Hi Ken, The marriage counselor we went to was a psychologist. Not all marriage counselors are psychologists but this one was. We went to see him for eight months. The diagnosis of narcissistic personality disorder was based on both the psychologist's observations during our counseling sessions and a test which is used in the field of psychology to further determine NPD. My ex-huband was not receptive to being told he lacked empathy and that it was a critical deficit. The counselor started by telling him that after our test results were interpreted rather than say narcissistic personality disorder immediately. My ex-husband said the test was stupid what's the big deal if he doesn't care if a dog falls through the ice on the evening news or a stranger loses their job. The test was probably at least 100 questions. The psychologist then said this isn't my opinion this is a test widely accepted in the field of psychology as one of the tools for determining this. My ex-husband never believed he was a narcissist which is common. It would be highly unlikely and unusual for a true narcissist to question whether or not they are one. If an individual has enough self-reflection to do so they are likely not a narcissist.