HealthyGamerGG - The Worst Red Flags I’ve Seen As A Therapist

Episode Date: August 10, 2026

In this episode, Dr. K tackles a fascinating and highly requested question: Do therapists actually know when their patient is the "villain" of their own story? He explores how toxic individuals and narcissists frequently weaponize therapy language, why some therapists miss personality disorders for years, and the clinical signs—like an external locus of control and a failure of mentalization—that reveal when a client is the real problem. What to expect in this episode: The "Therapy Villain" Paradox: Why the most toxic people in your life are often the ones raving about therapy, using therapist validation to cast everyone else in their life as a narcissist or a sociopath. The Trap of Misdiagnosis: Why therapists frequently spend years missing personality disorders—such as confusing Borderline Personality Disorder (BPD) with bipolar disorder or severe anxiety—and Dr. K’s honest admission about his own susceptibility to these blind spots. Identifying the "Victim" Pattern: What it means when a patient is consistently surrounded by people they claim are abusive, and how to tell if they are attracting toxic relationships or simply projecting their own narcissistic tendencies. The External Locus of Control: Understanding the diagnostic red flag of patients who believe their entire life is controlled by external forces (like society, bosses, or spouses), leaving them feeling powerless rather than empowered. Supportive vs. Action-Oriented Therapy: The clinical purpose of "supportive psychotherapy" (which focuses on unburdening and venting), and why true growth requires decompressing emotions so you can focus on personal responsibility and change. Weaponizing Therapy Speak: How predatory or narcissistic individuals hijack modern mental health concepts—like "I'm entitled to my feelings"—to justify inappropriate emotional reactions and continue traumatizing those around them. Projection and "Theory of Mind": How narcissists convert internal insecurity into external attacks (such as believing a friend lost weight specifically to make them look bad) because they project their own feelings onto everyone else. The Failure of Mentalization: A deep dive into the core deficit of Cluster B personality disorders, where an individual is entirely unable to separate their own internal discomfort ("I feel bad") from the actions of independent people ("someone did this to me"). The Narcissistic Blind Spot: Why narcissists assume that if they don't understand a complaint, it simply doesn't exist, whereas healthy individuals recognize they might just have a personal blind spot. Dr. K's NEW Guide to Love, Sex, & Relationships is here! Order now: https://bit.ly/4dO3x0VHG Coaching : https://bit.ly/46bIkdo Dr. K's Guide to Mental Health: https://bit.ly/44z3SztHG Memberships : https://bit.ly/3TNoMVf Products & Services : https://bit.ly/44kz7x0 HealthyGamer.GG: https://bit.ly/3ZOopgQ Learn more about your ad choices. Visit megaphone.fm/adchoices

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The most selfish person you know is at therapy being told they're allowed to be selfish sometimes. Somewhere out there, the worst person you know is being fed an Instagram graphic on their algorithm telling them it's okay to put themselves first, right? So do therapists know when their patient is actually the villain? One of the most toxic people I know has been seeing the same therapist for about five years with no change in their behavior slash life, mind you. And I just have to wonder if this therapist secretly knows that her client is actually the problem. The person I know, M, is just truly awful to everyone around her, but she's constantly raving about her therapist and how her therapist tells her that everyone else is the villain in her story,

that her mom is a narcissist, her sister is a sociopath. I've never heard of a therapist casually diagnosing family members with personality disorders. Does this therapist likely know that M is actually the villain? So this is a really great question, right? So if you're a therapist, do you know when your patient could be the villain? It's kind of an interesting question, right? Like, do we, know? And this is where I would say a couple of things. The first is that I think it's like super scary, but I have had so many patients who have people in their life, who are in therapy for years. And it appears that from my lens of working with my patient, that the person in their life is basically not, that their therapist is missing this person's personality disorder. And it's shocking,

like, I would say the most common example of this is I will be working with someone who is dating someone who has borderline personality disorder. and that person is in therapy. But the therapist seems to think that they have severe anxiety. Bipolar disorder is a very common misdiagnosis of borderline personality disorder. And so it seems like they just are working with them for years and like nothing is getting better. Now, is that actually what's going on? Like, I don't know, right?

Because the problem with that is in my shoes is my patient is in a relationship with someone with BPD. They have a therapist. And I'm like, oh, my God, the therapist is misdiagnosing them. But maybe it's my patient who is narcissistic. or borderline or whatever and represents this other person in a bad light. So I'm going to, I'm going to go ahead and say that as a therapist, I believe that there are many therapists who misdiagnose their patients. They misdiagnoses in their patients. Now, the other scary thing is that when I say therapists do this, do I do this? Almost certainly, right? So there's like no reason to think

that I am impervious to what my colleagues may experience as well. But what I can say is that when I work with people, I oftentimes find personality problems. Like, I see a lot of narcissism. I see a lot of sociopathy. I see a lot of borderline characteristics. And there are certain signs. So like if you, I mean, this is maybe me being arrogant here, but it's not just me. I think I was taught by many therapists to detect people who are narcissistic, right? So one key thing that I've learned is that if I have a patient who is surrounded by people who are problematic, this person mistreats me, this person mistreats me, this person mistreats me, that patient is somehow responsible for that. Now, I want to be clear about this because it doesn't necessarily mean that the patient is

personality disorder. Okay, this person is abusive, this person is abusive. The key thing there is that it could be that my patient is narcissistic and thinks that everybody is abusive, or it could be that my patient has certain relationship patterns where they enter into relationships with people who regularly abuse them. That when someone treats them kindly, they actually freak out, they don't know what's going on, they're waiting for the other shoe to drop, and they run away from the good relationships in their life. So one of the key things that I sort of think about as a therapist is how is my patient

responsible for their situation in life? Even when if it's someone who's like, let's say I have a patient who says, this person is taking advantage of me. In a weird way, I still kind of blame the patient in the sense that, okay, you are doing something that allows them to take advantage of you. So I think very heavily from a lens of what is my patient's role in responsibility in their life. And even if other people are bad to you, you may be able to do something that can change that. Because ultimately, we can't control them, right? So the field that we play on is like what the two of us can figure out and how my patient can actually change. So that's what I kind of focus on.

The interesting thing is I do have a lot of patients that I think are, you know, have features of sociopathy, narcissism, BPD. And I see those things. I can see and like I'll give you guys a couple of examples of what this looks like. I keep seeing comments. Dr. K, how do I apply this to a situation in my life? That's literally why we created a coaching program. Our coaches are certified on an evidence-based curriculum designed to help you get unstuck. This involves analyzing your patterns, increasing your understanding, and working with you week to week to help you develop a plan to create lasting change. So if y'all are interested, check out the link in the description below. So number one is if I have a patient who has a very strong external locus of control, this is a big problem. So what is external locus of control?

When I have a patient who comes in who says, the things in my life happen because things outside of me control my life. So that's an external locus of control. Where is the center of control in your life? Society is this way. Your boss is this way. Your parents are this way. Your wife is this way. your husband is this way, where is the power in the relationship? And now sometimes that can be narcissism, but it's not always. So that's kind of what I think about. Does the patient feel empowered? Or are they just a victim to everything going on around them?

And then the second thing is, even if they sort of play the victim, I think this is a really important point to understand. A lot of people think that therapy is about talking about your feelings. So you come in and you talk about, oh, this person did this and this person did this, and I feel this way and I feel this way. And there are forms of psychotherapy that are. like that. So something called supportive psychotherapy is an example of psychotherapy that's just supportive. So patient comes in every week. You just try to do your best to support them. Now,

sometimes this is what people need. Like if their life is genuinely falling apart and they have nowhere to turn to, they just need one place to go for one hour a week where they just vent everything out where we're not working on what's your responsibility. We're not working on what to change. They're just carrying so much weight that they need to unburden it some. They need to vent some. Then support of psychotherapy is fine. The other thing is if you look at patients with a history of something like Down syndrome or patients who have lower IQ, supportive psychotherapy is one of the most effective forms of psychotherapy for those people. That doesn't mean that if it's effective for you, that means you have low IQ, but there are certain populations where supportive psychotherapy is very effective. But for me,

when I work with people in their emotions, the goal is to decompress the emotion so that the emotion no longer clouds your thinking. And then you should be able to see the situation. Right. So, yeah, this person, you got, get this person a gift and they never give you a gift. And that hurts. You feel angry. You feel frustrated. So be it. Right. Let's get those emotions out. But then what? So what comes next? Now that we understand that you feel taken advantage of, and sure you're entitled to your feelings, but then what? What are we going to do about it? What comes next? And there are some therapists who don't push for that. And this is the really tricky thing. So it's easy for me to say, hey, I don't think that that is effective, but that's wrong. See, this is important to understand.

I suck at that. I'm pretty bad at supportive psychotherapy. So one of the key things about being a therapist is you have to understand that just because you're not good at a modality doesn't mean that the modality isn't effective, right? So it could be that, oh, it's like sushi is disgusting because I don't know how to make good sushi. So it's very possible that other psychotherapists are being supportive with their narcissistic clients and they are making progress. So I had a brilliant. supervisor who once told me, you know, it was after three years that we made a breakthrough. And my reaction was, what the hell were you doing for the verse two and a half? Why does it take three years to make a breakthrough? Because there's this presumption in especially fields like

psychoanalysis and psychodynamic therapy that like therapy is kind of like a long term, intense, slow, fertilized, growing kind of process. And I'm not saying that it isn't, but I have to wonder like from a almost like a randomized controlled trial standpoint, out of those three years of therapy, like how much of that is really necessary. And there are therapists who are far more experienced than me, arguably far more clinically superior. I don't know, because I've never compared my outcomes to their outcomes. We'll say, yeah, like, this is the way that it has to be done. I'll be the first to admit that maybe this is the arrogance of having a little bit of information. But when it comes down to it, I think that most of us know when our patient is the villain. I think most of us can tell because

there are conspicuous things that are absent from their stories, right? Oh, this person cut me off, like this person blocked me. This person complains about me. My boss doesn't recognize my credit or people at work or ostracizing me. I'm being bullied. And then if we tunnel down into it, is there something missing from that story? So what I really look for is like a sense of like do things stitch together in a way that is, that makes sense. And one of the, the trickiest things is, you know, everyone says nowadays that people are entitled to their feelings. Like, you're entitled to feel that way. This is where I got to respectfully disagree a little bit. I think some of the emotional reactions that we have, especially with narcissistic patients, are inappropriate to the circumstance.

Like, I know this is wild, but this is a key, you know, teaching from Buddhism. So in Western psychology, we have this attitude that all feelings are healthy, all feelings are good. You know, and this is like a good neuroscience evolutionary argument. Our brain has the capacity for anxiety. Our brain has the capacity for shame and guilt. These are important evolutionarily selected emotions. But if you look at sort of of the Buddhist perspective, some of them are good and some of them are bad. Compassion and appreciation are superior to envy and jealousy, are flat out better than envy and jealousy. And that ideally, it is not good to feel envy or jealousy ever. We want to get rid of that completely. Now, where I kind of settle is that in many of my patients, what I find is that they have what I would call

inappropriate emotional reactions to situations. Now, this isn't their fault because they have a template where this emotion is activating, but they're actually like, that's not the right thing to feel, right? So in a sense, like, we can't blame you for it, but I think something is really scary where a lot of the language that we're using around sort of the democratization of mental health where like now everyone's being emotionally supportive and mental health aware and things like that, like I think that's generally a good trend. But I think it's really scary because you, you have this subpopulation of people who have become incredibly predatory, like the narcissists, who are now weaponizing the language of therapy to continue to traumatize other people. I'm entitled

to my feelings. Well, like, sort of, right? So, yeah, I understand that you feel that way, but is that an appropriate feeling? Oh, this person lost weight and came to my wedding. How dare they? I feel attacked. They're doing it to make me look bad. And that emotional reaction, you're having that emotional reaction, isn't an appropriate emotional reaction. If you feel bad, does that mean that someone is trying to hurt you? So one of the key things that I look for when it comes to like, is my patient the villain, is something called theory of mind. So what we see in people who are narcissistic is the way that they feel projects out onto

the people around them. So if my friend lost weight and now I feel ashamed of myself, I feel hurt, I feel like, oh my God, my friend was able to do it. I used to be the attractive one. Now they've become the attractive one. Over the last 10 years, I've let myself go, whereas they have really taken care of themselves. And that shines a light on my own failures and their successes.

But then what I will do, what people who are narcissists, this is what I pay attention for is, do they attribute their hurt to the other person? This person lost weight to make me look bad. That's the nature of narcissism. Everything that happens around me is pointed at me, right? And then I'll ask a couple of questions. I'll be like, oh, so, you know, this person really tried to put you down.

What did that look like? What did they say? So I'll be inquisitive because I think this is the really important thing to remember. I like working with Clusterby patients a lot. My job is to help them be less narcissistic because narcissism causes an immense amount of suffering in their life, screws up their relationships, screws up their mood is a high risk factor for substance use, right? So my job, like my goal is to help this person become less narcissistic, to help them

realize that the world is not all pointed at them, that they take things too personally. And so I'm on the lookout for those kinds of features because if I miss that, then I'm doing my patient a huge disservice. And then we do the slow work of sort of helping them understand, right? And like, that's what the work is. Do we know that our patient is the villain? Oftentimes, yes. And then it's like, okay, let's understand what other motivations could this person have. How do you feel about their choices versus your choices? Because that's where the money is. This person did this to make me look back. That's not helpful because what's the action then? Are we going to cut this person out of their life?

And then someone else shows up and makes you look bad. And then we're going to cut that person out of their life. And this is what happens with people who are narcissistic. They leave a trail of burned bridges behind them. And as a psychiatrist, like my goal is to try to prevent that, unless that's what they really want to do. If they're acting with full awareness and they want to burn bridges right, left, and center, like that's their choice.

My goal is to give them the choice. And then as we examine, okay, what does it feel like? when someone shows up and has really gotten their life together and you've let your life slide away, what does that feel like? What's the emotion there? How do you feel about yourself? Right? And this is the, this is literally the deficit in Cluster B personality disorders is a failure of mentalization. They're not able to separate out if I feel bad. Someone did it to me. No, I can feel bad and this person can be a completely independent entity. And it is literally in the failure of that understanding. Oh, I hear this so much from like parents who have been cut off suddenly by their kids with no warning.

It came out of nowhere. My daughter blocked me. And that's what their experience is because their brain is not registering that when this person, a really good example of this is when someone complains to you about something that you do, a narcissist does one really interesting thing. If they don't agree with your complaint, they don't accept your complaint. They frequently think that people who complain towards them, hey, I think you're doing something wrong. They say, no, I am not. If they don't agree with it, if it doesn't make sense to them,

the other person is wrong. This is the key thing about narcissism. When you're narcissistic, if you don't understand something, that means it doesn't exist. Whereas someone who is capable of mentalizing spins around and tries to, okay, that's confusing to me, why you would be upset about what I'm doing. Can you help me understand? Like, I'm lost. I don't see it, but that doesn't mean it doesn't exist. So for a narcissist, if they don't understand it, that means it doesn't exist. Whereas, if, if they don't understand it, that means it doesn't exist. Whereas, If a non-narcissist gets some kind of feedback, it's not that it doesn't exist. It's that I have a blind spot.

That's why I don't see it. There's a differential diagnosis for the things that I don't see. Either they don't understand. Either they don't exist or I have a blind spot. And so these are the kinds of things that we pick up on. I want to say that most psychiatrists and therapists pick up on this stuff. But the tricky thing is I could have all kinds of patients that, you know, maybe I'm missing diagnoses on and I don't realize.

And that's what's really hard about psychiatry is like, we don't all. always know. Thanks for joining us today. We're here to help you understand your mind and live a better life. If you enjoyed the conversation, be sure to subscribe. Until next time, take care of yourselves and each other.