Narcissism, particularly when it manifests as Narcissistic Personality Disorder (NPD), is often seen as one of the most difficult personality disorders to treat. Individuals with NPD exhibit a pervasive pattern of grandiosity, a deep need for admiration, and a lack of empathy for others. These traits often create interpersonal conflict, emotional manipulation, and exploitation in relationships, leaving those around the narcissist feeling confused, hurt, or emotionally drained. But can narcissists change? And what role does therapy play in this process?

This article explores the complexities of treating Narcissistic Personality Disorder, the types of therapy that are most effective, and the likelihood of lasting change for individuals diagnosed with NPD.

Understanding Narcissistic Personality Disorder (NPD)

Narcissistic Personality Disorder (NPD) is characterized by an inflated sense of self-importance, a constant need for admiration, and a lack of empathy for others. People with NPD often believe they are special, deserving of special treatment, and may exploit others to meet their own needs. While they may seem confident on the outside, their self-esteem is often fragile, making them hypersensitive to criticism.

The causes of NPD are believed to be multifaceted, involving genetic predispositions, early childhood experiences, and environmental factors. Some theories suggest that narcissism develops as a defense mechanism to cope with early feelings of inadequacy or emotional neglect.

Individuals with NPD typically lack insight into their condition and are reluctant to seek help. This denial of their own shortcomings and their tendency to blame others makes the disorder particularly resistant to treatment.

Challenges in Treating Narcissistic Personality Disorder

One of the primary challenges in treating NPD is that many narcissists do not believe they have a problem, thus unwillingness to want to change. Their self-perception is often distorted by feelings of superiority, making them resistant to feedback or criticism, even from a therapist. Some of the key challenges in treating narcissism include:

• Lack of Self-Awareness: Narcissists often struggle to recognize their behavior as problematic. They may believe their issues stem from other people’s actions, which can hinder the therapeutic process. Therapy is often seen as unnecessary or irrelevant, leading them to avoid seeking help.

• Defensiveness and Denial: Even when a narcissist enters therapy, they may approach it with defensiveness and denial. They might resist introspection, blame others for their problems, or attempt to manipulate the therapist into agreeing with their views.

• Fragile Self-Esteem: While narcissists project confidence and superiority, their self-esteem is typically fragile. Criticism or perceived slights can trigger feelings of shame or rage, leading them to react defensively. Therapy often involves addressing this deep-seated vulnerability, which can be difficult for the narcissist to face.

• Difficulty Developing Empathy: Narcissists often struggle to understand or empathize with others’ feelings. This lack of empathy makes it challenging for them to form healthy, reciprocal relationships, and it can limit the effectiveness of therapy focused on interpersonal dynamics.

Despite these challenges, therapy can play a crucial role in helping individuals with NPD develop healthier coping mechanisms, improve their relationships, and reduce harmful behaviors. While the process may be slow and difficult, it is not impossible for narcissists to change with professional help.

Types of Therapy Used to Treat Narcissism

Several therapeutic approaches have been developed to treat individuals with Narcissistic Personality Disorder. While no single therapy is guaranteed to work for all individuals with NPD, certain approaches have shown promise in addressing the underlying issues that drive narcissistic behavior.

1. Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is one of the most widely used therapeutic approaches for treating personality disorders, including NPD. CBT focuses on identifying and changing dysfunctional thought patterns and behaviors. In the context of narcissism, CBT helps individuals recognize how their grandiosity, entitlement, and lack of empathy are contributing to their problems.

Therapists using CBT help narcissists challenge their distorted self-image and address their negative patterns of thinking. For example, a narcissist might learn to recognize when they are seeking excessive validation from others or when they are devaluing someone who fails to meet their expectations. By helping the individual understand these patterns, CBT can facilitate a greater sense of self-awareness and reduce maladaptive behaviors.

One of the strengths of CBT is its structured, goal-oriented approach, which can appeal to individuals with NPD who may be driven by a desire for self-improvement. However, lasting change often requires a willingness to examine deep-seated vulnerabilities, which can be uncomfortable for many narcissists.

2. Schema Therapy

Schema Therapy is an integrative approach that combines elements of CBT, psychoanalytic theory, attachment theory, and Gestalt therapy. It focuses on identifying and healing maladaptive schemas—deeply ingrained patterns of thinking and behavior that develop in childhood.

Narcissists often have schemas related to abandonment, emotional deprivation, or inadequacy, which they may mask with grandiosity and entitlement. Schema therapy seeks to address these core vulnerabilities by helping the narcissist understand how these early experiences shaped their current behavior. The therapist works to “re-parent” the client, offering empathy and validation while also challenging unhealthy schemas.

Schema therapy is particularly effective in addressing the emotional needs that narcissists typically deny or repress. It encourages the individual to develop healthier coping mechanisms and fosters emotional growth, empathy, and self-reflection.

3. Psychodynamic Therapy

Psychodynamic therapy focuses on exploring unconscious motivations and the influence of early childhood experiences on current behavior. For individuals with NPD, psychodynamic therapy can help uncover unresolved emotional wounds, such as feelings of shame or inadequacy, that contribute to their narcissistic defenses.

Through the therapeutic relationship, psychodynamic therapy aims to build trust and create a safe space for the narcissist to explore these painful emotions. By examining the defense mechanisms that the narcissist uses to protect themselves—such as grandiosity, denial, and projection—the therapist can help the individual develop healthier ways of relating to others.

Psychodynamic therapy can be a long-term process, but it is well-suited to individuals with NPD who are open to exploring their deeper emotional struggles. However, because narcissists may resist vulnerability and introspection, this approach requires a highly skilled therapist who can navigate the individual’s defenses with patience and persistence.

4. Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) was originally developed to treat borderline personality disorder but has since been adapted to treat other personality disorders, including NPD. DBT focuses on teaching individuals skills to regulate their emotions, manage stress, and improve interpersonal relationships.

For narcissists, DBT can be particularly helpful in addressing emotional dysregulation, impulsivity, and interpersonal conflict. The therapy teaches mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness—skills that can help narcissists manage their volatile emotions and reduce manipulative or exploitative behavior.

DBT’s focus on emotional regulation can be particularly beneficial for individuals with NPD who struggle with intense feelings of shame, anger, or envy. By learning healthier ways to cope with these emotions, narcissists can improve their relationships and reduce harmful behaviors.

5. Group Therapy

Group therapy can be a challenging but valuable therapeutic approach for individuals with NPD. In a group setting, narcissists are exposed to feedback from their peers, which can help them see how their behavior affects others. This environment can also provide opportunities to practice empathy, accountability, and humility.

However, group therapy may not be suitable for all narcissists, particularly those who are highly defensive or prone to manipulating others in the group. A skilled facilitator is essential to ensure that the group dynamic remains healthy and that narcissists are encouraged to engage in self-reflection rather than seeking validation or dominance.

Can Narcissists Truly Change?

The question of whether narcissists can truly change is complex and depends on several factors. One of the most important considerations is the narcissist’s willingness to engage in therapy and commit to the process of change. Since many individuals with NPD are reluctant to seek help or acknowledge their own shortcomings, change is often slow and difficult.

That said, change is possible. While it may not be realistic to expect a complete transformation of personality, individuals with NPD can develop greater self-awareness, improve their relationships, and reduce harmful behaviors. Therapy can help them learn healthier ways of coping with their emotions and foster a more realistic sense of self-worth.

Several factors influence the likelihood of change:

• Motivation for Therapy: Individuals with NPD who seek therapy voluntarily, rather than being coerced by others, are more likely to engage with the therapeutic process. Motivation can stem from a desire to improve relationships, reduce personal suffering, or achieve greater success in their personal or professional life.
• Therapeutic Alliance: The relationship between the therapist and the client is crucial for success in treating NPD. A strong therapeutic alliance built on trust, empathy, and patience can help the narcissist feel safe enough to explore their vulnerabilities.
• Willingness to Self-Reflect: Narcissists who are willing to engage in self-reflection and confront their emotional pain are more likely to make progress in therapy. Developing empathy and understanding the impact of their behavior on others is a key component of change.

Conclusion

Treating Narcissistic Personality Disorder presents significant challenges, but it is not impossible. Therapy, particularly approaches like Cognitive Behavioral Therapy, Schema Therapy, and Psychodynamic Therapy, can help narcissists develop greater self-awareness, emotional regulation, and healthier relationships. However, the likelihood of change depends on the individual’s willingness to engage in therapy and confront their vulnerabilities.

While a complete transformation may not always be achievable, therapy can lead to meaningful improvements in the narcissist’s behavior and emotional well-being.