I've learned so much more about how shame and fear impact our lives and the defenses we create to protect against them.

Learning more about (some of) the origins and dynamics of anxiety became the "lightbulb" moment for me.

In my agency work I bore witness to caregivers whose behaviors could in many ways perpetuate a narcissistic family system using forms of shame.

At Telos Counseling I'm now working with the adult children who have lived through those narcissistic family systems and are learning how to become themselves.

Resources for Adult Children of Narcissists

If you've read this far and feel like you could use some support on this topic, below are some resources to explore:

You are also welcome to explore my therapy services for Adult Children of Narcissists or contact me to see if I can be a helpful support for you on your recovery journey.

Remember: how your parents treated you was never your fault. Healing and growth are possible.

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