Dr. Mark Ettensohn addresses a question that frequently arises in discussions of narcissism and abuse: Is it possible to maintain accountability without dehumanizing? Can someone preserve firm boundaries without abandoning empathy?

Dr. Ettensohn clarifies a distinction he often sees misunderstood. When he speaks about compassion toward pathological narcissism or narcissistic personality disorder, he is referring to a cultural and societal stance, not advising individuals to remain in unsafe or harmful relationships. He emphasizes that safety must always come first. If someone is being harmed, the primary question is not whether the other person “knew what they were doing,” but whether the situation is safe and what steps are necessary to ensure protection.

The episode explores the gray area between total innocence and calculated malice. Dr. Ettensohn discusses how dissociation and shifting self states can impair consistent self-awareness in personality disorders, while also making clear that impaired awareness is not the same as blamelessness. He examines how behavior driven by triggered trauma states may later be rationalized from a different organizing center of experience, and why this dynamic is often misinterpreted as deliberate manipulation.

Finally, the discussion turns to boundaries. Dr. Ettensohn distinguishes kindness from niceness and empathy from permissiveness, arguing that the most empathic stance can sometimes be a firm refusal of access. The episode concludes by asserting that accountability does not require demonization, and that it is possible to reject harmful behavior without reducing a person to a monster.

Additional Resources

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About Heal NPD: Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members.

Learn more or inquire about services: https://healnpd.org